Implementation and Evaluation of a Best Practice Initiative

Venipuncture is now the standard method of phlebotomy for well newborn infants at Kingston General Hospital (KGH), Canada. Newborn infants require at least one blood sample for mandatory genetic screening. Some will require additional samples for monitoring of hyperbilirubinemia or other laboratory tests. A change from capillary heel sticks to venipuncture was implemented when the lancets in use were discontinued and a suitable replacement could not be found at the time. A review of the literature discovered a Cochrane Neonatal Review that supported newborn venipuncture as a safe, pain-reducing practice when performed by trained phlebotomists. As a result, a quality improvement project was developed to implement the practice of venipuncture for the well newborn. The implementation and evaluation included lectures, demonstrations, return demonstrations, and eventual integration into clinical practice. Process and summative evaluation demonstrated a willingness of staff to learn a new procedure, particularly when they had identified the need for change. In addition, infants were not subjected to multiple, ineffective blood draws.