New Insights on Pediatric Pain Reduction
A certified child life specialist at the University of Michigan Health System's C.S. Mott Children's Hospital is shedding new light on an age-old problem: pediatric pain during blood draws. In an interview recently published by CAP Today, Julie Piazza, studied education, training, experience, and stress levels among phlebotomists who draw blood from pediatric patients. What she found was that the education phlebotomists receive on child development differs significantly from what the literature recommends for addressing children's fears and anxieties.
Piazza used focus groups, surveys, and observation to assess the best use of distraction and other comfort techniques during pediatric phlebotomy. She found phlebotomists are uneasy with the extent to which their demanding workload impacts their ability to deliver a positive pediatric experience. They also expressed a lack of empathy from those who are more concerned with their productivity.
It came as no surprise to Piazza that 67 percent of phlebotomists surveyed expressed some level of stress during pediatric blood draws, including the perceived anxiety of the patient and the parent. Nearly all phlebotomists reported using comfort techniques that did not require additional supplies or equipment, including verbal reassurance and positioning pediatrics on the parent's lap. Distraction techniques were used by 60 percent of those involved in the study while 28 percent used topical anesthetics, sucrose, and the Buzzy device. Twenty-six percent called upon the support and assistance of a child life specialist.
Editor's Note: HTL-Strefa, a leading manufacturer in medical sharps, has produced an illustrated poster on best practices for finger capillary blood sampling. The HTL Lancing Technique poster is compiled from myriad resources including text books, public health organizations, clinician interviews, and consultations with the Center for Phlebotomy Education. For more information on how to obtain this process/poster, please contact Michael Billedo at firstname.lastname@example.org.
Center's Director to Log 500th Conference Presentation
Sometime this year, Dennis J. Ernst MT(ASCP), NCPT(NCCT), will deliver his 500th conference presentation.
Ernst's first conference presentation took place at the annual meeting of the Indiana chapter of the American Society for Clinical Laboratory Science in Angola, Indiana. Since then, he's given public and private presentations on a wide variety of phlebotomy and management topics in 39 states and 11 countries.
"I remember them all as if it were yesterday," says Ernst, who directs the Center for Phlebotomy Education and edits Phlebotomy Today. "They've all been unique in some way, and many were the backdrop of experiences I'll never forget."
As an example, Ernst cites the time he was in a hotel lounge in Salt Lake City for the Clinical Laboratory Educator's Conference when someone across the room pointed at him and shouted "Look, it's him! It's the man in the movie!" referring to his appearance in the Center's Basic Venipuncture video.
"Then there's the time I left my wallet in a taxi cab on my way into the CDC offices in Atlanta to address the Clinical Laboratory Improvement Act Advisory Committee on credentialing phlebotomists," says Ernst. "Suddenly, my biggest concern wasn't delivering an effective presentation or even how I was going to get into the CDC without identification, but 'how am I going to get home?" His wallet was never recovered.
This year, Ernst will be delivering 22 presentations in 9 cities across North America on a wide variety of preanalytic topics. Exactly which lecture will be #500, Ernst isn't sure. "Over the years I've kept pretty good records, but I know my count is off by a dozen or so. But this is definitely the year."
When asked about his most unusual venue, Ernst recalled the time he lectured at the Millstone Nuclear Power plant in Connecticut. "There was so much energy in the room...it was electric. And I got such glowing reviews."
Product Spotlight: 22 months of in-house CE exercises
Do you struggle every month to find good material to put in front of your students or specimen collection staff? Those days are over.
We've just packaged 22 months of our popular Abbreviated Teaching Modules (ATMs) in one download, and priced it well under what you've budgeted for continuing education this year.
Our ATMs are short 1-2-page articles on a wide variety of phlebotomy topics your collection staff should know. Simply distribute one exercise to your staff each month, collect their answers to the accompanying quiz, grade it, file it, and get on with your day.
The 22-module set is downloaded immediately after your online purchase as zipped PDFs with answer keys for each exercise. That's almost two years of monthly in-house CE exercises for you to administer to your staff at a fraction of what you've been paying from other sources. Titles include:
- The Order of Draw
- Hematoma Prevention
- Tourniquet Time
- Needlestick Prevention
- Patient Identification
- Acceptable Sites for Venipuncture
- Blood Cultures Done Right
- Hemoconcentration: What is it?
- The Aggressive Patient
- Infants and Toddlers in the Healthcare Environment
- Communicating With Elderly Patients
- Give Your Patients Their Personal Space
- Tips for Successful Capillary Collection
- Non-verbal Communication: What Message Are You Projecting?
- Phlebotomist's Guide to PICC Lines, Central Catheters, and Imbedded Ports
- Therapeutic Drug Monitoring
- Customer Service Excellence
- Bloodborne Pathogens Review
- Are You a Pathogen Parade?
- Drawing From Young Children
Stop scouring the Internet for mediocre resources just to meet your monthly staff requirement. All ATMs are highly researched and reflect industry standards and guidelines.
