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Joint Commission Considers Relaxing Patient ID Requirements

Joint Commission is considering removing a crucial requirement prior to identifying patients when collecting specimens, including blood samples for crossmatching donor blood.
      The agency’s proposed 2010 National Patient Safety Goals (NPSGs) for laboratories recommends deleting the step requiring specimen collection personnel to use active patient involvement prior to collecting laboratory samples. Also at risk is the requirement to label laboratory specimens at the patient’s side, according to a Joint Commission spokesperson.

The requirement to actively engage patients by asking them to state their name prior to sample collection became a Joint Commission requirement in the 2009 NPSGs:

“Prior to any specimen collection, medication administration, transfusion, or treatment, the laboratory actively involves the patient, and as needed, the family in the identification and matching process. When active patient involvement is not possible or the patient’s reliability is in question, the laboratory will designate the caregiver responsible for identity verification.”

As reported in the March issue of Phlebotomy Today, specimen collection was exempt from the active-patient-involvement requirement in prior years’ NPSGs. Also absent prior to the 2009 NPSGs was the requirement to label the specimen in the presence of the patient. Both steps have been required in the Clinical and Laboratory Standards (CLSI) specimen collection standards, however, CLSI standards are voluntary.  Hospitals that don't comply with Joint Commission standards, however, risk losing their accreditation.
On May 12, Joint Commission opened a six-week comment period for individuals and institutions to state their opinions on the proposed revision.

The Center for Phlebotomy Education, Inc. submitted a four-page letter urging the agency not to weaken its requirements for labeling in the presence of the patient and requiring patients to be asked to state their name prior to blood collection procedures. The letter cites 14 studies, articles and publications that underscore the importance of maintaining the patient and specimen identification steps currently under reconsideration. The Center has posted its letter to the Joint Commission on its website.

Phlebotomy Today readers are urged to submit their comments on the proposed revisions to the Joint Commission by mail, email or through their web site here. Comments must be received by June 16.

FAQ Book a Finalist in Design Competition

Blood Specimen Collection FAQs, the latest book from the Center for Phlebotomy Education, has been named a finalist in the Ben Franklin Awards sponsored by the Independent Book Publishers Association (IBPA). The book, published last fall, was designed by Joseph Sims, Jr., the Center’s graphic designer and web developer. The award category is for outstanding interior design in a 1- or 2-color book.

This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 10^th year of publication, are reading about this month:

• Feature Article: Survey Sheds New Light on Blood Splash Exposures
  
• Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in May including these stories:
• Phlebotomist Must Remove Cross or be Fired
• Union Phlebotomists Negotiating Wages, Benefits with Red Cross
• Hospital Boasts Zero Blood Culture Contamination Rate
• Reused Needles Kill Over 300,000/year in India
• Study Measures Turnaround Times for Routine Chemistries
• New Figures Just in on Phlebotomy Salaries
• According to the Standards: Icing blood gas specimens
• Tip of the Month: Brother, Can You Spare Some Time?
• CEU questions (institutional version only).

Buy this issue for only $9.95.

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.

Featured FAQ: Trace element tubes in the order of draw

Q: Our laboratory has been discussing the order of draw, and there is one tube that we are uncertain about: the trace element tube (royal blue stopper). It contains sodium heparin and we use it for copper and zinc testing. Is this collected in the same position as any other heparin tube (i.e., after the serum tube but before the EDTA), or is it collected first because the glass or plastic in other tubes may contain trace elements that could carry over and contaminate it?

A: Trace element tubes have to be collected in a manner that prevents contaminants in the stoppers themselves from accumulating in the needle that pierces each one in a multiple-tube collection, and then carrying it over into the specimen to be tested.

• If a needle/tube holder assembly is used for the collection, it’s best to perform a separate venipuncture for the trace element tube. Putting the trace element tube first in the order of draw is not an acceptable alternative, since its additive could carry over into the next tube.
• If you are drawing into a syringe, fill the other tubes in the proper order of draw, then change the safety transfer device so a fresh one is used to puncture the trace element stopper.
• If you are drawing blood cultures, avoid drawing the trace element tube first, as it could transfer bacteria from the nonsterile trace element stopper into the blood culture bottles.
• If you are drawing a citrate tube (for coags) after the trace element tube, some of the sodium heparin could carry over and affect the coagulation studies. When drawing with a tube holder, a separate venipuncture would be required.

When a trace element is ordered, save the patient a stick and yourself the time by drawing with a syringe and changing the safety transfer device before filling the trace element tube.

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.

