Evesham 4th Jan 2012

1. RCN Competences
Competences:
an education and training
competence framework for
capillary blood sampling and
venepuncture in children
and young people

2. Acknowledgements
We would like to thank the NHS Modernisation Agency Review group
for sponsoring the development of the original
Anne Casey, Editor and Adviser, Royal College of
framework, first published in 2005. We are grateful to
Nursing
the following people for their assistance in the
production of the original framework document and Jennie Craske, Pain and Sedation Clinical Nurse
this updated version: Specialist, Royal Liverpool Children’s Hospital NHS
Trust
Expert group
Annette K. Dearmun, Lecturer Practitioner, Oxford
Karen Bravery, Nurse Practitioner/Practice Radcliffe Hospitals NHS Trust
Development Lead Intravenous Therapy for Infection,
Ansley McGibbon, Senior Nurse, Practice, Research,
Cancer and Immunity, Great Ormond Street Hospital for
Development and Education Unit, Lothian University
Children NHS Trust
Hospitals, Edinburgh
Pauline Brown, Lead Nurse IV Therapy, Royal Liverpool
Steve McKenna, Charge Nurse, Paediatric Ambulatory
Children’s Hospital NHS Trust
Care/Outpatients, Royal Free Hampstead NHS Trust
Julie Flaherty, Children’s Nurse Consultant, Unscheduled
Fiona Smith, Adviser in Children and Young People’s
Care, Salford Royal Foundation Trust
Nursing, Royal College of Nursing
Liz Gormley-Fleming, Senior Lecturer, Children’s
Nursing, University of Hertfordshire
We are also grateful to the Royal College of Paediatrics
Alison Hegarty, Teacher Practitioner, IV Therapy,
and Child Health for its support of the content of this
Central Manchester and Manchester Children’s Hospital
publication.
NHS Trust
Valerie McGurk, Practice Development Facilitator,
Paediatrics, Northampton General Hospital Trust
Louise Mills, Nurse Practitioner for Intravenous
Therapy, Great Ormond Street Hospital for Children
NHS Trust
Sally Ramsay, Independent Nursing Adviser, Ramsay
Consulting
Jo Rothwell, Lead Nurse, IV Therapy, Central
Manchester and Manchester Children’s Hospital NHS
Trust
Disclaimer
This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers are
advised that practices may vary in each country and outside the UK.
The information in this booklet has been complied from professional sources, but it’s accuracy is not guaranteed. While every effort has been
made to ensure that the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which
it may be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be
caused directly or indirectly by what is contained in or left out of this information and guidance.
Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN
© 2010 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers. This
publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which
it is published, without the prior consent of the Publishers.

3. ROYAL COLLEGE OF NURSING
Competences:
an education and training competence framework for capillary blood
sampling and venepuncture in children and young people
Approved by the RCN Accreditation Unit until 31 July 2011
Contents
Introduction 2
1. Guidance for programme development 3
Education pathways 3
Teaching and learning strategies 3
Assessment 3
2. Competences, learning outcomes and indicative content 4
Domain 1: professional and legal issues 4
Domain 2: preparing self, child and family 4
Domain 3:performing capillary blood sampling and venepuncture 5
Domain 4: risks and hazards 6
3. References and further reading 8
4. Online resources 12
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4. RCN COMPETENCES – CAPILLARY BLOOD SAMPLING AND VENEPUNCTURE
Introduction
Developing skills in performing capillary blood sampling The framework should also be used to develop new
and venepuncture can facilitate holistic care and timely programmes, and to review and revise existing ones. By
treatment. For nurses working with children and young using this framework, other professionals and employers
people this is usually regarded as an expanded role. Before can be confident in the standard and proficiency of
starting a programme of education and training practitioners.
practitioners should be should be competent and
confident to care for children and young people. Developing competence within age bands
Competence can be defined as: “The state of having the There are considerable differences between children of
knowledge, judgement, skills, energy, experience and varying ages, and we recommend that practitioners
motivation required to respond adequately to the demands develop competence within specific age bands according
of one’s professional responsibilities” (Roach, 1992). to their area of practice:
This education and training competence framework for G 0 to 1 year
capillary blood sampling and venepuncture in children G 1 to 5 years
and young people is an important step forward. First
published in 2005, it has been revised to reflect a number G 5 years and above.
of current political and professional issues and initiatives,
including:
G Agenda for Change (DH, 1999)
G the need for leadership in specialist nursing
G the need for the development of standards
G High quality care for all: the NHS next stage review
(DH, 2008) and its equivalents in Scotland, Wales and
Northern Ireland
G the increased focus on work-based and lifelong
learning plus supervision
G the changing focus towards professional rather than
academic accreditation
G multi-skilling health care practitioners to effectively
meet the needs of service users.
