Competency Checkup: What’s in it for you?

Do you dread your annual evaluation? Does it make you anxious to have your technique scrutinized? There are many reasons you should welcome the experience, and embrace what it means to your professional stature.

By having your work performance formally assessed on a routine basis, you create for yourself and your employer documentation that places you in a favorable light. You may already be great at what you do, but is it documented that you consistently collect blood samples according to established standards? If not, you might not be able to prove your expertise if your knowledge and technique were ever called into question.

Like an annual physical examination that determines the current status of your health, regular competency assessment activities serve as a checkup of your current knowledge and skill as a phlebotomist. Checkups have two purposes: to either verify all is well or to spot and address problems early on.

Assessment Methods
For the most comprehensive employee evaluation, a variety of assessment methods should be used. Four commonly used methods are described below:

• Direct observation—This method of assessment typically employs a standardized checklist that guides the evaluator’s review of the employee’s actual performance of phlebotomy procedures in the workplace. Such checklists also serve as a great self-assessment tool for employees prior to their formal evaluation. When checklists are shared with staff in this manner, anxiety about the process is lessened and performance expectations are clearly communicated.
• Written test—Because it may not always be possible to observe every activity you are assigned to perform, administering a written test is an effective way to measure the employee’s breadth of knowledge on a variety of topics and familiarity with infrequently performed tasks.
• Case studies/Problem solving—Case studies are particularly useful for addressing problem-prone or high-risk activities. Presenting scenarios for the employee to interpret that are based on actual or likely occurrences reveals an employee’s thought processes and helps ensure that appropriate action is taken should such situations be encountered in the future.
• Oral queries—More informal than the other assessment methods listed above, conducting a verbal Q&A session can overcome reading or language barriers an employee may have and is useful for reassessing employees who require retraining or additional follow up. Just make sure records of such oral evaluations are kept.

Frequency
After initial training is complete and prior to working independently, the competence of new or newly trained employees should be assessed by a qualified individual. In addition, when a new procedure or collection method is introduced, the competence of all involved staff should be measured prior to implementation. As a rule of thumb, it’s a good idea for employee competence to be evaluated every three to six months the first year, and annually thereafter. 

Tips for Successful Assessments
To establish an effective and robust competence program, supervisors should consider the following:

• Provide thorough initial training and ongoing phlebotomy continuing education;
• Keep blood collection policy and procedure manuals up to date;
• Use a variety of assessment tools and methods;
• Encourage employee self-assessments;
• Document all training and assessment activities;
• Obtain staff input on the process and provide feedback on performance;
• Implement corrective action, as appropriate;
• Ensure a qualified individual conducts and documents all assessment activities.

Each January, many of us participate in the New Year’s ritual of making resolutions. So for 2010, why not resolve to be the best phlebotomist you can be? Annual evaluations won’t automatically protect an employee from legal liability should a patient injury occur, but when a facility shows it’s serious about maintaining competent personnel, it can only help. So, if having your phlebotomy skills evaluated makes you feel ill, consider the process as an insurance policy that helps protect your credibility and career by proving you’re fit to perform the task.   

[Editor’s Note: a sample competency checklist is included in the Center for Phlebotomy Education’s Manager’s Toolbox.]

Center Posts Free Hemolysis Article

In keeping with our tradition of providing high-quality technical content for free, the Center for Phlebotomy Education recently uploaded a new Needle Know-How article on its web site. “The Art of Hemolysis” discusses how cells ruptured during sample collection and handling can significantly alter test results, especially potassium levels. The most common causes of hemolysis are listed along with preventative measures specimen-collection personnel can take. You can access the article here.

This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 11^th year of publication, are reading about this month:

• Feature Article: How Creativity Corrupts Phlebotomy
  
• Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in December including these stories:
• Patients Requesting HCWs to Wash Hands
• Physicians Lax in Reporting Needlesticks
• Healthcare Workers Spreading HIV to Patients
• Keillor Slams Outpatient Drawing Center
• Quest Responds to Keillor Comment
• Phlebotomist Buying Groceries Performs CPR on Cashier
• “A Voice for Patients” Spotlights Medical Errors
• According to the Standards: Reusing needles
• Tip of the Month: They're Called Stress Balls for a Reason
• CEU questions (institutional version only).

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.

