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March, 2015

Journal Roundup, part 2
The Empowered Healthcare Manager: Dwellers and Expanders
Product Spotlight: Order of Draw pens
Free Webinar: centrifugation
This month in Phlebotomy Today
Survey Says: Dirty keyboards
What Should We Do?: Labeling skirmish
Tip of the Month
: What kind of fly are you?

 

Journal Roundup, Part 2

  Marlboro manThis month we complete our annual roundup of studies and articles published in the last year pertaining to blood specimen collection. This month, we've corralled several new articles and studies on iatrogenic  anemia, issues with nursing draws, the effect of an educational exercise on phlebotomists, the effect of posture changes on test results, the WHO's new mandate, and a comparison of pain responses between Chinese and Italian pediatric patients during venipuncture.

Hospital-acquired Anemia More Common Than Thought

Out of 479 patients evaluated in a retrospective study, 65 percent experienced a drop in hemoglobin of at least 1 gm/dl, and 45 percent developed anemia. The authors recommend more aggressive strategies such as reducing blood draws and expanding the use of smaller volume tubes for other laboratory panels.

View the article

Nurses Surveyed on Blood-collection Issues

One-hundred-twenty-three nurses in Russia completed a questionnaire about the most frequent issues encountered when drawing blood samples. Broken collection tubes, patient-identification errors, hemolysis, difficult venous access and needlesticks were high on the list. Nearly 20 percent of those responding indicated they were never trained to draw blood samples.

View the abstract

Phlebotomists Surveyed on Phlebotomy Training Program

 Thirty phlebotomists from ten primary health care centers were interviewed after an educational intervention strategy about their impression with the training. The participants admitted the program increased their awareness of the importance of safety and patient identification. While the program resulted in overall improvements in clinical practice, not all changed their methods even though they know them to be incorrect. 

View the article

Posture Change Plays a Role in Blood Test Results

Nineteen patients were drawn for a wide variety of chemistry tests in supine, sitting and standing positions. Changes were significantly different between recumbent (supine) and sitting positions for hemoglobin, hematocrit, albumin and total proteins. [Editor's note: we are confused about the importance of results obtained from patients drawn while standing since patients should never be drawn in this manner. We consider the results obtained from a standing position in this study to be irrelevant to the practice of phlebotomy.]

View the abstract

WHO to Mandate Single-Use Syringes

The World Health Organization is urging all countries to transition to the use of syringes that cannot be reused. The organization is urging manufacturers to begin or expand production as soon as possible of "smart" syringes that meet the Organization's standards for performance, quality and safety so the mandate can be met by 2020.

View the WHO press release

Chinese Children Feel More Pain During Venipunctures Than Italian Children

Ninety-three Chinese children and 239 Italian youngsters subjected to venipunctures were assessed for pain and self-control. The Chinese children experience higher levels of pain, but showed more self-control when experiencing venipuncture.

View the article

 

  EmpoweredManager

The Empowered Healthcare Manager: Dwellers and Expanders 

Every month, Phlebotomy Today-STAT! reprints one of the prior month's posts to The Empowered Healthcare Manager blog, written by Dennis Ernst. 

We all have comfort zones. Some employees must remain within theirs to thrive in the workplace; others thrive only when they get to step out of theirs now and then.  You can't manage without both types on your team.

Those who thrive because their tasks remain within their comfort zone are your loyalists, your Dwellers. They will stay happy (and stay forever) as long as you don't force them out of their zone. Not everyone is happy advancing into new territory. Make Dwellers uncomfortable with new challenges and you make them temporary. Just don't. You need them. 

Others are bored when kept within their zone too long without a challenge. They are your Expanders. They will love their job as long as you help them expand the limits of their comfort zones. Not everyone is happy with a predictable routine. Deprive Expanders of new tasks or responsibilities and they will seek new employment that invites them beyond their perimeter. Don't deprive them. You need them, too.

Empowered Healthcare Managers know into which category every member of their staff falls, and don't force Dwellers to be Expanders or vice versa. 

   Subscribe to The Empowered Healthcare Manager.

 

Product Spotlight:  Order of Draw pens

OODPen_banner (2)Managers and trainers looking for an inexpensive but unique educational gift for their students and staff cankeep the recommended order of tube collection right at their fingertips. Just intime for National Medical Laboratory Professionals Week (April 19-25), the Order of Draw pen is comfortable and attractive with the order of draw illustrated in full color on the barrel for easy reference.

OOD_pen_800wMany studies have proven that when blood collection tubes are filled in the wrong order, test results can vary, sometimes wildly, from the patient's actual condition. Those who follow the prescribed order of draw collect specimens that are less likely to yield misleading test results that impact how the patient is diagnosed, medicated, and managed.

Reinforce the importance of the order of draw with phlebotomists, nursing personnel, medical assistants, the ED staff, and all those who draw blood specimens in your facility by putting this constant reminder in every pocket. The pens are available for immediate delivery in packs of 12 or 24.

For more information or to order.

 

 Free Centrifugation Webinar Set for April 9

Center for Phlebotomy Education director Dennis J. Ernst MT(ASCP) will deliver the second in a series of free webinars on tube handling and centrifugation on April 9, 2015. Part 2 of "Best Practices in Blood Collection" will take place April 9th at 1:00: p.m. EST. The event is jointly sponsored by Drucker Diagnostics and Greiner Bio-One.

