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Phlebotomy Today
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January, 2014


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Journal Roundup

This month, Phlebotomy Today–STAT! has rounded up some recent publications appearing in the literature pertaining to blood specimen collection. To keep you up to date, we’ve corralled several new articles and studies on reducing hemolysis, patient fasting awareness, pediatric pain management, blood culture volume requirements, hepatitis C in your work environment, and ways to save big money at your facility.   

Reduce hemolysis while using IV catheter
This study found that the use of discard tubes and low vacuum tubes reduce hemolysis in the ED when drawing from IV catheters. Drawing blood by straight needle venipuncture still proves to have the lowest hemolysis rates.
http://www.ncbi.nlm.nih.gov/pubmed/23603143

Infant sucking, not sucrose, reduces pain
Pain Management Nursing published an article clarifying that the non-nutritional sucking helps reduce pain in infants during venipuncture and heelstick, not the use of sucrose. 
http://www.ncbi.nlm.nih.gov/pubmed/24315282

Fasting
This study concluded that only 60% of patients are well informed about the fasting requirements for laboratory blood testing. Patients surveyed felt their requesting physician should inform them of the test requirements.
http://www.ncbi.nlm.nih.gov/pubmed/24266303

How clean is your draw area?
An article published this past November in the Journal of Infectious Diseases Advance Access has found that the hepatitis C virus (HCV) can remain infectious at room temperature on environmental surfaces for up to 6 weeks.  Dried blood drops become inconspicuous and are more likely to cause accidently exposures of HCV to healthcare staff.
http://www.natap.org/2013/HCV/120513_03.htm

Blood-culture volume
One study published in the Journal of Microbiology, Immunology and Infection found that the rate of detection of bacteremia and fungemia in blood culture bottles is directly proportional to blood volume inoculated in the bottles.
http://www.ncbi.nlm.nih.gov/pubmed/22738875

Eliminating five needless lab tests saves $2M
Neurosurgery residents at the University of California San Francisco Medical Center have demonstrated that a 50%reduction of five common lab tests has no effect on patient care. The reduction did save the medical center $75,000 in direct costs.  
http://www.healthleadersmedia.com/content/HEP-297529/Residents-Save-2M-By-Eliminating-Needless-Lab-Tests##

Featured Product

Phlebotomy Supervisor’s Boot Camp 2014

The Center for Phlebotomy Education will conduct its next Phlebotomy Supervisor’s Boot Camp on June 4–6, 2014 in Indianapolis, Indiana.

Over 150 of the world’s most dedicated laboratory managers, and phlebotomy supervisors, educators, and trainers have already completed the popular 3-day event, previously held in Louisville, Kentucky and at the Center’s home offices in Corydon, Indiana.

The Center’s team of world-class presenters will give 18 presentations and moderated group discussions over the course of three days at the Embassy Suites Conference Center in downtown Indianapolis. Attendees will learn strategies to:

  • Reduce expenses by cultivating satisfied, long-term employees;
  • Cut costs through process improvement;
  • Nurture professionalism and responsibility among your staff;
  • Understand different learning styles for effective teaching;
  • Mentor students and new staff...and more.

“We know managers are struggling with high staff turnover, low morale, soaring specimen rejection rates and plunging patient-satisfaction surveys,” says Program Coordinator Catherine Ernst RN, PBT(ASCP). “It’s time to wage war against mediocrity.” According to Ernst, the event is designed to empower managers, supervisors, trainers and educators to change the preanalytical culture where they work and the caliber of phlebotomists they train. Past participants have glowing comments.

“The Center for Phlebotomy Education has truly outdone themselves with this program,” says Cape Cod Hospital’s (Hyannis, MA) phlebotomy supervisor Jim Harrington. “I enjoyed every moment spent!”

Bruce Brown, Lab Manager at Good Samaritan Hospital in Vincennes Indiana echoes Harrington’s sentiment. “This was a fantastic opportunity for bettering my training program, and beginning a new mentoring program. A lot of work went into this program. I’m looking forward to sending phlebotomists to the next seminar! Thanks for all the reference material.”

Attendees came from some of the most prestigious healthcare facilities and academic institutions across the U.S., Canada, Australia, and the Caribbean.

“The workshop is very informative and it gave me confidence to carry on my training and help people perform phlebotomies properly.”

S. Akter
Melbourne, Australia

“Excellent lectures, hand-outs, sharing of experiences with everyone, resources. Exactly what I had hoped it would be and more.

