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February, 2017

 

CMS Cuts Payments to 769 Hospitals for Infections, Injuries

MoneySeven-hundred-sixty-nine hospitals in the U.S. will see a one percent reduction in federal reimbursements for Medicare discharges in 2017 because they failed to show progress on reducing patient injuries and healthcare-acquired infections.

The government's Hospital-Acquired Condition Reduction Program, now in its third year, will result in a collective loss for hospitals in 2017 of $430 million. That's 18 percent higher than last year, in which 750 facilities were penalized. Sixty percent of those on this year's list as the worst performing 25 percent of hospitals in the U.S. (those in this linked chart with scores greater than 6.75) in reducing HAIs and patient injuries were also on last year's list. Two-hundred-forty-one have been on the list all three years.

According to a Healthcare Finance article, hospital-acquired conditions declined 21 percent between 2010 and 2015. However, the U.S. Agency for Healthcare Research and Quality (AHRQ) estimates there were 3.8 million hospital-related injuries last year.


This Month in Phlebotomy Today


Here's what subscribers to Phlebotomy Today, the Center for Phlebotomy Education's flagship newsletter currently in its 17th year of publication, are reading about this month:

PT_sample_2017Feature Article
Can Phlebotomy Be Automated?

On the Front Lines
Blood cultures from IV devices

From the Editor's Desk
If I had a boss, I'd have been fired by now

Customer Care Corner
Your professional persona

Test Talk
Gamma-glutamyltransferase

Soapbox
Rants and chants from our readers

WikiTeach
How we teach hemolysis

Subscribe to Phlebotomy Today and get this issue immediately. Sign up for an institutional subscription during the month of February, and get one month free!


Phlebotomy Today Special Offer

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Ernst Receives John Bergen Award

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Ernst accepts the John V. Bergen award from CLSI president Jack Zakowski, Ph.D., FACB

The Center for Phlebotomy Education's director, Dennis J. Ernst MT(ASCP) NCPT(NCCT) was recently presented with the prestigious John V. Bergen award for excellence in standards development. 

According to CLSI, "the award is presented annually to an outstanding volunteer or group of volunteers in recognition of advances in CLSI organizational directives and objectives, through unique and significant contributions."  Established in 2006, the award has been presented every year in honor of John V. Bergen, CLSI's first full-time Executive Vice President.

"Dennis' direct contributions to all essential standards within the pre-examination areas of laboratory medicine is unequaled," said CLSI president Dr. Jack Zakowski during the award ceremony last month in Tempe, Arizona. "He has made great contributions to the field, most notably in the area of blood specimen collection. "His leadership in CLSI's standards ensures consistent emphasis on the customer-related and patient-related aspects of blood sample processes, professional standards of behavior, and critical technical skills.  Besides that, he's a really nice guy."

BergenPlate (2)_1500Since 2002, Ernst has been involved in writing or revising almost every preanalytic document in CLSI's library. He's chaired six Document Development Committees and served as a member for five others. In 2015, he was appointed to the organization's Consensus Council, which has authority over all CLSI standards development activities.

"In 1999, I got into my rusty old pickup truck and drove from Indiana to Raleigh, North Carolina to attend an educational conference presented by CLSI, known then as NCCLS, about their newly revised venipuncture standard, H3-A4," says Ernst. "The presenters involved in the revision were so warm and welcoming, they even invited me to join them for dinner. From that moment, I knew I had to become involved with the organization, and with that standard."


Center Seeking Social Media Consultant

SocialMediaLogosThe Center for Phlebotomy Education is looking for a phlebotomist or phlebotomy manager/educator who also has expertise in social media marketing. "The dual expertise is essential," sad the Center's director Dennis J. Ernst.  "Nobody better understands the phlebotomy community than those who perform, teach or manage blood collection procedures. There's plenty who fit that skill set among our readers and have social media savvy."  

The Center connects with the phlebotomy community on social platforms including Facebook, Twitter, YouTube, LinkedIn and Pinterest. The successful candidate will serve as an independent freelance consultant under a work-for-hire agreement out of his/her own home or office.  Interested individuals should send their qualifications and experience in phlebotomy and social media to support@phlebotomy.com. No calls, please. 


