Professionalism: Telephone Etiquette
When you answer the phone, can callers hear you smiling? They should. They should also hear you give your name, your department or office, and a friendly, sincere request to help them. Mastering good telephone etiquette makes the difference between projecting a positive or negative impression of the quality of your work and workplace, and makes a statement about your professionalism. Identifying yourself and your department is basic phone etiquette. It's polite, it's professional and it tells the caller they dialed the right number. Even telemarketers, who can be some of the most annoying creatures on earth, identify themselves when they call. Even if it's a department you call frequently, don't assume the person on the other end knows the sound of your voice. How you answer the phone is just one of many good habits when using the telephone to communicate with other healthcare professionals, co-workers, and patients or their families. Here are some others:
One ringy-dingy, two ringy-dingy.... When the phone rings, answering it is inevitable. But how long do callers have to wait for you to be available? If you answer the phone beyond three rings, callers start to wonder if 1) you're open; 2) you're too busy to help them; 3) they're being a burden to you; 4) how much time you'll have for them once you do answer; and 5) what's more important to you than answering the phone in a timely manner. Projecting the impression that their phone call is an intrusion starts the conversation out on the wrong note. When the phone rings, consider it an opportunity to serve instead of a problem to dread.
Signing off. Do you end every call with "Thank You. Goodbye?" It's a good idea. If this isn't your habit, think about this: abruptly ending a conversation without signing off can be perceived as being cold, and tends to leave the other party wondering if he/she said something wrong. Instead, end all calls with warm and polite closures. It leaves the caller with a good impression of you and your department.
Place calls properly. When you place a call to another department, do you identify yourself when the other person answers? Too often, long-time employees tend to think their voice is recognizable to everyone who answers phones throughout their facility. They may be right, but sooner or later, a new employee may be on the other end and have to ask the embarrassing question, "who's calling?" When you hear those words, you've been busted for being presumptuous. Bottom line: don't assume the person on the other end knows the sound of your voice, even if it's a department you call frequently.
"Hello, can you hold?" If you're ever tempted to say these words when the phone's ringing, don't answer it in the first place. Callers who are put off like this feel like they are nothing more than a noisy annoyance you couldn't wait to silence.
Forcing callers to eavesdrop. Have you ever placed a call, and when the other party picked up the phone they were still engaged in a conversation with someone else? You feel like you've been forced to eavesdrop on a conversation in which you have no interest. It's an awkward feeling, and entitles you to hang up. Callers don’t want to hear the end of a conversation you’re having with someone across the room. Avoid the temptation to answer the phone before you’re ready to talk to the caller. Likewise, don’t carry on a conversation while you are placing a call, either. Few things are as annoying to the receiving party as finding that you’ve engaged in another conversation while you were waiting for them to answer the phone. It works both ways.
On hold for eternity. What's the limit you will allow callers to be on hold? If it's more than one minute, they might start wondering if they've been forgotten. Some requests take longer to look up than you initially anticipate. If it takes a while to find the information you need to answer their question, go back and ask if you can return the call when you have the information. Assuming they have nothing better to do than wait and wonder is presumptuous.
Proper telephone etiquette instills confidence in the quality of service and work that person provides and the department for which that individual works. It also shows respect for the caller's time and patience. Follow these suggestions and callers will get the impression that you are a polished professional, and that your office, department, or facility does quality work.
[Editor's note: for a more in-depth article on professionalism, visit the Center for Phlebotomy Education's download library and look for "When Professionals Aren't: Behaviors that Create Bad Impressions." ]
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 8th year of publication, are reading about this month:
For subscription rates and to subscribe to Phlebotomy Today, visit www.phlebotomy.com/PhlebotomyToday.html. The current month’s issue will be emailed to you immediately upon subscribing.