This framework describes the competences, learning
outcomes and the indicative content necessary for
education and training programmes to meet the needs of
children and young people. It aims to support consistent
curriculum and practice development so that practitioners
can develop and, maintain the ability to carry out this task,
regardless of where they work.
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5. ROYAL COLLEGE OF NURSING
1
Guidance for programme development
When either planning new courses or reviewing existing Assessment
courses, we recommend that hospitals and universities use
this as their competence framework. As a minimum each programme needs to assess
competence in practice. Practice assessments should
reflect the competences and learning outcomes. There are
Education pathways various assessment methods that are appropriate:
This framework can be used to develop hospital-based G observation under supervision and demonstration
training programmes for nurses working with children G reflective practice
and young people. Alternatively, it can be used to review G portfolio of evidence showing skills, experience and
existing programmes to ensure that they meet the needs of development
children and young people. Training may be linked to
other competences, such as those required for cannulation. G formal examination.
Each of these relies on the use of practice assessors.
Programme developers should consider who this may be
Teaching and learning strategies and the criteria needed to become and maintain this
status. We recommend that an assessor should be
Capillary blood sampling and venepuncture in children experienced in capillary blood sampling and
and young people is a practical skill, which is underpinned venepuncture in children and young people. Their ability
by theoretical knowledge. Teaching and learning strategies to assess others should be determined by a formal
should focus on developing the competence and assessment process. We also advise that they receive clear
confidence of the practitioner in performing the procedure guidance on their role and responsibilities.
safely, and with minimum distress to the child or young
Regular updating and assessment of skills can assist in
person. Assessment of prior knowledge, particularly in
ensuring ongoing competence. We suggest that this takes
caring for the child undergoing intravenous therapy, can
place annually.
be useful in developing programmes that reflect the
individual needs of the practitioner.
A variety of new ways of learning can be used for these
programmes:
G workbooks
G problem-based learning
G taught provision
G scenarios
G supervised practice
G e-learning
G simulation
G blended learning.
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6. RCN COMPETENCES – CAPILLARY BLOOD SAMPLING AND VENEPUNCTURE
2
Competences, learning outcomes
and indicative content
Domain 1: G reflect on own practice, identifying accountability and
competence issues.
professional and legal issues
Indicative content
Competences G Department of Health requirements for record-keeping.
G Performs capillary blood sampling and venepuncture G The Nursing and Midwifery Council Code (NMC, 2008).
in accordance with legal, professional and policy
G Legal, professional and local policies regarding
requirements.
enhanced nursing roles.
G Uses appropriate evidence to underpin best practice in G Accountability when performing capillary blood
capillary blood sampling and venepuncture in children sampling and venepuncture.
and young people.
G Local policies and procedures for capillary blood
G Records and reports information in a manner that is sampling and venepuncture in children and young
clear, concise, timely and accurate. people.
G Reflects on own practice and takes action to develop G Evidence base for good practice in capillary blood
and improve knowledge and skills. sampling and venepuncture.
G Describes circumstances where it is inappropriate to G Policies and good practice guidance in obtaining
perform capillary blood sampling and venepuncture informed consent.
and the alternative action to take.
G Policies and good practice guidance for holding and
G Demonstrates best practice in gaining informed restraining children.
consent from the child and family.
G Demonstrates awareness of the limits of own
skill/competence/knowledge. Domain 2:
preparing self/child/family
Learning outcomes
At the end of a course of study and period of supervised
Competences
practice the nurse will be able to:
G Performs the preparatory processes for capillary blood
G discuss the legal and professional issues associated sampling or venepuncture in a safe and effective
with performing capillary blood sampling and manner.
venepuncture
G Uses appropriate procedures for correctly identifying
G outline current evidence to support best practice in the patient.
capillary blood sampling and venepuncture
G Describes the anatomy and physiology applicable to
G describe the process for obtaining informed consent capillary blood sampling and venepuncture.
from the child/young person and family
G Assesses the child’s physical and psychological needs
G give an account of professional and local policies before, during and after capillary blood sampling and
relevant to performing capillary blood sampling and venepuncture and uses these in preparing a care plan.
venepuncture
G Employs appropriate methods to select and prepare
G describe the legal requirements for good recordkeeping suitable sites for capillary blood sampling and
in relation to capillary blood sampling and venepuncture selects suitable collection devices and
venepuncture equipment and gives rationale for choice.
