Nurse Arrested For Not Permitting Officer to Draw Blood
On July 26 in Salt Lake City, Utah, a driver fleeing police slammed into a semi truck and died at the scene. The truck burst into flames and the driver was admitted to the burn unit at University Hospital with life-threatening injuries. An officer with the Salt Lake City Police Department insisted on drawing blood from the victim without a warrant. The victim was not under arrest and could not consent because he was in a coma. It isn't clear why the officers were seeking to draw blood on the truck driver, although some speculate if the truck driver could be found to be under the influence of alcohol or a controlled substance, positive test results could prevent legal action against the police for causing the accident.
In a tense exchange caught on body cameras, the nurse, former Olympic skier Alex Wubbles, reminded the officer seeking access to the patient the requirements permitting them to draw blood from the victim had not been met. The officer then forcefully wrestled Wubbles outside, applied handcuffs, and placed her under arrest as she screamed "I've done nothing wrong." Campus security officers stood idly by. Only later did the officers realize blood had already been drawn on the patient, and they could have sought a warrant to obtain access to the samples.
The video was not released until August 30 when Wubbles and her attorney felt they were not getting an adequate response from the University of Utah about why their own officers did not intervene. Only after the video was released did the Salt Lake City Police Department place two of the officers involved in the arrest on paid leave. In the five days since its release, the video has had over 5 million views.
Phlebotomy Q&A Book
Standards Update: Trays and tourniquets
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.
Nearly 100,000 patients die every year in the U.S. from infections they acquire during hospitalization. Phlebotomists and other healthcare professionals who draw blood samples play a role in the chain of infection that must be minimized, if not eliminated. Two new provisions in the newly released CLSI venipuncture standard are designed to prevent those who draw blood samples from spreading infection.
While many facilities have moved away from phlebotomy trays in favor of wheeled carts, trays are still widely used. Unfortunately, too often they are carried into patients' rooms and set upon surfaces patients contact frequently. Since the bottoms of phlebotomy trays are among the most highly contaminated pieces of equipment used in patient rooms, the threat they pose to patients is significant.
Patients use bedside trays, tables and nightstands to set their glasses, hearing aids, dentures, and other personal items upon. Visitors and healthcare professionals sit in the chairs next to patient beds. That's why the committee that revised the recent venipuncture standard banned the practice of setting phlebotomy trays on surfaces patients and visitors frequently come in contact with. When such surfaces are used for phlebotomy trays, the standard requires a protective barrier, such as a disposable pad, between the tray and the surface.
The standard also requires phlebotomy trays to be cleaned on a "scheduled basis." Most OSHA consultants recommend inspecting trays for cleanliness daily and cleaned whenever there is visible contamination or exposure to blood or body fluids due to a spill. The standard doesn't mandate how frequently trays should be cleaned, but requires it to be at regular intervals of the facility's choosing.
When cleaning is required, a thorough cleaning would be to completely empty the tray of supplies and decontaminate the interior and exterior with a tuberculocidal spray, making sure all of the surfaces have been decontaminated. A consultation with an infection control officer would be helpful in establishing a good policy and effective procedure.
One study found 78% of all reusable tourniquets at one facility had microorganisms. Twenty-five percent of the tourniquets harbored methicilin-resistant organisms. There is no regulation or standard mandating single-use tourniquets, but it is an effective means by which to reduce hospital-acquired infections. Some facilities mitigate this risk by assigning patients their own tourniquet to be used exclusively on them throughout their stay.
While the new venipuncture standard does not mandate single-use tourniquets, it recommends the practice, and also suggests facilities consider assigning tourniquets to be used on each inpatient exclusively.
Editor's note: Readers are urged to obtain their own copy of the standard as soon as possible and begin implementing all new provisions as soon as possible. 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.
Read an interview by CLP Magazine with Dennis J. Ernst MT(ASCP), NCPT(NCCT) about the revised standard.
Global Preanalytic Summit
What Should We Do?: Transporting tubes from isolation rooms
Question: If a patient is in isolation, what is the proper way to transport your tubes of blood out of the patient room once contaminated PPE is removed?