Sample ATM and more information.
What Should We Do?: Tearing off the fingertip
Dear Center for Phlebotomy Education:
I know my staff is tearing the tips of their glove's finger off to palpate for veins. The problem is, I can't catch them. When I'm in the area, they're on their best behavior, but I hear about it all the time and often find gloves without fingertips in the trash. I know there's a fine for such reckless behavior in the U.S., but we're not subject to OSHA in my country. What should I do?
You are right to be concerned. Even where there is no threat of fines and citations, the consequences can be devastating to the healthcare professional. Often, those who engage in this practice argue that a glove won't prevent an accidental needlestick. They are correct, but that's not the purpose of a glove in the first place. You should bring to their attention the results of a study that showed when a person sustains an accidental needlestick while wearing a glove, the glove's material wipes off up to 86 percent of the potentially infectious blood on the needle before it enters the flesh. Fine or no fine, who wouldn't want that kind of protection?
Clearly, your staff is not going to violate your policy while you are watching. The fact that they're insubordinate when you're not watching is concerning. It's hard telling what other policies they're abandoning when you're not in the area. When you find evidence, you should put the entire staff on notice that you take the violation seriously, and lay out the consequences. Use it as an opportunity to have an open discussion on why they find it necessary. Those who do comply will likely have pointers on how to locate a vein after gloves have been donned for those who don't. Placing an alcohol pad on the patient's skin with a corner pointing to where the vein was initially palpated is just one technique.
In the U.S., the fine for something as blatant and willful as ripping the tip off of a gloved finger is $129,336 per occurrence plus a citation. All it takes is one concerned employee who sees a safety violation go undisciplined to file a complaint that brings an unannounced inspection. At that point, it's too late to check the trash.
Got 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.)
From the Editor's Desk
Si quaeris peninsulam amoenam circumspice. "If you seek a pleasant peninsula, look about you." Such is the motto of the state of Michigan.
I was born in the pleasant peninsula, and spent 17 years there as a student. When I was finally free from scholarly pursuits I entered the workforce as a medical technologist. Three years later, at the age of 25, I looked at the peninsula about me and promptly moved to Indiana.
For the record, I have nothing against peninsulas or the Wolverine State (in which only one wolverine has ever been spotted in the last 200+ years). It was just a case of curable wanderlust. I simply wanted to live in a different, but not too distant, state. I moved and was cured. I've been a Hoosier ever since.
In October of 2016, wanderlust struck again. Not me, this time, but while sitting on our deck one evening, my bride made a two word announcement that would change my life forever: "We're moving." There were lots of reasons, both mysterious and spiritual, but the sultry summers and stagnant air of the Ohio Valley are the easiest to explain. Lovey craved a cooler climate.
Never mind that my roots have been in Hoosier soil for 36 years, and that I had planned on living out my days in the home to which we had just finished ten years of renovations. Happy wife, happy life, they say. Besides, I have the luxury of being able to work from anywhere. Just give me a desk, a PC, and a high-speed Internet connection and I'm good to go. Keeping our Indiana office open and staffed is a no-brainer. It runs like a fine Swiss watch whether I'm there or not. Regular visits would be necessary, but as Director, I can do what I do no matter where I call home. Put a lake out my window and that's even better.
Over the next 13 months we conducted an exhaustive search for our next forever home in the four states that were calling to us the loudest: Maine, Minnesota, Wisconsin, and the state in which only one wolverine has been seen in the last 200+ years. We registered on the usual dotcoms---Trulia, Zillow, Realtor, LandAndFarm and multiple state-specific realtor sites---took three house-hunting road trips, logged thousands of miles, and toured 29 homes---some in less than ten minutes.
On January 3, 2018, we closed on our new northern home and took immediate possession. We wanted a cooler climate, and that's exactly what we got. When the Mayflower truck arrived the next day with all our possessions, it was 5oF with a wind chill of -15 and a foot of snow on the ground. The crew of three from Louisville, Kentucky, some 600 miles in latitude to the south, were literally and figuratively out of their element. So were we. To make matters worse (for them, not us), their truck couldn't get up the snow-covered driveway, so they had to walk all of our worldly possessions from the road to the house, all 13,000 pounds of it. It took eight hours, five breaks, and two servings of Lovey's world-class chili to finish the job. They're not likely to forget the haul any time soon, but they never complained. (For those of my readers with wanderlust, we highly recommend Mayflower.)
We've been in our new state two full months now. We didn't settle in Minnesota, the "Land of 10,000 Lakes." It didn't have one with a home in our price range that appealed to us. We didn't select a home in Wisconsin, either. With a state motto like "Forward," how does one make that their next stop? Nor did we settle in Maine, the Pine Tree State, although we nearly did. The state motto "dirigo,"(Latin for "I direct") just doesn't have the charm of the motto where we now call home.