During the April webinar Ernst will discuss fixed-angle versus swing-bucket (horizontal) centrifugation, g-force versus RPM, executing a validation study for alternative g-force centrifugation, and the nuances between serum and plasma samples. The event free and qualifies registrants to receive 1 P.A.C.E. continuing education credit.

Part 1 of the series in February drew over 1500 registrants.

Registration is open to anyone through Greiner Bio-One's web site. Register here.

 

This Month in Phlebotomy Today:
 
Here's what subscribers to Phlebotomy Today, the Center for Phlebotomy Education's flagship newsletter currently in its 15th year of publication, are reading about this month:

Feature Article
Rules and Exceptions

On the Front Lines
Orientation of heelstick devices

Sticks, Staph, and Stuff
Needlestick rates continue declining

The Empowered Manager
A Good Day

Mythbusters
Do clot-activator tubes clot faster?

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

 

Survey Says:  Contaminated Surfaces

  Lady listeningIn clinical laboratories, outpatient drawing areas, and nursing stations, electronics have among the most contaminated surfaces. Healthcare professionals can make contact with telephones, keyboards, touch-screens, and handheld devices hundreds of times each day. Often with contaminated hands and fingers. 

While electronics subjected to frequent hand contact should be designated as "contaminated" or "clean" (or the areas in which they reside) and regularly disinfected, Phlebotomy Today-STAT! wanted to know what's actually happening in the facilities in which our readers work.

We asked "does your facility designate certain phones, keyboards and touch monitors as "contaminated" requiring staff to wear gloves when using?" Fifty-nine percent of those responding answered "no" while 41 percent answered "yes." Of those where there is no designation, 20 percent felt there should be such a policy.

Of those working where such items are designated as contaminated, 29 percent admitted they either sometimes (25%) or always (4%) touch them without gloves. Fifty-three percent said they sometimes (37%) or always (16%) see others touching them without gloves.

Comments include:

  • We have 'clean' and 'dirty' areas to regulate PPE. Anything in a 'dirty' area is considered contaminated.
  • Most devices within the triage area require lab personnel to wear gloves.
  • No one checks; nothing gets logged.

 When asked about their facility's policy on decontaminating phones, keyboards, and touchscreen monitors, 21 percent indicated there is no policy in their facility. Of those who have a policy, 42 percent said that policy is to disinfect during every shift. Twenty-nine percent are supposed to disinfect every day, while eight percent should every week. Unfortunately, half of those with a policy say it's either never enforced or only randomly.

In this month's survey, we want to know about your pet peeve. Is it patients with morning breath? Other healthcare professionals who think your name is "lab?" Physicians who ask you to abandon facility policy? Tell us what grinds you most about patients and coworkers. Then tell us what you like most.

Take the survey

 

What Should We Do?: Labeling Skirmish

Right way wrong way sign  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: I have a real problem here. Our nursing staff is giving the lab pushback on their demand that tubes not be sent to the lab without their labels attached, They claim as long as the labels are in the same bag as the tubes, there's no reason why the lab staff can't label them. The nurse manager and lab manager are at loggerheads. What should we do?

 Our response: Someone needs to step up and deal with this decisively before interdepartmental warfare breaks out. We suggest a summit between nursing and laboratory management including hospital administrators and medical directors so all parties can plead their case. On the one hand, the laboratory staff has to understand the unrelenting pressure the nursing staff is under every day, and how a simple act of labeling a tube shouldn't be an issue.

On the other hand, the nursing staff needs to realize they are violating the standards and a Joint Commission requirement by not labeling tubes in the presence of the patient. They need to understand labeling the tube is part of the procedure, and if you can't complete the procedure, you shouldn't start it. The nursing staff also has to realize asking the laboratory personnel to label a sample they did not draw is no different than asking the nurse to administer a syringe of medication she didn't prepare. Both can have catastrophic results.

This never should have gone this far. There must be more at the core of this dispute than an unwillingness to label samples. Since patient death is one of the risks of sample misidentification, this disagreement is likely a symptom of some deeper, yet unresolved, issue. Time spent excavating the seeds of this resistance has to be invested before a patient becomes the victim. There may be a history between the two managers or a festering dispute that's getting in the way. Address the underlying issues and this one should evaporate on its own. If the two parties can't/don't vent their frustrations, including those deep and unrelated, their superiors or surrogates need to step in and resolve this where they are incapable.

Ultimately, the laboratory is responsible for the quality of the samples it tests, and should have the authority and administrative support to enforce its policies for collecting blood samples even when those individuals are under the authority of another department. Without coming to a mutual understanding that the samples must be labeled in the presence of the patient, the only alternative you have is to discontinue phlebotomy as a procedure nurses perform at your facility.

 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:

EmpoweredPair_250wAnswers just ahead signGot a challenging phlebotomy situation or work-related question?

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

 

Tip of the Month

Each month on our home page, we post a "Tip of the Month" from our rich library of archived Tips.

This month's Tip: "What Kind of Fly Are You?"

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