Collecting with care

© Copyright NSW Health Pathology 2022

Illustration and graphic design of this resource by Lucy Klippan of Good Point Design.

Collecting with care

A resource to support care-ful pathology collections

Acknowledgement of country

NSW Health Pathology acknowledges

and

of New South Wales and their special place as Traditional Custodians of this land. Through their sacred cultures and customs, they have nurtured and cared for this land for thousands of years and continue to do so today. We would like to pay our respects to the Elders past, present and emerging, for they hold the memories, the traditions, the cultures and hopes of Aboriginal and Torres Strait Islander peoples across the state.

Acknowledgement of lived experience

How was this resource created?

To create this resource, we’ve carefully reviewed complaints, compliments, and critical incidents, held semistructured interviews with consumers and carers, and, importantly, listened to our collectors across NSW about their expertise and experience. You’ll see the contributions of many of our colleagues throughout this document who told us what helps and hinders pathology collections. Further, we’ve drawn on literature, existing research, and service design best practice. We would also like to acknowledge the staff from across the wider NSW Health system who’s invaluable insight helped us craft this document.

Who is this resource for?

The content in this resource is for collectors and collections managers across NSW Health Pathology (NSWHP). It may also be useful to staff working to improve patient safety and quality, area trainers and other staff wishing to improve their knowledge by learning from others.

A special acknowledgment to the staff of the Collection Collaborative who shared their insights and learnings throughout the development of this resource and helped to create this valuable tool for all our collection teams across NSWHP.

Aboriginal

Torres Strait Islander peoples

Part one: different identities and experiences ...................................... 12

Collections with children (aged 3-12) ..................................................................................................................14

Collections with babies (aged 3 – 18 months) ..................................................................................................16

Collections with neonates in NICU .......................................................................................................................18

Collections with young people (aged 12 – 18) 20

Collecting with trans and non-binary people 22

Collections with Aboriginal and Torres Strait Islander peoples ..............................................................24

Collections with pregnant people.........................................................................................................................26

Collections with adults who are nervous and fearful ...................................................................................28

Collecting with people who are chronically ill .................................................................................................30

Collecting where there are language barriers 32

Collecting at end of life, or from a seriously ill person 34

Collecting with a person experiencing mentally ill health .........................................................................36

Collecting with disabled people ............................................................................................................................38

Collecting with people who use intravenous (IV) drugs ..............................................................................40

Part two: when there are challenges, confusions and obstacles ....... 42

Someone becomes extremely unwell 44

Someone returns for a recollection .....................................................................................................................46

We can’t complete a collection ..............................................................................................................................48 Pain or injury following a test .................................................................................................................................50

Violence and aggression ..........................................................................................................................................52

Part three: collecting in different settings ............................................ 54

Collecting in community settings .........................................................................................................................56

Collecting in someone’s home................................................................................................................................58

Introduction

Everyone deserves care when having a pathology collection.

Public pathology collection services are for everyone. We know that consumers and carers are diverse in their identities and past experiences with health services. We also know that pathology collectors do their best to navigate differences, often without formal training in working with specific populations. If we’re not attentive to these dimensions of difference (Figure 1), we can fail to deliver a quality pathology service that is equally accessible to everyone. We know that some people are less likely to have a positive experience, due to their needs and experiences being overlooked, misunderstood, or minimised. This includes Aboriginal and Torres Strait Islander peoples, LGBTQIA+ people (people with diverse sexualities and genders), people with a disability, culturally and linguistically diverse communities, and people who may experience stigma in accessing health services, such as drug users. These inequalities are often made worse where a person has multiple commonly overlooked and poorly understood identities (this is known as intersectionality: www.hcnsw.org.au/partners-projects-campaigns/intersectional-needsexplained/). Figure 1: Dimensions of difference

Aboriginal & Torres Strait Islander people

While technical skills are essential, we also need more focus on relational and customer-service skills – how we communicate, listen, and deliver care in partnership with consumers and carers. This resource focuses on relational and customer-service skills across groups, and specific to a population (e.g. collecting with children, collecting with transgender and gender diverse people) as well as collecting in different environments. It isn’t designed to replace technical skills, but to enhance our skills and ensure we consistently provide a quality collection service that is safe and respectful.

We hope you’ll benefit from the content in this resource and invite you to suggest edits and additions by contacting Judy Kempton-Webb, Director of Pre and Post Analytic Services on judith.kemptonwebb@health.nsw.gov.au

Shared needs and customer service commitments

Before we get into specific needs and experiences, we describe:

• The six guiding principles for NSWHP collection service delivery and redesign

• The non-negotiables of service delivery

• The NSW government customer service commitments

“From the receptionist to the collectors...they present a calm and comforting environment... [while] there would have to be some behind the scenes stresses to deal with they never allow them to surface... I look forward to my visits and for someone who isn’t fond of needles – that is a big call.” Consumer

Six guiding principles

In early 2022, the NSW Health Pathology (NSWHP) Strategic Leadership Team (SLT) agreed to the following principles for collection service delivery and redesign. These principles were developed through analysis of complaints and compliments, semi-structured interviews with consumers and carers, and input from an advisory group of NSWHP collections managers known as the Collections Collaborative. We summarise these principles below and refer to them throughout this resource.

1. We explain who we are, what we are doing and why

This involves:

• Introducing ourselves

• Explaining the procedure

We don’t expect consumers and families to know what we know about pathology. We treat their questions seriously and provide answers where we can. Patients and carers expect an integrated service and don’t need to know about internal divisions (such as between collections and analysis).

2. We make decisions with people and families

All consumers have the right to partnership and making decisions about their own care.

This involves:

• listen to people without minimising their concerns, for example, that they have a needle preference, fear needles or poor vein access.

3. We give consumers and families choice

This involves (where possible):

• Offering the option of an open space or closed room

• Offering the option of curtain closed or open

• Offering a choice of Aboriginal or non-Aboriginal collectors

• Being sensitive to men’s and women’s business

• If they’d like us to refer to them using a different name to what is on their Medicare card.

4. We avoid making assumptions about people’s identities

Such as someone’s gender, sexuality, how they feel about their illness, how they feel about being pregnant. This is different to anticipating people’s needs, such as responding to someone who is faint.

5. We ask only for the information we need

Inappropriate curiosity occurs when something is done not to provide care to a patient but to satisfy the curiosity of the collector.

6. We see and respond to individual differences

We do not expect that everyone has the same experience, needs or preferences. We have different protocols, for example, for people who are fearful of blood/blood collection, transgender, and gender diverse people.

The non-negotiables of service delivery

All pathology collection services must ensure consent, avoid inappropriate curiosity and inform the consumer about the collection procedure. Let’s look at each of these concepts, starting with consent.

What is consent?

As the NSW Health Consent to Medical and Healthcare Treatment Manual states: “Adults with capacity have a right to decide what happens to their own bodies. These principles are reflected in the law that governs consent to medical treatment. As a general rule, no operation, procedure or treatment may be undertaken without prior consent from the patient or, if the patient lacks capacity, from the patient’s substituted decision maker.”

All patients have the right to withdraw their consent at any time.