D. Beran
Coconino Community College
Flagstaff, Arizona

“I have been to another Boot Camp of yours and this was just as     interesting as the first. I have learned even more and am taking back a lot of things I want to work on for myself and my facility”

Samantha Pearcy
Mattoon, Illinois

“Your seminar is by far the best I have ever attended. I have something to take back to implement, NOT leaving thinking I could have taught that seminar myself. Much impressed!!! Thanks!”

Mary Armbrecht
Nashville, Tennessee

“The case studies, mentor program, safety and infection control      discussion….great topics!” “I will definitely incorporate the teaching aids into training/competency.” “I can’t wait until next year!”

Alandria Hatcher
Wichita Falls, TX

Sessions worth 17 continuing education credits will be conducted by the staff of the Center for Phlebotomy Education including the Center’s Program Administrator Catherine Ernst, RN, PBT(ASCP),  Program Coordinator Lisa Steinam, PBT(ASCP), and Executive Director Dennis J. Ernst MT(ASCP).

Each attendee will receive a portfolio filled with resources, tips, and tools they can implement immediately. Besides learning how to be a more effective trainer, participants will have the opportunity to network with peers to share ideas, strategies, and solutions to their most perplexing problems.

A second Boot Camp will be held November 12–14, 2014 in San Francisco, California. For more information on this unique opportunity to learn from the most respected authority in the industry, call: 866-657-9857 toll-free or visit the seminar’s webpage.

Preanalytical Errors Cause
Majority of Test Cancellations

A College of American Pathologists Q-Probe study found preanalytical (preexamination) errors account for nearly 52 percent of all cancelled laboratory tests. Thirty-eight percent of test cancellations are due to problems with the order.

It comes as no surprise that, among all preexamination errors that lead to cancelled orders, hemolysis tops the list (14.2 percent) with clotted samples a close runner-up (13.8 percent). Samples of insufficient quantity was the cancellation cause of 13.2 percent of orders while samples sent to the laboratory in the wrong tube or container caused 3.2 percent of the cancellations. Samples contaminated by IV fluids was the cause of 2.8 percent.

Full Article

This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 14th year of publication, are reading about this month:

  • Feature Articles

    Phlebotomy Benchmarks: Productivity and Customer Service
    What Image Do You Project?

  • Playing it Safe

    Broken Tubes in Pneumatic Transport

  • Phlebotomy in the News

  • Tip of the Month

    A “Simple” Venipuncture

  • CE Questions

    (Institutional Version Only)

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, click here.

Featured FAQ

Restraining Children

Question

What are the acceptable means to restrain a child during phlebotomy?

Answer

Gentle physical restraint is necessary to make sure that the arm to be punctured remains immobile during the venipuncture. Avoid forcefully restraining a child who appears to be calm or only mildly anxious. Kids don’t like to be restrained any more than adults do, and a firm, forceful grip can increase their anxiety. It is best to use only as much assistance as is necessary to assure the success of the procedure, and no more.

Regardless of the degree of necessity, restraint should never be applied with a force great enough to cause injury. For outpatients, it is ideal to position the child on the lap of the parent or guardian, who can restrain the free arm of the child while an assistant secures the wrist of the arm to be punctured. For inpatients, or for outpatient situations in which a parent is unable to assist, the patient should lie on a bed or cot with the parent or assistant providing gentle restraint to the legs, the free arm, and the wrist of the arm to be punctured.

Each month, PT-STAT! will publish an excerpt from “Blood Specimen Collection FAQs. For a preview and for information on obtaining your copy, visit http://www.phlebotomy.com/product/8225.cpe.

Survey Says

Sniffing Out Danger

Last month we asked Phlebotomy Today–STAT! readers about their use of ammonia inhalants for patients who feel faint or pass out during blood collection procedures.

In response to our question “How do you react to patients who become dizzy or actually faint?” 88 percent shared that they use a cold compress on the patient’s head or neck and 44 percent said they recline patients (multiple responses were permitted). Fifty-six percent indicated they lower the fainting patient’s head, while 12 percent use ammonia inhalants. The use of ammonia inhalants goes against the provisions of the Clinical and Laboratory Standards Institute’s venipuncture standard, which states “The use of ammonia inhalants may be associated with adverse effects and is not recommended.”

Comments associated with this response include:

  • Call for help and stand in front of patient with arm rest in front of their body. If patient passes out in a sitting position, the MA that came to assist me and I hold the patient by the arms and stand in front of him/ her to avoid they falling forward.
  • Some of our sites have only one staff member in them. We never leave a patient alone that has fainted so we are set up to be able to get them in a reclining position on our own. We never use ammonia inhalants, they can be harmful to patients with breathing issues.
  • When the face is pale, raise the tail (trendelenburg position); when the face is red, raise the head (reverse trendelenburg)
  • We have a buzzer to call for help and an overhead page for a first response team if necessary.

