Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [165], C).
2. 2.Show
   Fully explain the steps of the procedure.
   The procedure requires the patient to fully understand and co‐operate in order to optimize the quality of the sample (NMC [165], C).
3. 3.Show
   Position the patient upright in a chair or in a high semi‐Fowler position, supported as necessary with pillows.
   For comfort and to facilitate optimum chest and lung expansion. E
4. 4.Show
   If secretions are thick or tenacious, or are difficult to clear: administer nebulization therapy and/or enlist the help of a physiotherapist.
   To loosen secretions and assist in techniques that will optimize sputum sample collection (Welch and Black [254], E).
5. 5.Show
   Wash hands with bactericidal soap, or decontaminate physically clean hands with alcohol rub. Put on apron, gloves and eye protection.
   To reduce the risk of cross‐infection and splash injury to the practitioner (NHS England and NHSI [155], C).

Procedure

1. 6.Show
   Ask the patient to take three deep breaths in through their nose, exhale through pursed lips and then force a deep cough.
   Deep breathing helps to loosen secretions and a deep cough will ensure a lower respiratory tract sample is obtained. E
2. 7.Show
   Ask the patient to expectorate into a clean container. Secure the lid.
   To prevent contamination. E

Post‐procedure

1. 8.Show
   Dispose of waste; remove apron, gloves and eye protection; and wash and/or decontaminate hands.
   To ensure correct clinical waste management and reduce the risk of cross‐infection (DH [48], C).
2. 9.Show
   Label the sample immediately and complete the microbiology request form (including relevant information such as indication for sample and current or recent antimicrobial therapy).
   To maintain accurate records and provide accurate information for laboratory analysis (NMC [165], C; Weston [255], E).
3. 10.Show
   Dispatch the sample to the laboratory as soon as possible (within 4 hours).
   To increase the chance of accurate organism identification (Higgins [84], E).
4. 11.Show
   Document the procedure in the patient's records.
   To ensure timely and accurate record keeping (NMC [165], C).