Different kinds of consent in pathology collections

In pathology services we have several different kinds of consent, that all pathology collections staff and managers must understand and adhere to. Although a person’s initial consent is implied by their presentation of a request form, consent is an on-going process, and we have a responsibility to the patient when performing a Procedure. Consent must be obtained for any procedure as required by the NSW Health Consent to Medical and Healthcare Treatment Manual

We explain consent further here:

• Initial consent on presentation of a pathology request form: When we’re presented with a pathology request form, this tells us we have consent to explain the procedure to the patient and/or carer.

• Then, we must seek verbal consent (or, through another means such as sign language interpreter). After we’ve explained the procedure, we must seek verbal (or sign-language) consent that the person agrees (e.g., “are you okay for me to begin?”). If we miss the vein, we must ask again (e.g., “are you okay for me to continue?”). We cannot assume the person is comfortable with us continuing and must stop the procedure immediately if the person says so. If this occurs, we must respect this decision and leave the option open for the person to return another time and inform their doctor they do not want to proceed.

You do not need to agree with – or even understand a person’s reason for withdrawing their consent. As the NSW Refusal of Treatment guideline states: “the right to refuse treatment exists where the reason for making the choice may seem irrational , are unknown or even non- existent... Treating a person who has validly refused treatment could constitute an assault or battery.”

Other kinds of consent

• Informed financial consent (IFC). Patients and families must know ahead of the collection procedure if they are required to pay out of pocket costs (e.g., for non-MBS covered items). We cannot assume the referring clinician has explained this to a patient that some tests are not covered by Medicare and that they will receive an invoice for the out-of-pocket costs. To proceed with the collection of this specimen we seek their approval to pay either at the time of collection or when they receive the bill.

• Special categories of consent. There are some special categories such as genetic testing that require written consent to proceed with testing.

• Minors (babies and children). It is important to always address the person having the collection at any age. A staff member experienced in communicating with children should provide an explanation of the procedure, in consultation with the person responsible, in developmentally appropriate language that can be understood by the child. Read more in Collecting with children.

What is inappropriate curiosity?

Inappropriate curiosity is where staff ask a patient, carer or family something to satisfy their curiosity, not to provide better care.

While small talk and sharing personal stories can feel like we are putting people at ease, some questions have the opposite effect and can cause some people to disengage with us or even feel unsafe. We’re not suggesting that staff shouldn’t talk to patients, carers and families, rather, that we only ask for the information that we need to provide safe and effective care.

Here are what people have shared feels inappropriate in collections services, and in healthcare settings more broadly:

Aboriginal and Torres Strait Islander peoples

Asking an Aboriginal or Torres Strait Islander person:

• How Aboriginal are you?

• Are you Aboriginal?

• You don’t look like it

• Do you receive any Centrelink benefits?

• About trauma they’ve experienced, or trauma experienced by Aboriginal and Torres Strait Islander peoples more broadly

LGBTQIA+ people

• Assuming someone is heterosexual, such as asking a pregnant female-appearing person about their husband/ male partner

• Asking transgender and gender diverse people:

– What were you born as? Have you had ‘the surgery’

– How long have you been transgender?

– Why are you on hormone treatment?

– What’s your real name?

Pregnancy, IVF, or recent loss of pregnancy

• Assuming a pregnant person is keeping their pregnancy and asking questions about it (e.g. the due date, about baby names)

• Are you nearly due?

• Sharing personal pregnancy stories or stories of pregnancy loss

• Asking questions about reasons for genetic testing, IVF, and reproductive choices

• Assuming someone is too old or too young

Culturally diverse

• Why a person is wearing/doing something (e.g., wearing a Hijab)

• How long have you lived in Australia? (Implying someone isn’t Australian)

• Why do you need a man/ woman to collect your blood? [challenging cultural protocols]

• Asking about trauma experienced by a group or nation

Disabled people

• What is it like having [x] disability?

• What’s wrong with you? Or asking a carer: “what’s wrong with them?”

• Why do you need [aid/permit] you don’t look disabled?

• How did you get pregnant? Why are you having a baby?

• When are you going to get better? Can they cure what you have?

Across groups

Asking people about:

• Their illness or treatment

• Their appearance (cultural dress, tattoos, piercings)

• Their trauma (for example, why they’re scared of needles)

• What scars are from

• Asking someone why they can’t afford a test

Customer service commitments (NSW Government)

The NSW Government has six customer service commitments, developed through research and input from staff across NSW Government. The Commitments give a clear picture of what is expected when receiving government services. NSWHP must ensure a high-level of customer service on-par with and even exceeding other NSW government departments. Here are the Customer Commitments:

Commitment What does this look like in collections?

Easy to engage

Make it easy to access what I need. Make it simple for me to understand.

Act with empathy

Show you understand my situation. Treat me fairly and with respect. Provide service in my time of need.

• Clear signage, waiting area and waiting process (e.g., take a number)

• Clear instructions ahead of a collection (e.g., if fasting is required and what it means)

• Clear and professional instructions for self-collection

• Clear advice for post procedural care

• Working in partnership and acknowledging each person as an individual, listening carefully to the person’s wishes, and ensuring they know they’re in control and can stop the procedure at any time

• Being sensitive to people’s fears (such as needles) without minimising their fears, challenging their fears or making the person feel uncomfortable

• Being sensitive to what is happening for a person and their distress, such as recently having experienced a miscarriage or received a diagnosis

Respect my time

Tell me what I need to know beforehand. Minimise the need for me to repeat myself. Make what I need to do straightforward.

Explain what to expect

Be clear about what steps are involved. Contact me when I need to know something. Let me know what the outcomes could be.

Resolve the situation

Be accountable for your actions. Be clear in decision-making. Reach an outcome.

Engage the community

Listen to the community to understand our needs. Ask how we want services delivered.

• Ensure people aren’t waiting for too long, before checking their request form (e.g., preventing people from waiting a long time, to be told they can’t have the test, are in the wrong place or having prepared correctly e.g., fasted)

• Provide an explanation and approximate timeframe if there is a delay in providing the service.

• Letting people know roughly how long their results will take

• Letting people know where they can take their self-collected specimen

• Listening to learn and improve, not defend

• Reflecting on patient experience survey results

• Regular patient and community engagement, including with specific groups and services (e.g., disability services, Aboriginal and Torres Strait Islander services).

Read more: www.nsw.gov.au/customer-experience-unit.

Part one: different identities and experiences

In this section we explore what collectors can do and must do to ensure a consistent and quality experience of collection services. Everyone doesn’t have to know everything, if you need support in an area, you can:

• Ask around your team who has expertise in a particular area

• Ask your manager for support or recommendations of additional learning

Collections with children (aged 3-12)

“

The staff were beyond amazing. I took my 3-year-old daughter and was naturally a bit anxious about her having blood tests so young. However, [the staff in the collection centre] and the lovely lady who took the bloods were so wonderful and completely put my mind at ease. They made my daughter feel so comfortable and made it a pleasant experience for her. Can’t speak more highly of our visit. Thank you!” Consumer

A child’s first collection experience shapes their view of pathology (and often needles) for the rest of their lives. As a young person told us: “A bad collection as a child can set you up for a lifetime of fear and avoidance of pathology. We want your best collectors, not people who are learning on us.”

Therefore, the experience must be a partnership with the family and as gentle as possible. We know collections with children can be difficult, exhausting work and not all staff have the personality or skill to do paediatric collections. Communication should be a little different for younger versus older kids (this is known as developmentally appropriate communication). Here are several things we must do:

• Introduce ourselves to the parent(s) and child(ren)

• Let the parent/caregiver know they’re in control and can stop at any time

• Stay calm, to put the child and parent/caregiver at ease

• Check if the parent can hold their child (not all parents can)

Parents shouldn’t have to ask our staff to introduce themselves or explain the procedure.