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7. ROYAL COLLEGE OF NURSING
G Demonstrates knowledge of pharmacological and non- G The use of play to communicate with children.
pharmacological pain relief.
G Distraction techniques.
G Applies local anaesthetic cream correctly to an
G Role of the play specialist and psychologist in
appropriate site.
preparing children for blood sampling procedures.
G Identifies when other health professionals e.g. play
specialist, child psychologist, should be involved in G Needles: helping to take away the fear (Action for Sick
preparation. Children, 1994).
G Uses strategies to minimise the risk of injury to others G Creating a safe, comfortable, calm and child-focused
who may be present. environment.
G Importance of the practitioner’s attitude (empathetic
Learning outcomes rather than directive).
At the end of a period of study and supervised practice the G Patient group directives.
nurse will be able to: G Local anaesthetic preparations.
G give an account of the anatomy and physiology of G Vein selection: influencing factors and methods.
capillaries and veins, and describe the relevance for
capillary blood sampling and venepuncture G Cleaning the skin.
G explain the theory of capillary blood sampling and
venepuncture in children and young people
Domain 3: performing capillary
G describe the methods used to identify appropriate and
inappropriate sites for capillary blood sampling and blood sampling and
venepuncture venepuncture
G develop a care plan appropriate to the child’s physical
developmental and psychological needs before, during,
and after capillary blood sampling and venepuncture Competences
G demonstrate good practice when preparing self, child G Demonstrates the safe application of the principles of
and family for capillary blood sampling and “restraining, holding still and containing children”
venepuncture (RCN, 2003b).
G create a safe environment for performing capillary G Demonstrates the correct procedures for minimising
blood sampling and venepuncture infection, including hand washing, use of gloves, apron
and aseptic technique.
G identify the various devices and equipment used for
capillary blood sampling and venepuncture for G Uses appropriate strategies for minimising pain
children of different ages associated with capillary blood sampling and
venepuncture.
G explain the interventions that minimise a child or
young person’s pain and anxiety during capillary blood G Applies pressure or a tourniquet appropriately and
sampling and venepuncture safely.
G describe the roles of other health professionals in G Takes appropriate action to prevent iatrogenic
preparing children or young people for painful anaemia.
procedures
G Demonstrates practical ability and dexterity during
G give an account of the use of patient group directives. capillary blood sampling and venepuncture.
G Responds appropriately to troubleshoot or overcome
Indicative content any difficulties experienced during the procedure.
G Anatomy and physiology of capillaries, veins, arteries G Identifies the appropriate blood container and reagent
and nerves. for the tests required, and fills them in the correct
G Theory of capillary blood sampling and venepuncture. order.
G Devices and equipment for capillary blood sampling G Fills, labels and dispatches containers correctly,
and venepuncture and their use. demonstrating knowledge of factors that can adversely
influence the results.
G Cognitive development, and a child or young person’s
perception of pain. G Identifies reasons why capillary blood sampling and
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8. RCN COMPETENCES – CAPILLARY BLOOD SAMPLING AND VENEPUNCTURE
venepuncture may be unsuccessful and describes G Blood volumes.
actions to address this.
G Containers, reagents, order of filling.
G Describes correct care of the site following the
G Laboratory requirements.
procedure.
G Emergency situations: their prevention and resolution
G Removes and disposes of devices and equipment in e.g. patient moving, arterial puncture, fainting.
accordance with infection control and health and
safety policies. G Labelling specimens.
G Communicates with the child and family during and G Completing investigation request forms.
after the procedure in a manner that minimises G Problems with sample quality that could lead to
anxiety and encourages compliance. erroneous results.
G Describes the indications for some frequently used G Encouraging and rewarding children.
blood tests.