Editor Addresses Ireland's Phlebotomists
Phlebotomy Today-STAT! editor Dennis J. Ernst MT(ASCP) will address Ireland's national phlebotomy membership organization this month in Dublin. The Phlebotomists Association of Ireland (PAI) invited Ernst to address the assembly of its members at its annual general meeting taking place March 1. Ernst will give two presentations, "Preventing Preanalytical Errors" and "Preventing Patient Injury."
Prior to the annual general meeting, Ernst has been invited to attend the graduation ceremony of the National Ambulance Service College at St. Mary's Hospital in Dublin, where 100 phlebotomists will graduate from their phlebotomy program. On behalf of the program's administrators, Ernst will present framed posters of the Center for Phlebotomy Education's Blood Collections and Precautions wall atlas to six hospitals in recognition of their participation in the Certificate in Phlebotomy Program.
Featured FAQ: Syringe Safety
Question: A phlebotomist drew blood from a patient in a syringe, and then stuck the syringe needle into the tube stopper and let the vacuum pull the blood into the tube. Several other phlebotomists said this was not an acceptable practice. They say the sample would be hemolyzed and/or clot in the syringe. Are they right?
Response: Your phlebotomists are right, but there are more reasons than just to avoid hemolysis and clotting. First of all, clotting in the barrel of the syringe is only an issue if the draw takes a long time and the blood sits in the syringe for a prolonged period. Secondly, it’s best that blood not impact the bottom of the tube full force, but rather flow down the side of the tube to prevent hemolysis. Both of these are secondary to a much larger issue. Piercing the stopper of the tube with the same needle that was used to draw the blood is not safe and violates OSHA regulations. The risk of the needle accidentally piercing the finger is too great. The proper procedure for filling tubes from a syringe is to activate the safety needle after the needle is removed from the vein, remove it from the syringe, discard it immediately, apply a safety transfer device, and fill the tubes. A safety transfer device is like a tube holder that threads onto the syringe, and has an interior needle to fill the tubes, just like with a tube-holder draw. They’re widely available.
Each month, PT--STAT! will publish one of the hundreds of phlebotomy FAQs in the growing database of questions and answers available in Phlebotomy Central, the members-only section of the Center for Phlebotomy Education's web site. For information on joining Phlebotomy Central, visit www.phlebotomy.com/PhlebotomyCentral.html.
Specimen Collection Safety: Safety Needles
Earlier this year, Phlebotomy Today---STAT! informed readers of a study that found safety needles reduced accidental needlesticks by 93%. Since it has been widely reported that over 20 diseases can be transmitted by blood exposure, healthcare professionals in facilities who are late in implementing safety needles should work to make them accessible, if not exclusively available. Studies also show the average cost to treat an accidental needlestick is between $2,500 and $5,000 just on immediate wound care, lost productivity, and follow-up care and counseling. Should the individual develop hepatitis and require a liver transplant, the cost of the incident skyrockets to $150,000. If HIV is transmitted during the needlestick, the cost can exceed $500,000.
Every manufacturer of blood collection devices has products with safety features. Implementing them requires some staff retraining, but most specimen collection personnel find the transition easy, and one that brings peace of mind. Most facilities transitioned to safety needles in response to the OSHA mandate in 2001. However, there may be hold-outs on staff in some facilities who continue to resist the change. Since OSHA has cited facilities who use non-safety venipuncture needles with fines exceeding $70,000, correcting resistors may require disciplinary measures.
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 "Accurate Results Begin With Me!® t-shirt. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.
All of those who responded to last month's WWYD case study agreed that combining the contents of two tubes together was indeed a "pour excuse" for not redrawing the patient. This proves once again that PT-STAT! readers are very astute and passionately dedicated to specimen collection excellence. As proof, 85% of respondents indicated that they would not label the specimen. Most of them echoed the sentiments of Deborah B. of Florida:
"I would not label this tube for testing. I would nicely inquire if they had ever been taught that what they were doing was unacceptable.... I would then refer to my classroom training and explain to them that each blue top tube is manufactured with anticoagulant that is prefilled with the specified amount of anticoagulant.... Meaning that the samples that they just mixed now has too much anticoagulant to the ratio of blood, and that the sample should not be used for testing. I would suggest to the lead phlebotomist that I would like to recollect the sample. I would do this, however, as humbly as possible."