What helps What hinders

If parents ring in advance, let them know when to come in (quieter times, times with enough staff) and how to prepare. For example, some parents like to use numbing cream, drinking enough water, or bringing along something for the child to watch during the procedure.

Ask if it’s the first time. You’ll adjust your approach for someone who is having their first blood test. This will often mean slowing down to explain the process and ensure everyone feels comfortable.

As a parent shared: “The collector for my daughter’s first time was excellent because she talked through the whole process. I really like when people don’t just tell the parent, but they talked to the kid like they’re a person. Because you know the procedure was happening to her, not me … she was really great and she kind of you know really validated that she would be feeling… you know, she said like “I know that this isn’t really what you wanna do, and this is a bit scary, but I promise I’ll be really fast and you know your mum’s here.”

Set up first, calmly. As Loretta from Hunter shares: “I like to review the test-set and set up first to ensure I give the family my full attention. I’m calm (even if I don’t feel it) and make eye contact.”

Show before doing. As Carolyn from Tamworth shared: “if it’s the first time, I often apply the tourniquet to the parent first to show the child it doesn’t hurt”.

Make frequent visitors feel special. This could involve having a VIP badge for kids having frequent collections, or something similar.

Make a friendly joke. In some situations, it can help to joke such as “oh my gosh, you’ve got green blood!”

Children love stickers, especially if they can pick one.

Telling the parent or caregiver you know best, or that they must have the test(s) on the request form. We must work in partnership with parents and families. They know their child and if they’re not comfortable progressing, that’s their right.

Assuming everyone is the same. Assuming all parents and children are the same – while some parents and children want to take time, others will want to move through quickly. Griselda from Wollongong stresses taking your lead from the parent(s).

Having no distractions. Without anything to look at or do, kids are often bored and more anxious. It can help to have things for kids to look at and play with, such as a nature or Where’s Wally poster on the wall.

What to avoid:

“

The collector gave my son no time to absorb what was about to happen and no explanation was given for the procedure. The tourniquet was roughly applied and then no warning was given before the actual [needle went in].”

Consumer

Collections with babies (aged 3 – 18 months)

“

I brought my daughter in for a blood test and ECG, she is three months old. We struggled to find her vein as she was quite dehydrated, so [the manager] helped and took us over to the public hospital where [the collector] managed to take the blood successfully and do the ECG. They were both fantastic and we could not have done this without [their] help. [The manager] even went down to orthotics because my daughter wears a hip brace so doing the ECG with that on would have been tricky. He managed to get one of the orthotics team to come and assist so we could do the ECG and they could take the harness off properly. Thank you so much for making such a traumatic experience a little easier for a first-time mum and her tiny little bub”

While collecting blood can feel like a routine procedure for our staff, it’s often distressing for new parents to see blood being taken from their baby. Here are several things we must do:

• Introduce ourselves to the parent(s)

• Let the parent/caregiver know they’re in control and can stop at any time

• Stay calm, to put the child and parent/caregiver at ease

• Check if the parent can hold their child (not all parents can)

While many of the same principles apply for collections with older children, here are some differences:

• It takes time collecting from this age group, only senior experienced collectors should collect from this age group

• An extra collector may be required in the room to secure the child firmly throughout the procedure

• Communication with the patient will be different for babies versus older children

As Rajeshwari from Westmead shares “With paediatric collections, having excellent technical skills and experience helps in addition to having an extra collector in the room to provide a helping hand.”

What helps What hinders

Have the room and collection equipment set up so you can help minimise the anxiety of the parent/carer.

Gain consent from the parent/carer. Explain the procedure and what is expected before obtaining an informed consent.

Be mindful that the parent may be experiencing anxiety over the collection or diagnosis. This can be particularly true for new parents. Always be professional, respectful, and caring when carrying out the procedure.

Acknowledge the parent’s/carer’s fears, concerns or emotions. It can be hard for parents to watch this procedure on their young baby, so consider them and comfort them where you can.

Provide advice on post collection care. This advice will provide support and guidance for the parent/carer, especially if it is the first time they have presented for collections for their young baby.

Commencing the procedure without explaining what is involved. Ensure you explain the procedure and what is involved to the parent/carer before gaining consent.

Rushing and not giving the parent or carer time to ask questions. Take the time to explain the procedure to the parent/carer and answer their questions or concerns.

Attempting the collection if you don’t feel comfortable or confident. As mentioned above, only senior experienced collectors should collect from this age group.

Not appearing confident and knowledgeable. This can increase a parent/carer’s stress or anxiety over the procedure.

Collections with neonates in NICU

A Neonatal Intensive Care Unit (NICU) is an intensive care unit specialising in the care of critically ill newborn infants. Some of these babies are born prematurely and while others are born at term, they often have serious conditions such as congenital heart disease, major surgical and complex medical conditions.

Collecting from neonates in a special care location requires a specialised skill and understanding of the needs of these tiny babies.

Here are several things we must do:

• Nurses provide the specialised care to the babies and must be consulted when entering the unit to undertake a pathology collection

• Speak to the Registered Nurse (RN) to ensure this is the right time to proceed

• Always include the parent if they want to be involved and be respectful if they choose not to be present

• Allow the mum or nurse to comfort the baby

• If unsure at any time during the procedure, you should always ask for help

As a collector it is important that you are comfortable with the position of the baby and you must let the RN know if you’re unsure or uncomfortable.

What helps

Calming the baby. After identifying the vein, swaddling the baby or cuddles with mum or RN, or breast feeding promotes endorphins and calms the baby and reduces their stress. Dummies can also be used to keep the babies calm.

Sucrose is also used to calm the baby and will be charted and administered by the RN. Remember, sucrose takes a few minutes to take effect.

Keeping the baby calm and reducing the stress of the procedure will assist both the baby and the collector undertaking the collection procedure.

Effective communication with mum and the nurse looking after the baby. Speak to the RN, ensuring it is the right time to perform the collection. Engage with the mum, let them know why you are there and explain the procedure. Some mums may find it hard to be present whilst others want to be involved. Always be respectful of their decision.

Be mindful that the parent may be experiencing anxiety over the collection, diagnosis or situation. It can be distressing for the parents, always be professional, respectful, and caring when carrying out the procedure.

Collecting only the minimum volumes. If you have questions or it seems to be a large collection, check with the lab before proceeding.

Once the collection is complete, where possible, give baby back to Mum or the RN to comfort the baby.

What hinders

Overlooking NICU protocols. The NICU and the LHD have strict protocols and infectious control policies in place for the protection of the babies that we must follow.

Not acknowledging parent(s) worry or anxiety. Take time to explain your role and the procedure to the parent(s), include them throughout if that is their preference and comfort them where appropriate.

As Rajeshwari from Westmead explains “If the parents are first time parents, they may be more anxious about the procedure on their newborn baby.”

Not advising if you are uncomfortable or unconfident. This is a highly specialised procedure, if at any time you lack confidence or feel uncomfortable with the procedure, let the RN know and/or ask for help from a more experienced collector.