What we found interesting is that the over one-third of those who responded admitted their facility had no policy on how to react to patients who become dizzy or actually faint. Most had it as their written policy to use a cold compress on their head and neck and recline the patient with assistance.

We also asked “are ammonia inhalants accessible for use on fainting patients?” Seventy-six percent said inhalants are not stocked on phlebotomy trays or outpatient draw stations while nine percent admitted to stocking ammonia inhalants on all trays and all outpatient stations.
Comments include:

  • They are available, but I have been told not to use them.
  • We had a physician this week that demanded we have it on hand. I cleared that mess up right away! We will not keep it on hand.
  • They are not stocked because we cannot be sure if the patient has asthma which could make things worse for them

Finally, we asked if participants have ever used an ammonia inhalant on a fainting patient. Thirty-seven percent said they had. Eight percent of those admitted patients reacted adversely.

This month’s survey question:  Does your facility’s dress code policy for scrubs prohibit pant legs from touching the floor? How often do you see staff in any department with pant legs sweeping the floor as they walk?

Take the survey.

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What Should We Do?

What Should We Do? gives you the opportunity to ask our team of technical experts for advice on your most pressing phlebotomy challenges. Whether technical or management in nature, we’ll carefully consider solutions and suggestions based on the industry’s best practices so that you and those in other facilities with the same problem can benefit, all the while maintaining your facility’s anonymity. What Should We Do? is your opportunity to ask us for suggestions on the best way to handle your real-life dilemmas.

This Month’s Case Study
Phlebotomist Not Getting Respect

One reader writes:
Do other phlebotomists have to deal with MLT’s that treat them and refer to them as a “lowly phlebotomist”? This is a direct quote from a tech I have to work with. My manager knows about her attitude towards me and neither says or does anything about it. I am an ASCP certified phlebotomist and have been for 27 years.

Our Response

What you’ve described is beyond disrespectful. It constitutes bullying by your coworker and the sanctioning of a hostile work environment by your manager.
Disrespectful behavior causes tension in the workplace. Employees may feel uncomfortable coming to work and interacting with certain team members. Productivity is always affected.  The National Institute for Occupational Safety and Health found that 24.5 percent of companies surveyed reported instances of bullying in the previous year.  Women are responsible for a surprising 80% of bullying in the workplace according to a study by Manchester Institute of Science and Technology. According to a study by the Joint Commission, the effects of workplace bullying can result in errors, poor client satisfaction, increased costs, and higher turnover rates among employees.
There are several things you can do.

  1. Have a meeting with your manager and let her know how you feel about being considered a second-class citizen by your coworker. He/she should also know that his/her inaction signifies they’re in agreement with the bully’s perception of your value. Managers are responsible for setting expectations on employee behavior and holding employees accountable for meeting their expectations.
  2. Confront your disrespectful co-worker in the presence of a mediator, manager, or a representative from your facility’s human resource department. Have knowledge of your facility’s bullying policies. Document every time an issue occurs and who, if anyone, might have witnessed it. If things do not improve you have the option of filing a complaint with your state’s labor relations board.
  3. Neither of the options above are enjoyable, but if you otherwise like your job, you may have to endure some stressful encounters in order to preserve your long-term employment there. If not, you may choose to look for a job elsewhere. Talented individuals don’t have to put up with a disrespectful workplace if they can take their gifts to an employer who values team harmony. Thoroughbreds don’t want to run with donkeys. You shouldn’t have to, either.

Phlebotomists are often easy targets for healthcare professionals with higher degrees and low self-esteem. Just make sure you’re not acting unprofessional or otherwise feeding a negative perception, then take steps to stop the abuse by bringing it to the attention of those who have a moral and professional obligation to intervene.

At the end of the day, nobody can take your self-esteem away but you. You are a certified phlebotomist, a highly skilled healthcare professional whose work contributes in no small way to how every patient is treated, medicated and managed. Nobody with a superiority complex can ever take that away from you unless you let them. But they shouldn’t be allowed to constanty chip away at your morale, either.

Each month, our “What Should We Do?” panel of experts collaborates on a response to one of the many compelling problems submitted by our readers. Panelists include:

Dennis J. Ernst
MT(ASCP)

Catherine Ernst
RN, PBT(ASCP)

Lisa Steinam,
PBT(ASCP)

Got a challenging phlebotomy situation or work-related question?

Email us your submission at WSWD@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)

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