Product Spotlight: Merchandise Just for Phlebotomists

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Last fall, the Center for Phlebotomy Education launched a new online store offering merchandise just for phlebotomists.

Aptly named, Just For Phlebotomists promotes phlebotomists and their profession, proclaiming the critical role they play in healthcare. The shop offers a variety of shirts, mugs, hoodies, hats, and other merchandise with images and text that lets phlebotomists show pride in their profession. Imprints include caricatures of blood collection tubes including Lolita Lavender, Randy Red, Guy Green, and Bobby Blue. Phrases include Phlebotomy: It's not as simple as I make it look, and I'm a professional, perfectionist, phlebotomist!

"Over the years, we've been almost exclusively an education company," says the Center's Director, Dennis J. Ernst. "But since phlebotomists are the backbone of the laboratory, and so critical to the care of every patient they draw, it's time we help them shout it from the mountaintops."

The Center is partnering with Cafe Press to host the growing collection of custom designs on a wide variety of clothing and accessories. Visit Just For Phlebotomists.

 

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Survey Says: How many patients do you draw per hour?

Lady listeningLast month we got curious about how many patients our readers and visitors to our web site draw per hour, and how many they are expected to draw. First, some background.

We are often asked what number of patients is reasonable to expect a phlebotomist to draw. That's a toughie. There is no easy answer because there are so many variables. The skill of the collector, the condition and accessibility of the patient's veins, transit time to and from patients, skin punctures versus venipunctures, needle-phobic patients all factor into phlebotomist productivity. We always advise facilities to set up an internal audit so they can calculate a fair productivity rate given their own unique circumstances, and to include phlebotomists with varied experience. 

That's exactly what researchers in Calgary, Alberta did, as we reported in our March 2016 issue. After clocking 110 phlebotomies performed by six phlebotomists they found the average "cycle time" to perform the required steps of a routine, uncomplicated venipuncture to be four minutes and nineteen seconds per patient with a standard deviation (SD) of 52 seconds. With that as their baseline, they added two SDs, extending the typical draw to 6:44, and established a benchmark for productivity of ten patients per hour.

In our survey, over 23 percent of those responding said when they are at their busiest they draw over 15 per inpatients per hour. The second highest number of patients was ten per hour (18 percent). Surprisingly, the highest volume of outpatients drawn per hour was eight (15 percent). Only 35 percent of those responding drew ten or more outpatients per hour at their busiest.

For those drawing a combination of inpatients and outpatients, the greatest number of respondents drew ten per hour (25 percent). Twenty percent drew twelve patients per hour while seventeen percent drew eight when they were at their busiest. Six percent drew more than fifteen patients.

Fifty-three percent of those participating in the survey said they did not have any quota, formal or informal, where they worked. Thirty-eight percent said there was no official quota, but there is an unofficial number we're expected to be able to draw. Eight percent said there was a firmly established number of draws they were expected to perform per hour. When asked what that quota was, answers ranged from 12 per hour (inpatients and outpatients combined) to 30 inpatients per eight-hour shift. Most responded with a quota of six to seven patients per hour.

Of those who said there was no formal quota but felt there was an unofficial expectation, the range was enormous. Some felt they were expected to draw only four per hour while others felt their employer's unofficial quota was 30 patients per hour. Most fell between 6-12 per hour.

Speed compasSome comments:

  • 30 patients minimum per hour for morning rounds. That is including difficult draws, STAT draws, and calls to assist other phlebs with UTOs
  • During a 3.5 hour morning shift on the wards it would be usual to be rostered to cover 4/5 wards each requesting 10 - 20 draws.
  • 1 every 3 min
  • 10 per hour expectation from management however coworkers often expect more
  • I feel that 10 min per patient should cover all the necessary good outcomes and quality standards required of the job. We have other admin related jobs to comply with. Babies & children pose a different challenge requiring 2 staff members if needs be. Nobody gets a medal for trying to be a hero and single-handedly bleed challenging kids.
  • I work at a decentralized phlebotomy hospital, so we no longer have a quota. It use to be 10/hr.
  • Phlebotomy shouldn't be expected to draw a specific number of bloods per hour, as patient issues arise, i.e., anxiety, difficult draws, infection control, barrier nursing, etc;
  • On average 12 per hour depending on the difficulty
  • Closer to 7 minutes per patient rather than a specific # of patients
  • We must be fast and not have anyone wait more than 5 min.
  • It's the quality of the draw, not the speed.
  • We are a mobile company. Depending on distance we can draw 3 to 5 patients an hour
  • For outpatient clinic there is no set quota because patients come first
  • When doing morning rounds, it is expected that we complete 30 patients at least an hour.