A parent’s experience with their newborn, shortly after leaving hospital. “I didn’t know what to expect before I took my son for his first blood test - I thought it would be straight forward. Soon after the first attempt he was really distressed. I hadn’t heard my newborn scream like that before. I felt helpless and I was in shock while it was happening. I was distressed and upset afterwards. I still have a sinking feeling when I think back about it. The staff were faultless. I realise now they had full control of the situation and were equally managing me and my son at the same time. They were empathetic, reassuring and comforting me from the very beginning before we went into the collection room. It was an experience I totally underestimated at the time”

Collections with young people (aged 12 – 18)

“

The collector who attended to me was full of care, kindness and consideration”

Consumer

Young people should be treated differently to children, as they’re starting to develop their own independence and are sensitive to being treated like children, or having their views not taken seriously. It is important that young people have autonomy and a ‘voice’ within the health setting and feel that any procedures are being undertaken with them, not to them.

One young person told us about feeling highly anxious and being told by the collector to “suck it up and be a big girl.” We want to be a place that young people come back to and feel safe at.

Here are several things we must do:

• Remember to remain patient-centred with young people

• Take time to explain the procedure

• Show the patient that you do understand why they feel anxious

• Let them know that they are in control

What helps

Modifying procedures for trans and non-binary young people [see next section]. “Young people are being asked in your collection centre why they are on hormone treatment – that’s not acceptable, it’s nosy.” Specialist clinician

Explaining to the young person what you are doing in a simple, calm and caring manner so they understand the procedure and what is involved to help minimise any fears or concerns they may have.

Being patient. Young people may have different levels of experience in healthcare settings, so they may be shy, anxious or ask questions.

Engaging them. This is particularly true of young people that may spend a lot of time in hospital. They know a lot more about their bodies and they often have many blood tests.

On the importance of autonomy and engagement

“I told the person who was collecting my blood to use a vein that I knew worked well for blood collecting. The blood collector said they would try a different vein on my other arm. Three times they tried to draw blood from this vein, but they couldn’t get any blood. It hurt a lot and upset me. The collector then went to the vein that I had told them to use and they were able to get the blood.”

Young person

What hinders

Asking questions about the young person, as if they weren’t there. This is particularly true of children with a disability (such as autism).

Talking to them like a child. This can make them feel as though they do not have choices or control of the situation.

Not listening to or valuing young people’s input on their own bodies. Young people can be sensitive to not having their views taken seriously so ensure the young person is heard and has autonomy over their body.

A foster carer’s perspective.

“

The collector challenged if I was the legal guardian of the child and then asked questions loudly about the child’s autism and history of trauma in front of him. We all felt uncomfortable, and the child was really embarrassed as he’s not come to terms yet with his identity as an autistic person. None of that seemed relevant to the collection.”

Carer

Collecting with trans and non-binary people

A trans man visited one of our collections centre for a pregnancy test.

One of the collectors shamed this person in front of a busy waiting room saying, “you’re obviously a man, why would you need this test?

Consumer

Trans and non-binary people experience high levels of discrimination in the health system. Therefore, it’s important to not make assumptions about their lives, bodies, wants, needs, or experiences (transhub.org.au). 53% of young trans and nonbinary people in Australia report at least one negative experience with a health professional and almost half of all trans and gender diverse people have reported experiencing inappropriate curiosity.

Here are several things we must do:

• Not assume the person’s gender or how they want to be referred to (both their pronouns and their chosen name)

• Not question or challenge the test the person is having, even if it doesn’t make sense to us (e.g., a prostate test for a woman)

• Avoid inappropriate questions such as why the person is on hormone treatment, if they’ve had ‘the surgery’ or what they were ‘born as’

Here are what trans health professionals and trans people have told us helps and hinders:

What helps What hinders

Checking the request form and any additional notes from the referring doctor. The request form may include a name that the person doesn’t use and shouldn’t be said out loud.

Not making assumptions. Don’t assume a person’s gender or how they want to be referred to.

Ensure dignity of trans and non-binary people while accessing pathology services, upholding their right to access care, free from discrimination.

If you make a mistake, apologise immediately and sincerely. If you use the wrong name, wrong pronouns or wrong gender, apologise straight away.

Inappropriate curiosity. Don’t ask questions to satisfy your curiosity that does not affect the procedure.

For more information on inappropriate curiosity, refer to Shared needs and customer service commitments above.

Challenging the person’s identity or test request accuracy. For example, don’t question what test is requested for an individual by asking questions like “do you really need that test?”

Knowingly using someone’s deadname. A deadname is a term used by some trans people to describe the name they were given and known by prior to affirming their gender and/or coming out.

Collections with Aboriginal and Torres Strait Islander peoples

“

Having a better understanding of the cultures and challenges faced by Aboriginal people means I can help to bridge the gap and encourage people to have a voice with regards to health service”

Appropriate care for Aboriginal and Torres Strait Islander peoples is person-centred and meets their needs, expectations, rights, and those of their family. Cultural safety means that people have the power to influence care which supports positive patient-centred outcomes.

Here are several things we must do:

• Have conversations with local Aboriginal and Torres Strait Islander people and services to understand how your service delivery and the physical environment can be more culturally welcoming, so patient’s feel comfortable within the clinic. As Ange, our Aboriginal Training Coordinator told us, this can include “Symbols, Flags, Totems, Artwork, Nation’s map and Poster of Acknowledgement of Country.”

• Be mindful and understanding of the diversity of Aboriginal and Torres Strait Islander peoples and the diversity of traditions, processes and language

• Be understanding and respecting that Aboriginal and Torres Strait Islander people often bring family with them

What helps What hinders

Communicating well. Aimee, our Change Manager, advises that some Aboriginal and Torres Strait Islander people can feel shy or unconfident, and so we need to be friendly and communicate clearly. Avoid lots of technical jargon and check in that the patient understands what’s happening.

Being conscious about physical contact to respect men’s and women’s business.

Not making assumptions or questioning people’s identity. Our Aboriginal Training Officer, Nathalie explains “That’s really important if you want to make it a comfortable space…and have cultural safety”.

Being accepting of and respecting different cultures Leisa from Kempsey explains that “Some Aboriginal or Torres Strait Islander peoples will not look others in the eye, this is out of respect, and we need to be aware of, and realise this is a cultural difference”.

Check out NSWHP’s work on Closing the Gap and our Reconciliation Action Plan, at pathology.health.nsw.gov.au and go to Closing the Gap

Mimicking

people’s ways of speaking.

Using inappropriate terminology. Don’t use offensive terms to describe or address Aboriginal and Torres Strait Islander people.

Being biased or judgemental

Don’t assume the way Aboriginal and Torres Strait Islander people may speak reflects a person’s understanding of the procedure.

Don’t judge or assume anything. Don’t judge if Aboriginal or Torres Strait Islander people speak a little differently, don’t make eye contact, or appear withdrawn and shy.

Not appreciating the challenges faced by Aboriginal and Torres Strait Islander people. This can include trauma, that is not understood, that has been experienced by many Aboriginal and Torres Strait Islander peoples. This may lead to nervousness in a healthcare setting.

Collections with pregnant people

“Thank you for the amazing care received…while having [my] glucose tolerance test [the] staff member was gentle and explained all processes”

Consumer

People’s experiences of pregnancy vary and we can’t assume that everyone is happy to be pregnant or wants to make small talk about their pregnancy. Remember, it is not only cisgender woman who become pregnant, men (transmen), nonbinary and people with intersex variations also become pregnant and deserve respectful care.