Featured FAQ
Hemolysis and IV draws

Q: Our nurses start an IV, they attach a tube holder and draw a red top. We’re finding these specimens frequently hemolyzed. Is hemolysis expected in this circumstance?

A: Vascular access devices are notorious for hemolyzing red blood cells. Every facility that draws blood during an IV start has a hemolysis problem. Guaranteed. The best way to prevent hemolysis is to avoid using an IV for the purpose of drawing blood. Statistics show they’re 10 times more likely to hemolyze a specimen than drawing by venipuncture. 

Even though IV cannulas may be of the same gauge as a blood collection needle, they’re not made for drawing blood. Therefore, they have a design that doesn’t consider the fragility of red blood cells. We know that the interior of a blood collection needle is smooth and without interruption, but assuming the same for any other vascular access device is overly presumptuous.

Each month, PT-STAT! will publish an excerpt from our newly released book Blood Specimen Collection FAQs. For a preview and for information on obtaining your copy, click here.

Featured Product
Phlebotomy Today

Survey Says

Our latest survey asked Phlebotomy Today STAT! readers three questions about their use of blood collection devices.  The results are as follows:

• “Not any more. just stared one time use then throw them away. we had to many needle sticks. i'm, in long term care i do like this better.”
• “I have a coworkder who does reuse the tube holders. She only carries one on her tray.”

Readers should keep in mind that an answer of “Yes” to any of the three questions posed places the collector at greater risk for occupational exposure to bloodborne pathogens and in the U.S. represents a direct violation of OSHA regulations. Healthcare workers in other countries are no less vulnerable to accidental exposures, and should take precautions voluntarily to reduce their risk.

This month’s survey question: Does your facility formally evaluate competence of all staff who performs phlebotomy procedures? If so, how frequently are competency evaluations conducted and what methods are used?

What Would You Do?

Each month, What Would You Do? presents a different case study, then asks readers to contribute their ideas as to how each situation would best be handled. The following month, selected responses will be chosen by the editor and published (sender will be identified by first name and state only). The most accurate, well written response will receive a free download from the Center for Phlebotomy Education’s To the Point® library of articles. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.

According to our respondents, this type of negative patient reaction is not uncommon. Of those who would encounter patients with this attitude toward blood specimen collection, 64% indicated that their approach would be to attempt to calm and reassure the patient. Many readers expressed that such patient hostility is often rooted in previous phlebotomy experiences gone bad. After reassuring the patient of their technical abilities, 36% stated they would then ask for the patient’s consent, while 36% would also offer the patient the option of having someone else perform the draw. 

However, 29% of our readers stated they would not attempt to persuade or draw the patient, with 21% noting they would inform the attending nurse or physician. Some readers expressed concern for their own personal safety (14%), while 7% of readers would apprise their supervisor of the situation. 
Reader comments included:

• “I would definitely get someone else to come and try to stick this patient. I would not take a chance at harming myself with a violent patient. If no one else is available to stick the patient, I would talk to the nurse and /or doctor and see if he could be talked to and drawn at a later time.”
• “You have been threatened. Offer him to choose someone else. Let supervisor know. Maybe the supervisor and security can talk to the patient.”
• “All patients have the right to refuse treatment, including testing that doctors have ordered. If the patient is of legal age, and is not of diminished capacity, you must obey the patients wish and not draw on them. That is not to say, you cannot return in 1/2 hour or at the end of your rounds and try again.”

Because a patient’s cognitive status has great bearing on how he/she should be managed, those who perform blood specimen collection should be familiar with and follow their facility’s specific policies to ensure their own safety while respecting the rights of their patients.

 We particularly liked the response given by Kathleen D., of Arizona, below:
“I would tell the patient that I have 30+ years of phlebotomy experience, and probably say something like, “Have you had trouble when getting your blood drawn in the past?”  I’d ask if it was ok for me to apply the tourniquet and check for a vein.  I would assure him that if I were not completely sure that I could get the blood, I would not even attempt the stick.  My major job would be to find out why he was so angry/upset about blood draws, and try to calm his fears.  If it seemed as though he wouldn’t cooperate, I would not attempt the phlebotomy”.

For her detailed approach to diffuse a hostile situation and regain the patient’s trust, Kathleen will receive a free download from the Center for Phlebotomy Education’s To the Point® library of articles.