This month we're asking Phlebotomy Today-STAT! readers and visitors to our web site what policies where you work are most frequently violated and how consistently your manager enforces facility policies. Take the survey.


The Empowered Healthcare Manager

EmpoweredManagerWelcomeScreenShot_500wEvery month we run an excerpt from our editor's popular blog, The Empowered Healthcare Manager.

Inspire What You Require

Katy grew up in a home where nobody ever recognized her goodness, just her shortcomings and mistakes. She spent her childhood looking at herself through a mirror that showed only the faults identified by those who formed her way of thinking.

Remarkably, in spite of the oppressive environment she grew up in, she developed skills that brought her joy and ultimately a job in healthcare that required them. Though she was a proficient phlebotomist, her suppressed self-image prevented her from seeing she had any potential to be more than flawed in the eyes of any authority. One day her supervisor approached her.

"I noticed how you went out of your way today to help an outpatient overcome her anxiety about getting her blood drawn. You're really good at that, and I just want you to know you're one of the best on our staff at showing compassion. It's one of your shining gifts."

Katy was stunned. Nobody had ever recognized a positive attribute about her before. Someone actually defined her in a positive light, identified an asset she didn't know she had. Having it recognized gave her a newfound identity. It felt so rare, so good, that Katy started seeing herself as her supervisor saw her. Her demonstrations of compassion and customer service excellence exploded and became her defining attribute. She blossomed as an employee and a person. With one random but deliberate observation, a supervisor turned Katy from an other-actualized person to a self-actualized asset to the world.

Many supervisors and managers expect compassion, punctuality, compliance with policy, team-thinking, civility---all that and more---to be baseline skills among their staff. When it's not demonstrated, they chide and discipline. Worse, they let it slide.

Empowered healthcare managers recognize sparks of what they require in individuals and inspire it to blossom by recognizing the tiniest fragments of light. 

You have Katys on your staff.  Recognize a tiny fragment today and watch it become a beacon.

Subscribe to The Empowered Healthcare Manager.

 


What Should We Do?: 20 mL syringes

IMG_0080Question:

We have an inpatient phlebotomist who routinely uses 20 mL syringes when she needs a lot of blood for the tests ordered. I would never teach someone to draw blood with a 20 mL syringe since we all have access to tube holders and butterfly devices. When I teach phlebotomists, I tell them to choose the appropriate venipuncture device based on the patients' vein status, age, depth, and so on. I want to wean her off such large syringes. There's a lot of disagreement among other managers on what the standards say. What should we be doing?

Our response: 

First off, you should be getting a copy of the standard. That would end your arguments faster and with more acceptance by all involved. Every lab should have a copy of CLSI's GP41 in their library. Every passage needs to be reflected in your standards and policies if you are to be operating within the standard of care. If a patient ever seeks legal representation for an injury or complications he/she thinks was the result of a blood draw, you can bet his/her attorney will get a copy and compare it with your written procedure. [Editor's note: we anticipate CLSI to release its long-awaited revision of GP41 in May or June.]

The current standard does not restrict the size of a syringe. It merely reminds users that syringes are not the safest way to draw blood, and should be avoided. That's because it is the one device that's in use when most accidental needlesticks are sustained. Sometimes the patient's vein requires a syringe if the veins are small and/or fragile, and it is anticipated they will collapse when using the evacuated tube method (needle/ or butterfly/tube holder combination). A syringe allows the user to control the negative pressure applied to the inside of the vein whereas when a tube holder assembly is in use, all the vacuum in the tube gets transferred to the interior of the vein, causing collapse in some cases. 

When the physician orders blood cultures on patients with small or fragile veins, attaching a needle or winged collection set to a syringe and applying gentle pulling pressure to the plunger may be the only way the sample can be obtained. We recommend allowing your phlebotomists to use syringes when, in their professional judgment, it would be the most successful choice of equipment.

 


 

Tip of the Month: The Facts About Climate Change

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