Here are several things we must do:

• Provide an area for them to sit as they may often have young children with them

• Be mindful that not all pregnant people are having a positive pregnancy so limit discussion or inappropriate questions regarding their pregnancy experience

What helps What hinders

Be mindful of their physical limitations, if any. As the story describes below, noticing, assisting or modifying procedures for pregnant people with any limitations can help to make a positive collection experience.

“I am 38+2 weeks pregnant and one of the pathology ladies found me struggling to walk around to find pathology on the public holiday and helped me where I was and then got me a wheelchair to get back to my vehicle without too much pain. I am so grateful for [them].” Consumer

Be positive as some women may have risky pregnancies and are extremely worried about their baby and themselves.

Be cognisant of their demeanour. Give a smile and act in a calm and caring manner.

Don’t assume anyone is pregnant.

Inappropriate curiosity or sharing personal experience. Don’t ask questions about their pregnancy experience to satisfy your curiosity and don’t share personal experiences of pregnancy or birth.

For more information on inappropriate curiosity, refer to Shared needs and customer service commitments above.

Don’t assume their temperament (if any) is intentional. Be patient and understanding that there could be varying and external factors causing this.

Don’t assume they are having a ‘normal’ pregnancy or that they are feeling well as many people’s pregnancy experience varies.

“I went in for a GTT and the staff offered me a biscuit and a drink afterwards as I wasn’t feeling well. I was so grateful, and it made the experience better”

Consumer

Collections with adults who are nervous and fearful

“

[The collector] puts me at ease when taking my bloods as I don’t like needles or blood. She keeps me reassured which takes my mind off having the needle & blood taken.”

Consumer

Many adults are fearful and anxious about visiting a collection centre. Sometimes this is about the needle, about blood, or about being in a health care setting. It’s important that we do not shame anyone about their fear and take a compassionate approach. If we don’t, people often avoid having blood tests, and often with significant consequences to their health.

“I’m so scared of having a blood test I haven’t had one for seven years – I’ve got stacks of request forms piling up.” Consumer

“You feel like you’re being a problem… the longer you wait the worse you get, the more stressed and anxious. Hot and stressed ” Consumer

Here are several things we must avoid:

• Shaming someone about their fear or minimising their fear. This can sound like saying “it’s not that bad” or “just be brave”

• We should never ask people why they’re scared.

Instead, try to calm and assure the patient to help them through the procedure.

What helps What hinders

Providing a way for people to indicate their fear in advance or to discreetly signal to staff a different approach is needed. As a consumer told us, “I wish I could tell them in advance that I’m scared of blood tests and avoid having to go through explaining myself... sometimes to be told ‘it’s not that bad’, or ‘we only give butterfly needles to children.”

Asking people if there’s anything that has helped before and following the person’s advice (e.g., asking for a butterfly needle, to lie down).

Offer choices and remind the person they can stop at any time to ensure the person feels in control of the experience (for example, the choice of sitting or lying down, or being in an open or closed space).

If the person isn’t sure what could help or feeling overwhelmed, offering practical suggestions, such as:

• Lying down,

• Listening to music or watching a video,

• Taking deep breaths,

• Bringing along a support person who can distract you.

Minimising people’s fears through saying things like “it’ll be okay” or “it’s not that bad”.

Telling someone off for not having prepared properly (e.g., drank enough water).

“Sometimes they [collectors] tell you off for not drinking enough water. I don’t know where to get advice about how to prepare, it’s stressful when you’re unwell.” Consumer

Making the person feel like a problem, for example, by sighing, rolling your eyes or acting agitated or annoyed.

“I am very nervous when I attend, [the collector] makes me feel very comfortable…is very caring and gives a great needle. She is very professional.”

Consumer

Collecting with people who are chronically ill

People who are chronically ill are experts of their own experiences, bodies, and often have high levels of knowledge of the health system. It’s critical we listen to people and combine their expertise with ours.

Here are several things we must do:

• Respect peoples’ insights about their own bodies (e.g., which veins are best) as well as ensuring we’re checking the vein before using it

• Respect people’s requests, such as use of a butterfly needle

• Acknowledge carers or support persons that may be accompanying them, and include them if required.

As Jo from Wagga Wagga shares: “If someone asks to lay down, let them. If they ask for a butterfly, collect with it. Patients will come back for that service not someone telling them they know them better.”

What helps What hinders

Being aware of the patient’s physical state. You may need to modify the procedure to suit their condition. As Leisa from Kempsey explains “You can adjust the vacuum by after thorough assessment of the patient’s veins, choosing the correct fill tube for the vein of choice. For example, a 2ml tube will have lower vacuum pressure than a 5ml tube which helps to avoid collapse of the vein and therefore it is kinder on the veins, giving the same outcome as a butterfly needle”

Listening to their concerns and advice. Especially if they are having blood tests often, they probably know their own bodies well.

Being patient. Take the time to listen and understand their needs as they could be in pain or tired of repetitive blood collections and may not want to be in attendance.

Being very considered in conversation. Don’t say things like “don’t look so sad” or “it’ll be okay”.

Treating patients with care and empathy. Most patients are aware of how sick they are, treat them as you would others and with compassion.

Rushing them. Be patient and take the time to support them if needed, for example, modifying the procedure and listening to them and their concerns.

Assuming they can move quickly, or they are going to be responsive with questions. Look at using the arm band and not disturbing them if they are not able to respond to your questions.

Don’t be demanding of someone in that situation. They could be in pain or tired, be flexible in your approach.

What to avoid.

“I asked the phlebotomist if I could have the blood drawn from my left cubital fossa as I have a nerve in my right cubital fossa to which she replied, “yeah we all do.” When I attended the collection centre yesterday, I advised the phlebotomist that my venous access was poor due to hospitalisation and many blood tests and transfusions. I requested that the blood be drawn from the right cubital fossa but from low down in the vein and with a black needle. Her response to my request was “well would you like to do it yourself love?”

Consumer

Collecting where there are language barriers

“

A lot of consumers are very grateful that someone has taken the time and given them options to ensure they’re heard” Health worker

Receiving healthcare in a language we don’t understand can be a frightening experience.

As Jackie advises “It can be quite confronting and intimidating for people with a language barrier, especially if it is a parent or an elderly person who rely on their family to translate for them”.

Here are several things we must do:

• Where possible, use professional interpreting services with residents for whom English is their second or subsequent language

• In some cases, you may be able to converse with the patient directly as we have a multi-cultural workforce

• Try to communicate with the patient where you can be using slow, clear and simple language

What helps What hinders

Using the professional interpreter service or language cards can help us communicate with people whom English is not their first language.

Being patient. The collection process may take a bit longer but ensure you use patience in communicating to deliver a high-quality service.

Using effective communication where you can. Speaking slowly, clearly and simply may help the patient understand.

Using body language. Gesturing and using body language such as showing the patient the equipment and showing them what you’re doing, can help with communication.

Trying another word or synonym. If the patient isn’t understanding, you can try using another word to see if this helps the communication.

Assuming consent. If you cannot communicate effectively, do not assume that consent is provided.

Getting frustrated at the patient. Remember it is hard for the patient to express themselves in this situation so be patient, calm and respectful.