Si quaeris peninsulam amoenam circumspice. "If you seek a pleasant peninsula, look about you." After 36 years, I've returned to the land of my birth. The climate in the northern part of Michigan's lower peninsula is nothing like where I grew up and more like another planet than what I'm used to. So far, we've seen 15 nights of sub-zero temps, 9 days of single-digit highs, five snowfalls totaling 19 inches, a flock of pine siskins, and not one wolverine. I suspect all of that is our new normal for winter. When the summer comes, I'm sure we'll look around this peninsula and find it to be quite pleasant this time. After 36 years, a person looks at things differently.
Especially now that there's a lake out my window.
Dennis J. Ernst MT(ASCP), NCPT(NCCT)
Date Set for Global Preanalytic Summit
An entirely new agenda will be showcased at the 2018 Global Summit on Best Practices in Preanalytics, taking place October 15-18 in Charlotte, North Carolina. According to Greiner Bio-One North America, which produces the annual event, the Summit continues to build on the successes from prior years. "This year's event will be bigger and better than ever," says Greiner's conference organizer Mackenzie Farone-Waite. "We will be providing all new educational topics as we bring back some of your favorite speakers and include new experts in the field of preanalytics.
Some of the topics to be discussed by a panel of highly respected authorities include:
- The Cost of Errors: Patient Outcomes, Cost, and Safety
- Top 10 Reasons Hemolysis Happens
- Reducing Phlebotomy Draw Volumes
- Error Proofing Your Lab
- Training Preceptors to Train Your Staff
- Stop Bullying and Start Team-building
Last year's event offered attendees the opportunity to earn over 10 P.A.C.E. credit hours while listening to top experts in the fields of healthcare, change management, and preanalytics. For more information or to pre-register at a reduced rate, visit the Summit website or contact Greiner-Bio One North America for more information.
Empowered Healthcare Manager
Every month we run an excerpt from our editor's popular blog, The Empowered Healthcare Manager.
The Key to Motivating Your Staff...
...is realizing you can't. People motivate themselves. Big difference.
People choose to be motivated. Some choose not to. Regardless, the empowered healthcare manager leverages this realization by providing his/her staff with whatever it is the staff requires to motivate themselves. Carl needs respect, Caroline needs recognition, Carlos needs continuing education. Others may need a professional working environment, support, consistent policy enforcement, structure, or ownership.
Money is a temporary motivator at best. Nobody motivated by money alone stays in one place very long. It plays its role in getting applicants to take the position; the intangible motivators are why they stay.
Realizing people choose to motivate themselves can be a game-changer. But with it comes a trap of which the empowered manager is always vigilant: failing to provide what motivates and then blaming the staff for not choosing to be motivated.
Provide the intangibles and your staff will choose to perform according to your hopes, goals, expectations, and agenda with fierce loyalty. Fail to provide them and they will find an employer who will or, worse, stay where they are and poison the well.
Then there are those who choose to poison the well no matter what you provide. Unless you've walked a day in their shoes, you can't know why they choose not to be motivated, so tread lightly.
But still tread. The empowered manager doesn't tolerate a tainted well, but keeps it purified.
Subscribe to the Empowered Healthcare Manager.
Lab Week is Coming
Standards Update: A new unacceptable site
The newly revised venipuncture standard released by the Clinical and Laboratory Standards Institute in April, 2017 is the most comprehensive revision in the document's history. With over 140 new mandates, facilities have a lot of changes to implement. This series discusses one or more substantive changes each month.
Pop quiz: name the four sites previous versions of the CLSI venipuncture standard listed as unacceptable sites for performing a routine blood draw. If you answered the following, you're correct:
- front of the wrist (palm side)
- the same side as a mastectomy without physician's permission
- feet and ankles without physician's permission
- any artery
Now there's one more. When the industry's standard was revised and released in April of last year, the lateral wrist (thumb side) was added to the list. That's because the committee revising the document found numerous studies published since the 2010 revision that identify the site as prone to nerve injuries during vascular access procedures.
The vein in the lateral wrist that many are tempted to access is the accessory cephalic vein. Unfortunately, the superficial radial nerve passes through the same area, often nestled against the vein or traversing over it, putting it at risk of needle penetration. Because there is so much support in the peer-reviewed journals to avoid this site, the standard now includes the lateral wrist on its list of unacceptable sites.
Editor's note: Readers are urged to obtain their own copy of the standard as soon as possible and begin implementing all new provisions immediately. The document, Collection of Diagnostic Venous Blood Specimens (GP41-A7), is the standard to which all facilities will be held if a patient is injured during the procedure or suffers from the consequences of an improperly performed venipuncture. It can be obtained from CLSI or the Center for Phlebotomy Education, Inc.
Read an interview by CLP Magazine with Dennis J. Ernst MT(ASCP), NCPT(NCCT) about the revised standard.
Answers to February's CE quiz:
Tip of the Month: Every Patient is a Pedestrian
Click here for this month's featured Tip of the Month from our rich library of archived Tips.