Survey Says

Our latest survey asked Phlebotomy Today STAT! readers: “If you could change one thing to make your job easier, what would it be?”

Among all respondents, the single most commonly desired factor that would make their job easier—including more pay—was respect from other departments and patients. Teamwork was a close second with over 30 other suggestions. Comments include (as typed):

• I wish I didn't have to make cbc slides.
• …need creative scheduling, where we can get an off day or 1/2 day per week
• … more time to train so that all of our jobs are easier.
• It would be nice to have other professionals view our reports as being accurate! I'm tired of hearing the words "it may just be ANOTHER LAB ERROR!"
• I DON'T WANT TO SOUND LIKE A BROKEN RECORD BUT BETTER PAY FOR OUR POSITIONS WOULD HELP OUT. I KNOW MONEY DOES NOT MAKE ONE HAPPIER BUT IT HELPS TO RELEIVE STRAIN IN THESE ECONOMIC TIMES.
• Have everyone in the medical office learn that taking shortcuts in the Lab (proper drawing techniques, pouring off blood samples if they must sit overnight, refrigerating correct tests) DOES in fact alter results when done improperly!
• I WOULD HAVE EVERYTHING AT MY FINGER TIPS.
• I think it would make my job easier if there was more teamwork.

Among phlebotomy supervisors and lab managers, tops on the list include physicians who coordinate their orders, a motivated staff, and more space in outpatient drawing areas. Comments include:

• More physical space. Our phlebotomists work in a very cramped area which potentially is not safe for them or the patients
• Backing and support by our national registries. RN's are backed by their State Nursing Societies. It is a shame that we are not recognized by patients and Administration.
• We need set collection times. As it is, any doctor can order any test at any time and expect it to be drawn instantly. This results in patients being stuck multiple times in a day. It's just not an efficient use of our phlebotomy resources and results in patient dissatisfaction.
• Employees would have more dedication. They have many places to advance here but most don't take the chance at getting to the next level….

Of those who identified themselves as phlebotomists (68%) the most common answer was also respect from patients and other healthcare professionals. Nearly as common was teamwork among coworkers. Surprisingly, phlebotomists wished for better chairs to reduce their back strain while drawing specimens. More money and more training rounded out the list of requests from multiple respondents. Comments (as originally typed) include:

• I would allow piped in music to all the rooms in the PCS were i work.
• I think the work would be better if all in the lab worked as a team.
• To have the voice of the phlebotomists ACTUALLY be heard by upper management
• Mandatory handwriting classes for Doctors and health care workers and no abreviations for tests on requisitions.
• Anything would help to better suit Phlebotomist from constantly bending over. My lab chair is low so I am always bending over. I am young and it bothers my back, so I can only imagine what it will do years from now. Other than that I love my job.
• Adequate staphing
• One of the regulations should be that only CERTIFIED PHLEBOTOMIST draw blood.
• The one thing that I would change in my job would be the amount of respect that is given to my position.
• Get rid of people who are lazy and just DO NOT want to work or care about the patients!!
• double my salary
• For techs to realize that if we (phlebotomist) do not collect they do not have work to do. We are always treated as inferior to them because they have a degree. Just want to be respected for the job that we do in the Lab enviorment.
• more respect!
• I would change not being pressured by superv. to NOT use butterfly needles,

This month’s survey question: If given a choice, would you seek inpatient services at your employing institution for you or a loved one as opposed to elsewhere?

Click here to participate in the survey.

Featured Product: Venipuncture Training Aid

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 download articles from our To the Point® library. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study

Apparently, surfing the Internet is a common activity among our readers and their staff. Multiple readers expressed familiarity with their coworkers and subordinates being preoccupied with online activities unrelated to their work.

Eighty-three percent of those who responded said they would ultimately tell their supervisor if they found a coworker surfing the Internet. Sixty-seven percent said they’d first tell the coworker themselves as fair warning. Sixteen percent said they wouldn’t say anything, but would post the policy against online activity in a prominent place. Another sixteen percent said they would not say anything, confident that their judgment day would come soon enough.
Judy of Pennsylvania, our winner this month, put it this way:

“I have been in this situation with the Internet before. First I spoke with my co-workers…of course they didn't think they were spending that much time. As time went by I got tired of being the one going on the floors all the time. I gave them a second warning and by the third time I went directly to the supervisor. The supervisor [had] the IT team make everyone unable to use the Internet at all…. I told them that this was the only way to get everyone working. Well it worked!”

For her response, Judy will receive a free download from the Center for Phlebotomy Education’s To The Point® library of articles. Thanks, Judy, and all who responded.