Not giving them the chance to speak. It can be easy to try and pre-empt what patients may be trying to say, by giving them a chance to communicate it gives them confidence in our system.

“I noticed when I came to Australia, people in medical services tended to speak very loudly and very slowly. It makes you think ‘I’m not deaf, I just don’t understand you’. It doesn’t matter how much they would repeat the same sentence, I would not get it”. Consumer

Collecting at end of life, or from a seriously ill person

developed a very good relationship with one of our long-term terminal patients, Trevor, and he would often tell us of his journey. On his passing, his wife Jill came in and told us how special we made him feel when he came to us for all of the blood tests”

“We

Collection staff

Each experience is different for those at end of life or for seriously ill people. They may need varying levels of care and support, and we need to be flexible to adapt to their needs when performing procedures.

Here are several things we must do:

• Introduce ourselves to the person as well as any family, friends or carers that are with them

• Avoid giving advice to the person or family about their treatment. While people might ask for advice about their treatment, providing it is outside our scope of practice and is up to the consumer to talk with their treating clinician

• If an Aboriginal or Torres Strait Islander patient is close to death, it is important that they do not die alone. Family presence is culturally important

What helps What hinders

Acknowledging people’s grief and fear, without trying to provide counselling. This grief and fear is often more than the person you’re providing care to but with families, friends, carers.

Treating people with care and empathy. Most people are aware of how sick they are, treat them as you would others and with compassion.

Practice your own self-care. This can be a very difficult time for our Pathology staff. It is critical that you practice your own self-care when surrounded by these scenarios.

Respecting the person’s cultural beliefs, including the presence and support of family at end of life (e.g., not asking the family to leave the room, which may affect the person’s safety).

Being very considered in conversation. Don’t ask questions like “are you having a good day?” or “looking forward to breakfast?”. Some of these questions may seem innocuous or even relevant in other health care scenarios – such as “why aren’t you eating?” or commenting on rapid weight loss. These can be expected signs of decline at end of life.

Being prepared to easily end the process. The patient should not have to experience pain or injury following a collection. The patient may also be unable to give a collection and that’s okay.

Being aware of the patient’s physical state. You may need to modify the procedure to suit their condition.

Staying up to date with the patient’s situation before proceeding with the collection. Check with the medical team for any changes in the patient’s situation. When patients are seriously ill or at end of life, changes in their treatment plan can change very quickly including their choice to longer receive invasive treatments. We must ensure we are up to date with the latest changes.

Giving unsolicited advice to families about their loved one’s treatment. This is out of our scope of practice and patients must speak to their clinician about treatment.

Involving yourself in people’s personal life. It is human to feel deep empathy for the person you’re collecting from, however it is important to maintain professional boundaries when providing care.

Asking inappropriate questions. This could be related to their health or their expected outcomes.

Don’t be demanding of someone in that situation. They are going through a difficult stage of life and could be in pain or tired so be patient and flexible in our approach.

Using nicknames or pet names. It is key to not use names like ‘love’ and use the patient’s name. Remember to ask the patient their chosen name and/or pronouns.

Collecting with a person experiencing mentally ill health

Mental ill health is experienced by many people during their life with over two in five Australians aged 16-85 years having experienced a mental disorder at some point in their life (Australian Bureau of Statistics, abs.gov.au). We need to make sure we provide safe environments free of any stigma or judgements, where people feel welcome.

It is important to consider the safety of the patient, yourself and your colleagues, and others in the collections space.

As Michelle from Liverpool advises, “If possible, ask a nurse or carer, ‘Have they had blood collected before and how did they go with that?’”

Here are several things we must do:

• Offer choices that support the person to feel in control for example, whether they’d like to be in an open or closed room, sitting up or lying down

• Pay special attention to seeking consent to do the collection, as well as getting consent again to continue after you have your equipment ready

• Not ask the person about their trauma (outside of our scope of practice)

• Have someone with you when we’re collecting from an acute facility.

What helps What hinders

Noticing where people might be unsettled and adjusting your approach accordingly. As Jo from Wagga Wagga shares “if the person is sitting on the very edge of the chair, it’s a good indication they’re not comfortable.”

Being conscious of their initial response and openness to conversing with you before continuing to chat with the patient. You may need to adapt your approach to meet their needs.

Being patient. Show understanding of everyone’s situation and take the time to support them through the collection if required, for example giving them choices.

Keeping calm, gentle, and respectful whilst being as brisk as possible to avoid keeping them waiting.

Listening to the patient. Listen to their concerns, fears and questions and be respectful in your approach and procedure.

Seek assistance where needed. You may need assistance to restrain the person but only under the guidance and assistance of a RN on the ward.

Being judgemental. Every experience and situation is different, and as Jamie from Hunter explains “No two mental health issues are the same” so treat everyone with respect and understanding.

Minimising people’s fears. Acknowledge and be mindful of any fears or concerns people may have.

Not providing them with choices. Make sure the patient has choices to feel in control during the collection.

As Lesia from Kempsey advises “Possibly place your collection chair with a view of the exit. When people are frightened, they want to flee so being able to see an exit route is calming”

Young person

“As someone with PTSD, it’s really scary to be in a small room with my back to a wall and to have someone put a needle in my arm without asking me.”

Collecting with disabled people

On the importance of providing accurate information.

“My family member has difficult veins to access, and they have Down Syndrome, which can make the collection a bit challenging. We came to the collection clinic because we were told they have a vein finder. We confirmed this information three times before making our appointment. When we arrived, there was no vein finder. As a carer, it is so frustrating to be told incorrect information, particularly for my family member who is challenged to give blood. I am worried that the traumatic event could jeopardize future attempts for them. Thankfully blood was collected manually but I am still upset we were told many times a vein finder was available, but staff never produced it” Carer

Disabled people are incredibly diverse, with different life experience and access requirements.

Here are several things we must do:

• Speak directly to the person, as well as any carers or family members

• Not assume we know about a person’s disability by their appearance (for example, assuming because they have facial difference, that they also have a mental disability)

What helps What hinders

Asking the patient where they would like the blood collected from and/or listening to their advice as they may know their body well. They may have had many blood tests before and may know what works well for them.

Engaging with them. It is important not to communicate only through a carer, if present, but to communicate with and involve the patient.

Using assistance where required. You may need assistance with keeping a limb in a stable position or using a different site for collection if usual sites are not accessible for example, amputated limbs or muscle constrictions.

Being patient and respectful. Don’t rush people, take the time to ensure they are comfortable with the procedure and always treat patients with respect.

Not acknowledging people’s knowledge of their body. They may know their body well and what works for them for collections. Use their advice, combined with your own expertise to carry out the collection.

Making assumptions. Do not make assumptions about a person based on their appearance or disability.

Asking questions about them, as if they weren’t there. Engage with the patient and include them in your communication.

Collecting with people who use intravenous (IV) drugs

“

The patient said that he likes coming to the collection room when I am here as I have never been judgemental about him or his choices” Collection staff

People who use intravenous drugs often experience discrimination across public and private health and may be turned away from private pathology providers. People come to us for a compassionate and dignified public service.

As Jo from Wagga Wagga describes: “I always ensure people are as comfortable as possible – that can mean getting them a drink or applying a heat pack. We want them to know we’re here for them, without judgement .”