Learning outcomes Domain 4: risks and hazards
At the end of a period of study and supervised practice the
nurse will be able to: Competences
G perform checking procedures that maximise patient G Describes the risks and complications to self and child
safety associated with capillary blood sampling and
G wash his/her hands in accordance with good practice venepuncture, and acts to prevent these
guidance G Explains the infection control and health and safety
G demonstrate good practice when holding the child or procedures required for safe capillary blood sampling
young person still during the procedure and venepuncture
G identify the containers and volumes required for G Recognises, reports and records errors or adverse
effective blood sampling in children and young people incidents associated with capillary blood sampling and
venepuncture
G demonstrate knowledge of the correct sequence for
filling blood containers to avoid contaminating G Follows appropriate policies and procedures when
specimens disposing of equipment and hazardous substances
G calculate the maximum amount of blood that should G Takes action to maximise the safety of the child, family
be taken from a child and self when performing capillary blood sampling
and venepuncture.
G perform capillary blood sampling and venepuncture
safely on children and young people of varying ages Learning outcomes
G identify strategies for minimising anxiety and pain At the end of a period of study and supervised practice the
when performing capillary blood sampling and nurse will be able to:
venepuncture
G outline the risks and complications associated with
G demonstrate knowledge of the indications for certain capillary blood sampling and venepuncture, their
commonly used blood tests prevention and treatment
G access reference ranges to compare blood results G discuss infection control and health and safety policies
G describe factors that can lead to erroneous test results and procedures applicable to capillary blood sampling
and venepuncture
G describe techniques for encouraging and rewarding the
child undergoing peripheral venous cannulation. G describe the procedures for reporting errors and
adverse incidents
Indicative content G give account of relevant health and safety and infection
control policies
G Effective hand washing.
G demonstrate knowledge of factors that influence the
G Restraining and holding still.
safety of the child, family and self during capillary
G Communication strategies. blood sampling and venepuncture
G Applying pressure and tourniquets. G create a safe environment for performing capillary
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9. ROYAL COLLEGE OF NURSING
blood sampling and venepuncture.
Indicative content
G Safe practice in handling and disposing of sharps.
G Role of the National Patient Safety Agency and
Medicines and Healthcare Products Regulatory
Agency, and equivalent organisations in Scotland and
Northern Ireland.
G Right patient – right care (NPSA, 2004a).
G Health and Safety at Work Act 1974 and other
regulations (HSE).
G Government and NHS guidance on preventing
infection.
G Needlestick injuries: the point of prevention (RCN,
2009).
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10. RCN COMPETENCES – CAPILLARY BLOOD SAMPLING AND VENEPUNCTURE
3
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Paediatric Nursing, 14(8), pp.30-33.
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14. RCN COMPETENCES – CAPILLARY BLOOD SAMPLING AND VENEPUNCTURE
4
Online resources
G Action for Sick Children G Northern Ireland Practice and Education Council for
www.actionforsickchildren.org Nurses and Midwives
www.nipec.n-i.nhs.uk
G Department for Education and Skills
www.des.gov.uk G NHS Education for Scotland
www.nes.scot.nhs.uk
G Department of Health, Social services and Public
safety, Northern Ireland G NHS Scotland
www.dhspsni.gov.uk www.show.nhs.uk
G Department of Health (England) G NHS Wales
www.dh.gov.uk www.wales.nhs.uk
G Evidence-based Practice in Infection Control G Nursing and Midwifery Council
www.epic.tvu.ac.uk www.nmc-uk.org
G NHS Evidence G Royal College of Nursing
www.evidence.nhs.uk www.rcn.org.uk
G Health and Safety Executive G Royal College of Paediatrics and Child Health
www.hse.gov.uk www.rcpch.ac.uk
G National Association of Hospital Play Staff G Skills for Health
www.nahps.org.uk www.skillsforhealth.org.uk
G UK Health and Safety legislation G Hand hygiene, Scotland
www.coshh-essentials.org.uk www.washyourhandsofthem.com
G Health Care Standards Unit
www.hcsu.org.uk
G National Patient Safety Agency
www.npsa.gov.uk
G NHS Litigation Authority
www.nhsla.com
G Infection Prevention Society
www.ips.uk.net
G Joanna Briggs Institute
www.jbi.edu.au
G National Patient Safety Agency
www.npsa.nhs.uk
12

15. The RCN represents nurses and nursing, promotes
excellence in practice and shapes health policies
November 2005, revised July 2010
RCN Online
www.rcn.org.uk
RCN Direct
www.rcn.org.uk/direct
0345 772 6100
Published by the Royal College of Nursing
20 Cavendish Square
London
W1G 0RN
020 7409 3333
Publication code 003 004
ISBN 978-1-906633-45-5