Of the 15% who didn't indicate whether they would label the specimen or not, most indicated that the practice of mixing the contents of two tubes into one was wrong. One tactful respondent suggested labeling the tube but not initialing it, then reporting the incident to a manager and not submitting the specimen for testing. One respondent suggested the specimen should be labeled, tested, and the results reported with a disclaimer.
Almost all who would not label the specimen would explain to the lead phlebotomist the reason why the specimen is not acceptable. Fifty-three percent of those would also report the actions of the lead phlebotomist to a superior. But two respondents drew the scenario out a little farther than we anticipated, indicating that if the superior didn't support them on the issue, they'd find work elsewhere. We admire such courage and dedication. Here's the response from one of them, who prefers to remain anonymous:
"I would ask the patient to please wait and ask the lead phlebotomist if I could speak with her in private. I would respectfully state to her that I would not label the specimen, as the specimen is unacceptable. I would clearly identify to her that mixing of two specimens is not an acceptable practice, and will comprise the testing of the sample. In addition, doing this will affect the quality of care given to this patient, (which) could be life threaten. If the lead phlebotomist is aggravated with me and continues to insist she is correct in doing this, I would simply ask for the supervisor. I am confident with my education and training that this is not an acceptable practice, and would expect the supervisor to agree with me. If for some reason the supervisor does not agree with me, I would insist that my initials are not placed on the specimen and resign. I would not want to work for an organization that will comprise patient care or be forced to participate in this type of care."
Edna Q. of California will be receiving this month's t-shirt for her winning response:
"I would state that, as I had difficulty attempting this draw, I do not feel that it is a quality specimen. I think another attempt to obtain a quality specimen without possible tissue contamination (i.e., difficult draw) is in order. I would not label the tube under any circumstances as I am attesting to the quality of the specimen with my signature... A discussion with the lab manager is in order with evidence of incorrect procedure in hand. Do I think this might end my position at this facility? You bet. But I would not want to work where this is acceptable."
Every additive tube has a calculated quantity of additive that properly anticoagulates and prepares the specimen for testing when the tube is properly filled. Submitting underfilled tubes or, as is the case this month, tubes with twice the concentration of additives (half-filled tubes combined) tinkers with this chemistry. As a result, such specimens are "excessively anticoagulated." When the anticoagulant is in excess, its higher concentration can be detrimental to the analytes being tested. In the case of EDTA tubes, an excessive concentration of additive leads to red-cell shrinkage, which results in falsely lower hematocrit and MCV values. In the case of the sodium citrate tube discussed in this month's case, there is also a dilution factor that further threatens test results. That's because sodium citrate is a liquid anticoagulant as opposed to EDTA or heparin, which is typically dry.
When tested, protimes and aPTTs are reported out in seconds or minutes, according to how long the specimen took to clot within the testing instrument. If sodium citrate is diluted, as in the case of two partially filled blue-top tubes combined, the concentration of clotting factors will be falsely lower, and the specimen will take longer to clot. The result: falsely lengthened coagulation results with potentially catastrophic results. For example, if the patient is properly medicated but the protime or aPTT is falsely lengthened, the physician is likely to conclude the dosage of blood thinner needs to be decreased. Decreasing the dosage in patients who are properly medicated can lead to clot formation, thrombophlebitis, stroke, and other complications.
Tell us what you'd do in this case. Submit your response by the 20 th of the month and send it to this address and this address only: WWYD@phlebotomy.com. Submissions sent to any other address will not be considered. Keep your suggested solutions less than 100 words. Although you don’t have to be an English scholar to be considered for inclusion, submission with proper grammar and punctuation will be given priority. If you’re not sure of the appropriate solution, check your facility’s procedure manual or ask your manager. Who knows, you might be presented with the very same dilemma tomorrow.
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