Here are several things we must do:

• Treat the person with compassion, ensuring they’re as comfortable as possible

• Don’t assume they have used IV drugs and don’t ask them about it

• Listen to their advice as they know their body well

What helps What hinders

Applying a heat pack and ensuring the person is comfortable to help with the collection.

Asking the patient if they have a preferred, or good, vein. Make sure you still use your own observation and experience for the best collection, whilst acknowledging and listening to their advice.

Keeping calm, gentle and respectful. Remember they could be aggressive and anxious at times.

Be compassionate. As mentioned above, people come to NSWHP for a compassionate and dignified service.

Being judgemental. Always be respectful of people and their choices.

Making assumptions. Don’t make assumptions about a person, their life or their experiences. Matthew from Lithgow also advises “don’t assume they have used IV drugs before”.

Do not allow them to collect from themselves. As Michelle from Liverpool advises, “If they are in your care, you are responsible for them. If they injure themselves in a self-collect process, you are also responsible for the outcome of the patient. You also do not want to give a patient a needle as this is not a safe practice”.

Something to remember.

“I think that IV drug use is like any illness. Respect is the best option for any collector and listening to the patient not having any preconceived ideas of ‘I do this for a job, so I know better’.”

Jo from Wagga Wagga

Part two: when there are challenges, confusions and obstacles

In this section we explore what collectors can do and must consider ensuring consistent and quality experiences of collection services when things don’t go as planned. It is important to try and understand the situation from the consumer’s perspective and:

• Ask you manager for advice and support

• Know your safety procedures and how to get help if you need it quickly.

Someone becomes extremely unwell

“

The fast action of the collection staff meant my partner was transferred to hospital quickly after an episode and received timely, appropriate care”

Consumer’s partner

Sometimes people can become unwell whilst in the collection clinic. It is important to promptly assess the situation and help the patient, making them as comfortable and safe as possible.

All NSWHP collection staff should be trained in basic CPR, including how to lay a person down. Here are several things we must do in a hospital setting:

• If there is active chest pain, send straight to the Emergency Department (ED)

• Contact a next of kin or family member and stay with the person

• Use the code blue button or phone number

• Notify the Nurse Unit Manager (NUM).

In a community setting or in someone’s home:

• Ring an ambulance if there are serious concerns (such as breathing difficulties, chest pain, unconsciousness or sudden numbness or paralysis of the face, arm or leg)

• Use your duress alarm and follow your emergency procedures

• Contact a next of kin or family member and stay with the person.

It is important to note that if the duress alarm is not answered or you cannot get through to someone and you want to ring emergency services, ring. Do not hesitate or delay and do not fear any repercussions if the person is not as unwell as you observed.

What helps What hinders

Knowing your emergency procedures. Ensure you know, and follow, your local procedures available in the emergency flipchart.

Reading the situation. Assess the situation - the patient, the surroundings and what needs to occur to help the patient in need.

Responding without delay. Do not hesitate to help the patient, follow your local emergency procedures and/or contact emergency services.

Remaining calm. Being calm will help you rationally assess the situation and better help the patient.

Make the patient comfortable, providing privacy where possible.

Slow or delayed response rate. Not reacting promptly could cause further complications for the patient.

Leaving the patient alone. Stay with the patient if they become extremely unwell while in your collection space.

Not enacting the emergency procedures that need to be followed. This could delay required assistance for the consumer.

Someone returns for a recollection

“

One time staff did not know the protocol of the blood requested, they ended up having to call me to come back for another 2 hours to do the test.”

It can be stressful and time-consuming to return for a recollection. Regardless of who was at fault, we ensure people have a positive experience and understand that we appreciate them giving us (NSWHP) another chance.

Before someone is offered a recollection (a home collection if possible, to minimise inconvenience) there must be an open and honest dialogue about the mistake that led to the need for a recollection.

It is important to remain calm and respectful as some consumers may be agitated and upset by the requirement to return for another collection. Here are several things we must do:

• Make the person comfortable, start by thanking them for coming back in and acknowledge the error without discussing the reasons

• Avoid being defensive or blaming another colleague or department (e.g., “it wasn’t us, it was x.”). Consumers and carers see us as one pathology service and it’s important we act like one

What helps

Focusing on caring for the person, rather than bringing up what happened.

Ensure they do not have to wait. You may need to inform someone of their arrival, so they will not have to wait. Be considerate of their preferred time of return and try to accommodate.

Apologising. An apology for the recollection is very important and thank them for returning.

Being honest about the reason for the need to recollect if asked and if you know the facts but don’t dwell on the fact.

What hinders

Being defensive about the situation and the need for the recollect.

Criticising other staff members. Don’t criticise other collection or lab staff, just apologise for the error.

Never indicate that the patient is to blame. Regardless of the need for the recollection, do not blame the patient.

“

I require quarterly blood mutation tests as result of being diagnosed with Chronic Myeloid Leukaemia in 2016. I am very familiar with the number of vials required for these tests. On my most recent visit I queried the number of vials in the tray as there were only 2 or 3. I said to the person taking my blood that there are usually at least 4 vials required. She went off and checked the computer and came back and said that I only need what she had in the tray. I again said, “well I usually have at least 4 vials and I’ve been having these tests for about 5 years”. She assured me that was all that was needed. About an hour or so later, after I had got back to work, I received a message from the centre that I was right and would need to go back and give more blood. At this point I was quite annoyed as this was the third occasion this had occurred. I did receive an apology and returned to centre yesterday so the required blood could be taken and again received an apology for the incident.” Consumer

We can’t complete a collection

“

[I] wondered about the skill [of the collector] as he had a lot of trouble gaining access. All up the collection took well over 30 minutes. When [I] asked if there was another staff member available, [I] was told no and that to give him a chance.”

Sometimes we may not be able to complete a collection or locate a vein to proceed with confidence. This could be due to a number of reasons, but regardless of the reason it is important that we seek consent to continue if appropriate and always explain what is happening. When working in a team reach out for assistance.

Here are several things we must do:

• Apologise when we can’t access the vein and are unable to proceed

• Always notify the NUM or referrer if you are unable to undertake the collection for any reason

• Seek consent to continue trying (e.g., “is it okay if I try again?”)

• Listen to the patient’s insight about their veins and their preference, combining that with your own knowledge

• Document why we were unable to initiate or complete the collection

As Michelle from Sydney South West explains: “We listen to the patient and go where they’re telling us (for example, a different vein to the one they receive chemo into). However, we don’t go in if we can’t feel the vein. When someone tells us their preference and we’re not sure, we might say, ‘I understand, do you mind if I just have a look at the other side?’ ”

What helps What hinders

Asking for help from colleagues. As the patient story on the previous page describes, consumers and carers want to see our staff asking for helping instead of trying to ‘go at it alone’.

Offering water and/or a heat pack. Ensure they are not required to fast for the test before offering water. Apologise for the inability to complete the collection. Apologise when we can’t access the vein, for any extra time it has taken and for any discomfort of the patient.

Offer to try again tomorrow. If you have tried a second attempt and help from a senior collector, ask them to come back tomorrow to try again and advise them to drink plenty of water if it is not a fasted collection.

Blaming the person for their lack of preparation or poor veins. It is never okay to blame the patient, and remember they may not know how to prepare.

Not listening to the patient if they have advice about best arm. If they are providing advice, they may know their body well and what works for them. Acknowledge and use their advice, combined with your expertise.