Our response: The consensus in the published literature and among OSHA consultants is that standard precautions, if diligently applied, should protect everyone. However, samples removed from an isolation room are often recommended to be placed inside a separate bag for transport. Some encase them in the gloves as the gloves are removed, but we're not fond of that practice. If the patient has MRSA, why transport MRSA-contaminated gloves back to the laboratory along with the tubes, similarly contaminated on the outside? Contaminated gloves and other PPE should stay in the room. We recommend a clean isolation bag for samples labeled with the biohazard icon. Textbooks and CLSI agree.
The latest revision of the CLSI venipuncture standard contains detailed instructions on drawing blood in isolation rooms. It states only the necessary supplies should be brought into the room, and tubes should be decontaminated before leaving if required by facility policy. Tubes should then be placed in a secondary container, such as a sealable plastic bag for transport to the testing facility.
Product Spotlight: Answers to 400+ questions
The Center for Phlebotomy Education has just released its highly anticipated Lab Draw Answer Book.
The 440-page full-color reference book answers over 400 commonly asked questions on blood sample collection and handling, and managing phlebotomy services and personnel. It's the second edition of Blood Specimen Collection FAQs, which was released in 2008, with 100 new entries and all original entries updated to fully reflect CLSI's new venipuncture standard. The second edition is co-authored by Dennis J. Ernst MT(ASCP), NCPT(NCCT) and his wife Catherine Ernst, RN, PBT(ASCP)CM.
"Bringing Catherine on board as co-author adds a nursing perspective so necessary for a phlebotomy reference book," says Dennis Ernst. "She's been very instrumental in making sure all passages not only reflect the CLSI standards, which she helped write, but the Standards of Practice of the Infusion Nurses Society.
Chapters in the book include:
- Safety and Infection Control
- Training, Management and Certification
- Skin Punctures, Heelsticks, and Pain Management
- Patient Identification, Vein Selection, & Site Prep
- Tourniquets & Butterflies
- Order of Draw & Discard Tubes
- Hemolysis and Potassium Issues
- Blood Cultures
- Labeling and Post-venipuncture Care
- Line Draws & IV Starts
- Processing, Storage, & Transportation
- Patient Injuries & Complications
- Unorthodox Techniques
Copies are currently only available from the Center for Phlebotomy Education. More information and preview pages.
Survey Says: Value of certification
Last month we asked our readers and visitors to our web site about phlebotomy certification and if certified phlebotomists are paid more than their non-certified counterparts. If it sounds like a familiar survey to you, we've been asking these questions periodically over the years to see if there's a trend in either direction.
Does your employer require phlebotomists to be certified?
States that require phlebotomists to be certified include California, Louisiana, Washington and Nevada. In 2008, 23 percent of those who responded in non-certification states said their employer requires certification even though the law does not. In 2013, 26 percent responded the same way. Today it's up to 29 percent, signifying a gradual but steady climb toward a more certified workforce.
Of those participating in the survey who were certified, most were certified by ASCP. Here's the breakdown:
- American Society for Clinical Pathology (ASCP)--51.3%
- National Healthcareer Association (NHA)--14.1%
- National Center for Competency Testing (NCCT)---6.4%
- National Phlebotomy Association (NPA)---4%
- American Society of Phlebotomy Technicians (ASPT)---4%
- American Medical Technologists (AMT)---2.6%
- New Zealand Institute of Med Lab Science (NZIMLS)---2.5%
Here are some comments:
- But [my facility]thought it was okay to give CNA's a crash course, less than 8 hours, then get rid of the 2nd shift phlebs and have the CNA's draw blood. We are so against this terrible patient care practice and poor specimen quality and repeated recollects.
- I work for a large health system. Only the facility I work in requires certification for phlebotomists. My small facility was bought out by a larger one but we have kept the certification requirement.
- Only if you want to become a Phleb II.
- It isn't a requirement however, my goal was to get everyone certified. So now they are. Replacements can be hired as non-certified and get certified later.
- Because of staffing shortages, they will hire non-certified phlebotomist, right out of school.
- Unless you are climbing our career ladder then you have to have it to become a Phlebotomy III.
- In NZ certification or working towards same is being introduced over the next few years
- Our department is so short staff that they are hiring people without out skills.
- I wish they would.
- I am not certified but have been a phlebotomist for 44 years. I have been grandfathered in.
Are you paid extra if you're certified?
