Literature Review of Newly Published Studies Part II
This month’s feature is a continuation of the literature review we began last month providing our readers a summary of some interesting studies that have been published since last November.
Here at the Center for Phlebotomy Education, we make it our business to be a dependable source of accurate information on blood collection procedures. Not a day goes by when we don't hear of something newsworthy in the media or peer-reviewed journals. That's how we keep ourselves, our products, and our readers up-to-date in the world of phlebotomy. If it's new and pertinent, you'll find out about it here first.
False elevations of chemistry results due to pneumatic tube transport
Line draws in children
Barcode technology reduces patient ID errors
Physicians in need of phlebotomy training, reducing pediatric anxiety
All content reflects the standards and guidelines of the Clinical and Laboratory Standards Institute (CLSI), and are presented by a faculty of national and international speakers including Dennis J. Ernst MT(ASCP), the Center's Executive Director, and Lisa O. Ballance MT(ASCP), CLC(AMT), the Center's Director of Online Education. The Center has been providing educational materials and resources to healthcare professions since 1998.
Registrations are being accepted for individual events and are priced per site. Multi-site and healthcare network discount pricing is also available. For more information, contact the Center through their website at www.phlebotomy.com/webinars or call toll free 866-657-9857.
AMT Announces Phlebotomist of the Year
Phlebotomist of the Year, Kimberly Meshell, RMA, RPT, COLT, AHI, was among the national award winners recognized by American Medical Technologists (AMT) during the certification agency’s national meeting last month. AMT’s Phlebotomist of the Year award recognizes extraordinary service and contribution at all levels within the organization, and to the phlebotomy profession and total care community. Ms. Meshell, who was certified in 1999, is the phlebotomy/medical assistant program coordinator at Angelina College in Lufkin, TX.
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 11th year of publication, are reading about this month:
For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.
Center Being Followed
The Center for Phlebotomy Education, and its director are being followed... on Facebook and Twitter. In fact, hundreds of PT-STAT! readers and other healthcare professionals have been following their postings since their presence on both social networking sites was announced in last month's issue.
The Center's Facebook page provides those who perform, manage, and teach phlebotomy with a place to join discussions, leave comments or questions, post suggestions, learn about upcoming events, meet the staff of the Center for Phlebotomy Education, and keep current with day-to-day developments and newsworthy events that can impact the industry, the profession, and the way blood collection procedures are to be performed. The Center's Facebook page has already hosted lively debates on wearing gloves and managing patients who demand a butterfly be used for their draw.
To get connected visit the Center's Facebook Page and click the "Like" button. After you "Like" our page, you can post on our Wall, participate in Discussions, and get Updates from the Center in your News Feed. The page will be monitored and updated regularly, providing you a forum with not only the most reliable authority on blood collection procedures and specimen collection management in the industry, but with other phlebotomists and healthcare professionals who share your interests in the most commonly performed medical procedure in healthcare.
Q: I have been a Medical Technologist for over 30 years and misidentification was a problem when I first began and it continues to be one today. One of our facilities is being told that limiting a phlebotomist to two validated patient identification errors of major consequence is too stringent. They allow up to five errors of minor consequence.
I find this very frustrating. Are there are any standards that address the number of mislabeled samples that can be considered acceptable? Do you have any specific regulatory references that would assist this facility?
A: The acceptable number of mislabeled samples is zero. One hospital that adopted a “zero tolerance laboratory sample labeling” process, experienced a 75% reduction in labeling errors.(1) The facility would be hard-pressed to find one reputable supervisor, authority, text, article or regulation that states it acceptable to have even one mislabeled specimen. Regardless, all incidences of sample misidentification need to be documented. The frequency and type of labeling errors may warrant further investigation to identify the root cause and provide training or other corrective action, as appropriate. I think it is imperative that you hold to your high standards and apply them facility-wide. You may well be some patient’s last line of defense. Every patient, present and future, is counting on you to stand firm so that they may be protected.
As to the number of errors an employee is allowed before termination, that is up to the facility. CLSI in its patient and sample identification guideline recommends considering disciplinary action only after all of the processes are closely examined and revised to remove possible sources of error.(1) No precedent exists in the literature, nor are there any limits established by any regulating agency to my knowledge. I would call upon your risk manager for reinforcement.
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 website. For information on joining Phlebotomy Central, click here.
Our latest survey polled visitors to our website regarding the availability and location of a written exposure control plan (ECP) in their facilities. The results are below:
1. Does your facility have a written exposure control plan (ECP) in place?
2. If so, could you immediately locate it without assistance?
3. If available, how often do you review it?
According to OSHA, written plans must be accessible to all employees either online or in hard copy format in an area where they are available for review during all shifts. Of those surveyed who did not have a plan in place, all were from the U.S. Of the 28% who didn’t know if their facilities have an ECP, 60% were from outside the U.S. For facilities subject to OSHA regulations, the ECP must be reviewed and updated at least annually and whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure, and to reflect new or revised employee positions with occupational exposure.
A customizable model exposure control plan is available at http://www.osha.gov/Publications/osha3186.pdf. OSHA’s requirements for the written ECP may be found at 29 CFR 1910.1030(c)(1) and can be accessed at www.osha.gov.
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 from the Center for Phlebotomy Education’s library of articles. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.
According to those of you who responded to last month’s case study, what you wouldn’t do is perform a bleeding time on the 18-month old. All respondents indicated that they would refer the pediatric surgeon to a pathologist, the lab director, their immediate supervisor or a senior laboratory staff member. Well done.
Here’s how Dondi described her approach: “We don’t have pediatrics at our facility. However, we do get an occasional request for a bleeding time. Our response is that we no longer perform the test at our facility. If further explanation is required, we simply explain that, due to the infrequency of requests and the fact that the result is highly technique dependent, there is no one proficient in performing the test. If the physician insists on having the test performed, he is referred to our hematopathologist. She will discuss alternative tests with the requesting physician...”
Donna in Montana shared the following perspective: “I was never as happy as when we were able to stop doing bleeding times. This procedure was fraught with too many variables to satisfy my Medical Lab Science soul. Plus the biggest factor was Do No Harm…a scar is harm and I have seen arms riddled with those little white scars over the years. In this case I would not argue with the physician but go directly to my medical director. There needs to be an explanation of why a pediatrician wants a bleeding time on an 18-month-old when there are alternatives. The medical director has the authority to deny the test as well as being able to explain the alternatives and rationale for not doing an out-dated test.”
For her passion for accuracy, compassion for the patient, and tact in responding to the surgeon’s request, Donna will receive a free download from the Center for Phlebotomy Education’s library of download articles.
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