Not reaching out for assistance. If you’re unsure about proceeding with the collection, not seeking assistance from a more experienced staff member could impact on the procedure.

Pain or injury following a test

Whilst blood collection is a common minimally invasive procedure, in rare situations pain or injury may occur. This can range from bruising and pain at the insertion site, to haematoma and nerve damage. Although this is a rare event, we need to respond to the consumer’s concerns by ensuring the appropriate advice is provided and the incident is fully documented. Any report received from a patient or consumer should be escalated to the collection or laboratory manager.

Here are several things we must do:

• Listen to the patient’s concerns and understand the circumstances surrounding their pain

• Ask them to monitor their symptoms and follow post collection guidelines (for example no heavy lifting) and report if they have ongoing concerns

• Escalate to the collection manager to ensure they’re aware and document the incident in IMS+

• Ensure appropriate medical support is provided to investigate severity of pain, if required.

What helps What hinders

Provide an ice pack to help with any pain or injury.

Apologise that this has happened to them. Be empathetic and caring of the situation.

Active listening to understand when the pain began without placing blame. Try to understand when the pain occurred so the appropriate person can provide the appropriate advice to the consumer. This may be provided by a medical professional.

If the pain occurs during the collection, cease with the procedure and seek consent before attempting a second collection.

Dismissing the consumer. Don’t dismiss them if they indicate that the collection was painful, or they experienced pain after the collection. Pain or injury can occur.

Being defensive. Pain or injury can happen, it does not mean it is anyone’s fault.

Violence and aggression

NSWHP staff have the right to work in safe workplaces, and consumers, patients, carers and members of the community have the right to safe collections. If a consumer is exhibiting unsafe, violent or aggressive behaviours you can attempt to de-escalate the situation however ensure you know your local emergency procedures for the safety of yourself and those around you.

It is also important to recognise the signs of escalating or aggressive behaviour and try to understand what might be causing it before reacting. Many factors can contribute to someone’s violent or aggressive behaviour. Training for staff is available at Health Education and Training, heti.nsw.gov.au.

Here are several things we must do:

• Try and understand why they are showing aggressive behaviour

• Listen and attempt to de-escalate the situation

• Be clear that aggressive behaviour is not acceptable

• Know your local emergency procedures (code black), ensure the emergency flipchart is accessible and up to date for the location

• Use the duress alarm or call the Police if you feel in danger

• Report and escalate any incidents to your manager

• Remember it is okay to say no to the collection, if the person will not de-escalate and calm

What helps What hinders

Identifying the unusual behaviour and understand what might be causing it. Aggressive behaviour is not always predictable, identify any signs of unusual or escalating behaviour early and the factors that could be contributing to this.

Understand if the patient is known to be aggressive.

Being mindful that fear can turn into aggression. The patient could be fearful of the procedure or the diagnosis and this could present as aggression.

Remain calm and attempt to calm the patient. Be clear and calm with information. You can try to ask the patient politely, “Is there something I can assist you with?”

If they remain violent or aggressive ask a colleague for assistance, use a duress alarm or contact Police for assistance.

Ensure your safety at all times. We will not collect from any patient if they are showing signs of violence or aggression towards our staff.

Not creating a safe distance. Provide the patient with space as to not intimidate or aggravate the situation.

Not allowing them to have their say. Ensure you listen to and acknowledge the patient to help alleviate any concerns or aggression.

Raising your voice and becoming agitated. Remain calm to try and de-escalate the situation.

Not enacting the escalation process.

Part three: collecting in different settings

In this section we explore what collectors can do and must consider to ensure consistent and quality experiences of collection services when you collect in a different environment such as someone’s home. In a community or home environment we need to be mindful of:

• Being in someone’s home and respecting this

• Understanding you are often the first interaction our consumers have with pathology.

Collecting in community settings

Collecting in community settings can differ from collections in a hospital or home setting. Community collection may be located away from hospital facilities and resources, we are responsible for keeping the collection room tidy and safe for our visitors.

Here are several things we must do:

• Make sure the centre is open as advertised

• Acknowledge the arrival of patients with a warm welcome and communicate expectations of wait times

• Be mindful of asking for personal information in an open waiting area with others present

• Be aware of the specimen processing requirements for your location

• Understand the courier timetable to ensure specimens are delivered to the laboratory as soon as possible

• Be familiar with the local emergency procedures for your collection centre and location

What helps What hinders

Always be polite and respectful of everyone. This includes being respectful of the culture within the community that you are attending.

Let people know if there is a wait. If there is a full waiting room and some people have appointments for fasting tests, let the waiting room know there will be a wait and give them an approximate timeframe.

Let people know when they enter to take a number and advise that the collector is with a person. This will help the patient to understand the process of waiting for their collection and ensure they feel welcomed.

Always open and close the clinic as posted on the website and location.

As a consumer told us, “Sign says the centre was closed but was in fact open…My collection took less than 10 minutes, but I had to wait over an hour to get it. If I had been told the opening time was 9:30 instead of 8am then all the testing for myself and the ward patients could have been conducted without inconvenience”

If the centre is closed for some reason, ensure this is communicated as widely as possible. Always notify the Strategic Communications team: nswpath-news@health.nsw.gov.au

For more information on the importance of privacy confidentiality go to Health.nsw.gov.au and search Privacy where you can access the NSW Health Privacy Manual for health information.

Not acknowledging or welcoming patients as they arrive. Ensure patients feel welcome in the clinic by acknowledging their arrival.

Not being considerate of people that might arrive just before closing. We do not know, nor need to know, the background as to why people are coming in for a collection. It may be the only time the patient can come in for a test and we must still provide a high-quality service.

Lack of communication with patients particularly if there will be delays. As a consumer told us “Yes staff could at least let you know that you may have to wait and give you the option of coming back. But when you are the only person waiting what is the delay?”

Collecting in someone’s home

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We have staff who are requested by patients for a Home Collection because of their caring and compassionate nature” Collection staff

Home collection services play an important role in supporting our referring clinicians, patients and families. The NSWHP home collection services support the Local Health Districts, aged care facilities and local referrers in their management of home-based unwell patients, including haematology, and cancer care patients and/or patients who have difficulty with mobility.

“I prefer to have my blood collected at home because I have no transport and I can’t walk very well” Consumer

Here are several things we must do:

• Ask the right questions up front and set expectations, such as arrival times and turnaround times throughout

• Always show respect in someone’s home

• Ensure your safety, undertaking a risk assessment upon arrival and inside of the home, and carry a duress alarm at all times

It is important to seek support if you’re experiencing vicarious trauma and/or compassionate fatigue.

What helps What hinders

Respect in someone’s home. As Susan from Northern Sydney advises “We have to remember we are a guest in their home so showing respect while you are collecting any specimens in their home is very important.”

Being patient whilst finding an appropriate location inside the home for the collection and working with the patient and any limitations they may have.

Ensuring all details are confirmed before attending to a person’s home

• Date and time of the collection

• Access tips for entering the property

• Patient’s name and/or pronouns

• What tests they are having and what is required

• Translator options if required

• Carer details if required

• Any other relevant patient details for the collection

Overlooking carers. Include and engage any carers, explaining the procedure to them as well as the patient.

Being judgemental in any way about people, their home or their surroundings.

Making assumptions. Avoid making any assumptions or judgements of the person based on their demeanour or environment.

Not maintaining confidentiality of patient’s personal details or their home environment.