2.4.18 Delegation of blood sampling

1 Purpose and objective

Regulation of the distribution of tasks for injections, infusions and blood withdrawals

2 Scope of application

Entire hospital, nursing service and medical service

3 Description

Injections, infusions and blood sampling are part of the doctor's duties and responsibilities.
Provided that the following requirements are met, the doctor has the option of calling in suitable (paediatric) nurses (hereinafter referred to as nurses) to carry out the measures he/she recognises as necessary and to delegate the technical implementation to them, if this is necessary due to special circumstances, e.g. operational procedures or current emergency situations.
Delegation is inadmissible if the overall condition of the patient, the degree of difficulty of the measure, the effect and danger of the measure or, if applicable, the medication to be administered or other circumstances make it necessary for the doctor to take action himself.

3.1 Designation of nursing staff

Nurses who have acquired the special qualifications required to carry out the measures through basic and advanced training and suitable training measures are suitable to carry out the measures. The ordering physician must have satisfied himself of this qualification.
In order to carry out intramuscular and intravenous injections, infusions and blood withdrawals, the previous training, skills and experience that justify the special qualification of these nurses for this must have been determined by a doctor and confirmed in writing by the medical director of the clinic/institute and the head of the nursing centre. The continuation of the qualification must be checked by a doctor at suitable intervals (e.g. every 3 years), and the written confirmation must be renewed if the result is positive or the follow-up training has been successfully completed.
The doctor may only delegate the administration of intravenous injections, infusions and blood sampling to individual qualified nurses on an ad personam basis;
The performance of subcutaneous and intramuscular injections can generally be transferred to qualified nursing staff.

3.3 Order by the doctor

The doctor alone is responsible for ordering the procedure, for fully and correctly informing the nurse (in particular about the type, time, duration of injection, dosage and dangers of the procedure/medication and its effects) and for selecting the staff and supervising them. In the case of a drug that is rarely prescribed by the doctor, newly introduced or known to be "dangerous", the doctor must be present during the injection.

3.4 Responsibility

Irrespective of the delegation of the technical implementation of the procedure under the above conditions, the physician remains responsible for providing the patient with appropriate information about the planned procedure. Informing and obtaining the patient's consent is governed by the procedural regulation "Informing and obtaining consent prior to medical interventions" (1.2.02). Delegation to nursing staff is not permitted.

3.5 Refusal by the nurse

Nurses may not be forced to give injections, infusions or take blood samples if they consider themselves unsuitable for particular reasons in individual cases or do not feel able to carry out the ordered measure properly.

3.6 MTAs

If the clinic director decides that the clinic's operational procedures so require, the performance of injections, infusions and blood samples may also be delegated to suitable technical assistants (MTAs). The implementation of these procedural instructions applies accordingly in this case.
A further prerequisite for delegation to MTAs is that the transfer of activities has been regulated in concrete terms by an internal clinic procedure directive issued by the clinic director.

4 Documentation

The medical directors of the clinics/institutes, in agreement with the nurses concerned, determine on the basis of a card which measures can be assigned to which nurses in the clinic/institute. A file is created for this purpose. Ordering the measure and delegation

5 Responsibility and qualification

Responsible: ordering physician

6 Notes and comments

7 Applicable documents

Insofar as higher-ranking provisions (laws, ordinances, guidelines, etc.) or more specific regulations of the hospital management exclude delegation or contain special requirements regarding the admissibility of delegations that deviate from these general procedural instructions, the higher-ranking provisions or the special regulations shall take precedence.

7.1 Literature, regulations

- Guidelines on therapy with blood components and plasma derivatives (Board and Scientific Advisory Board of the German Medical Association)
- Guidelines on the collection of blood and blood components and the use of blood products (haemotherapy) (Scientific Advisory Board of the German Medical Association and Paul Ehrlich Institute)
- Guideline Radiation Protection in Medicine
(Federal Ministry for the Environment, Nature Conservation and Nuclear Safety)
- Transfusion regulation 3.6.04

Dr Matthias Deutsches Krankenhausinstitut e.V. Prof. Dr Karl Otto Bergmann Dr Eick & Partner Reorganisation of the tasks of the medical service - Report of the German Hospital Institute (DKI) 2008

7.2 Terms

Attachments