HCWs want reliable, comfortable sharps

More practice, design changes needed

Reliability is the most important performance criteria for phlebotomy devices, but everything from patient care to comfort with the technique influences preferences of frontline users, according to a survey of health care workers by the Safety Institute of Premier Inc., an alliance of hospitals and health systems based in Oak Brook, IL.

It’s critical to determine the key features of a device before making a selection, says Gina Pugliese, RN, MS, vice president of the Premier’s Safety Institute. That criteria may differ according to the unit’s patient population — from neonates to geriatrics, for example — or type of procedure performed. "It’s not a simple issue. There are many considerations when you’re choosing a device."

In a study involving 878 health care workers at 30 hospitals, Pugliese asked users for comments on what could improve their comfort with safety devices. Some 27% said they felt the ease of use could be improved with design modifications. And while most health care workers reported activating the devices each time, 26% acknowledged not always activating the safety feature.

In all, the health care workers had evaluated more than 34,000 syringes and phlebotomy devices, including self-blunting, retractable, and shielding technologies. "Only the frontline workers can really give this information about whether they feel comfortable in using a device," says Pugliese. "It ends up being worker preference, which is exactly what OSHA [the Occupational Safety and Health Administration] requires."

Here are some of the findings based on the surveys:

It’s often a matter of practice, not training.

More training isn’t what health care workers want when they begin using a new device. They simply want more practice — more time on the learning curve, the survey found. Sixteen percent of health care workers surveyed said they would feel more comfortable with more practice, while only 1% wanted more training.

It takes more time for health care workers to feel comfortable with phlebotomy devices than with syringes. Almost half (45%) of survey respondents said they felt comfortable with new safety-engineered syringes after just one use. By contrast, 30% of those surveyed said they needed to use the phlebotomy device five or more times before feeling comfortable with it. (A significant number never felt comfortable with a device — 14% for syringes and 17% for phlebotomy devices.)

The bottom line: Give it time when you’re conducting an evaluation. "Some of these technologies require a little more trial than others," adds Pugliese.

Users have individual preferences.

A left-handed person will feel differently about a device than someone who is right-handed. Someone with small hands may prefer one device and someone with big, beefy hands may not like it.

"Some people may prefer devices that have an audible click," she says. "Some prefer devices that have some visual cue that it has been activated."

Patient comfort and device effectiveness are among the performance considerations identified for a safety device. The top performance consideration for syringes was the ability of the syringe to deliver an accurate dose of medication.

While an independent rating of devices may be useful, health care workers may prefer one that isn’t the top choice of reviewers. They must feel comfortable using it, and comfort is based on many variables, Pugliese says. That’s why frontline input is so essential, she notes.

"No single device can be considered the best’ or safest. Safety devices that fulfill a specific organization’s needs and preferences of the staff are the best devices for that facility." One device won’t work hospitalwide. Users in different units should have the ability to make choices that best fit their particular needs, Pugliese says.

Make decisions based on data.

While there are some national databases that provide benchmark information on needlesticks (www.med.virginia.edu/medcntr/centers/epinet/benchmark01.pdf), your most useful data will come from your own facility.

Look at the circumstances behind needlesticks. If the safety device wasn’t activated, maybe you need to investigate how often they are activated and why health care workers might not activate them. If the needlestick came from an overfilled sharps container, you may need to look at the size, shape or location of containers.

Ask yourself, "Is there something in the data telling me to look at another device?" OSHA requires an annual review of new technology, and that is a good time to consider how successful your devices are in preventing needlesticks.

(Editor’s note: More information on the sharps safety device field evaluations study is available on Premier’s web site at www.premierinc.com/safety.)