In 2008, 38% of those who responded said that their employers pay certified phlebotomists more than non-certified phlebotomists. In 2013, the rate ticked down to 36%. This year, it's down to 24 percent. However, 37% admitted they didn't know.
Do you feel certified phlebotomists are more skilled and act more professional than non-certified phlebotomists?
This is where it gets interesting, but not entirely unpredictable. Of the certified phlebotomists responding, 55% said certified phlebotomists are more skilled than non-certified phlebotomists, while 52% said they also acted more professional. Among non-certified phlebotomists, the percentages were 25 and 22 respectively. What we found most surprising is that only slightly more than half of the certified respondents thought their certified colleagues were more professional and skilled than those without certification. We expected higher self-assessment scores.
- Some are in the field because quick study and not necessarily have a heart for it.
- Non-certified would be better with finding veins. But handling complications and performing right procedure are not always accurate.
- I was certified. Let it lapse for years. A new company took over our hospital. And I was told I would make less because I was no longer certified. I went and took the test again. And passed.
- I think that there are a lot of phlebotomists out there that have been doing this for a long time and are very good, but not certified. And there are a lot of phlebotomists out there that are certified and are not very skilled.
- Only phlebotomists certified by a national agency, not the fly by night weekend course. They get the certificate and assume they are certified.
- Certification does not prove that a Phlebotomist has the skill(s) required to perform the job.
- I feel some people are good and have not had time or money to sit for the test or class. The employer should step up to help staff with testing.
- [Being certified] makes me feel like this is my profession, not a fly-by-night job.
- Those that are certified have more knowledge about what we are doing, why we are doing it, and what can happen as a result, good or bad. The ability to find and successfully access a vein does NOT get better with certification.
- Quality of training and experience count.
- The skill level of a phlebotomists depends on how they have been trained and how much time and effort they have put in to growing their skill and knowledge to a higher level.
- I think [certified phlebotomists] show more commitment.
- Having a heart for it makes the difference.
- This is a trade. Honing skills takes years. It is an art.
- I feel that a certified phlebotomist has more pride in what they are doing than a non-certified phlebotomist.
- Some are [more skilled] and some are not. Too many of them are young kids getting certified in trade schools right out of high school and just do not have the maturity.
- Certification cannot determine professionalism.
- Those that are certified have taken the time to learn as much as possible about phlebotomy, which, to me, shows they care more. They are also better prepared to answer patient questions.
- Professionalism is something that needs to be modeled and learned. Certification is simply proving that you have skills to perform the job.
- Professionalism comes with the desire to know more; always remembering why we are in the field. Phlebotomy is not for everyone, and sometimes certification makes no difference.
- People skills and professionalism are good for a phlebotomist to have regardless of certification or not.
- Certification doesn't mean you are good at it.
- Some staff I have worked with that do not have the certification are very skilled, and absorb all that I tell them and become extremely knowlegable and skilled. Then I have some staff that have been certified, and reminders need to be given. In general, being certified gives them a good starting base and an advantage over those with no certification. The final result is somewhat dependent upon the initiative of the employee however.
This month we're asking our readers and visitors to our web site what products they wish were available to help them perform phlebotomy procedures. We'll start you off with some ideas, then let you do the brainstorming.
Take the survey.
Empowered Healthcare Manager: Intervention and diligence
Every month we run an excerpt from our editor's popular blog, The Empowered Healthcare Manager.
All the problems you are tasked to solve today will require either your intervention or your diligence. Those that require your intervention do so at the expense of your diligence.
In the clinical laboratory, problems that require your diligence include maintaining staffing levels, seeking quality continuing education activities, slashing your budget, and increasing revenue, productivity, efficiency, and quality.
Problems that require intervention are unpredictable and preventable. Customer-service disasters, lost specimens, interdepartmental warfare, interpersonal disputes, equipment malfunctions, and inaccurate test results that change how patients are managed in a profoundly negative way are among a few.
Interventions keep you from focusing on problems that require diligence. Enable the interventions and your lab stagnates. Reduce your interventions and you increase your diligence. The lab moves forward and so do you.
Problems that require your intervention are the enemy of your diligence.
Subscribe to the Empowered Healthcare Manager.
Tip of the Month: Seven Deadly Sins of Customer Service
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