The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [423]
2 Wash hands with bactericidal soap and water, or decontaminate physically clean hands with alcohol-based handrub. Apply gloves. To reduce the risk of cross-infection and specimen contamination (Fraise and Bradley, E).
Procedure
3 For trough levels:
Following venepuncture,withdraw the volume of blood appropriate to the blood sample bottle using the vacuum-assisted collection system.
To ensure the correct volume of blood is obtained and to reduce the safety risk to practitioner (DH 2006, C; DH 2007a, C).
4 Clearly label blood sample bottle and appropriate form with ‘pre-drug administration blood’. To ensure there is no confusion between the pre-drug and post-drug serum level specimens. E
5 Administer intravenous antibiotics as prescribed via the patient’s established vascular access device. To continue with patient’s prescribed drug regimen. E
6 If peak level required:
Within an allotted time after administration, repeat step 3. Clearly label blood sample bottle and appropriate form with ‘post-drug administration blood’.
To allow time for even distribution of the drug through the blood for peak blood levels to be achieved (Jones 2006, E).
Postprocedure
7 Ensure microbiology request forms are completed correctly including date, exact time and dosage of previously administered dose. To maintain accurate records and provide accurate information for laboratory analysis (NMC 2009, C; Weston 2008, E).
8 Arrange prompt delivery to the microbiology laboratory. To allow for prompt analysis and timely adjustments to patient’s drug therapy regime if indicated. E
Postprocedural considerations
Ongoing care
Changes in dosage regimens will depend upon interpretation of the results by the microbiology, medical and nursing team. Notably high serum drug levels should prompt the microbiology team to telephone a result through to the medical team in charge of the patient’s care, especially if this warrants withholding subsequent doses of the drug. A low drug serum level would instigate an increase in the dosage of the drug. Any changes to the drug regime should be communicated and clearly documented on the patient’s prescription chart.
Documentation
In accordance with the principles of good record keeping, the date and time of when a trough and/or peak drug assay level is sent to the laboratory should be documented clearly and promptly in the patient’s notes, care plan and/or on the patient’s drug chart (or antimicrobial flow charts as provided by the pharmacy department) (NMC 2009). This assists in communication and the dissemination of information between members of the interprofessional healthcare team.
Specimen collection: swab sampling
Definition
Sterile swabs are commonly used in clinical practice to obtain samples of material from skin and mucous membranes. They are utilized to identify micro-organisms in suspected infection or as part of a screening programme to identify patients who may be carrying pathogens without displaying clinical signs or symptoms (Ferguson 2005). The overall aim is to identify the causative organism and determine the most effective therapy.
Related theory
Rationale
Obtaining a swab is one of the easiest and most unequivocal methods of sampling in clinical practice (Lawrence 1999). Swabbing is aimed at quantitative or qualitative collection of bodily fluid or cutaneous material for the purpose of obtaining a specimen for microbiological analysis (Kingsley 2001). Samples of infected material can be obtained from any accessible part of the body by using a sterile swab tipped with cotton wool or synthetic material (Hampson 2006).
Swabs for screening programmes
Meticillin-resistant Staphylococcus aureus is one of the most significant problematic organisms within healthcare (Weston 2008). Colonized and infected patients represent the most important reservoir of MRSA strains within hospitals (HPA 2008b) The transmission of MRSA and the risk of MRSA infection can only be effectively addressed if MRSA carriers are identified and treated to reduce this risk of transmission