Scripting Standardizes the Patient Experience
In an attempt to standardize phlebotomist/patient interactions, many healthcare facilities are employing a technique called "scripting" to ensure that all patients are subjected to a standardized protocol that includes questions and comments that should be part of every phlebotomy interaction. When scripting is implemented, patients are assured the most important components of specimen collection procedures are followed—such as proper patient identification, inquiries about latex allergies and problems during prior venipunctures, and warning the patient of the imminent puncture.
Scripting also minimizes collector variables like attitude, interpersonal skills, and varying degrees of professionalism amongst the staff. Scripts consist of statements, actions, and conditional responses or actions, and flow naturally throughout the procedure. Good scripting not only standardizes every patient's phlebotomy experience to a protocol that reflects the facility's procedure manual, but removes variables unique to phlebotomists that patients might not welcome, like being called "hun" or "honey." As a result, patients can receive higher quality venipunctures performed by a more professional appearing staff.
The Center for Phlebotomy Education has developed this sample script for Phlebotomy Today--STAT! subscribers to customize and implement into their blood collection protocol.
Statement: “Good morning (afternoon, evening).”
Statement: “I am (name) from the laboratory. Your doctor would like me to draw a blood sample from you for the laboratory to run some tests. Have you had blood tests drawn before?”
Statement: Have you ever had any difficulties getting your blood drawn?
Statement: Ask the patient to state (not affirm) his/her name, address, unique identification number, and/or birth date. Ask the patient to spell his/her last name.
Action: After patient identification has been confirmed, select an appropriate venipuncture site according to facility policy. Prepare the site according to facility procedure and notify the patient of the imminent puncture.
Statement: “You will feel a little poke (alt: ‘stick’ or ‘pinch’), now.”
Action: Observe for superficial bleeding and hematoma formation for at least ten seconds after relieving pressure. After assuring that bleeding from both the vein and skin has stopped, bandage the patient.
Statement: “Here are some instructions for you should you notice anything unusual with the venipuncture site after I leave. I would like to ask you to leave this bandage on for at least 15 minutes. Do you have any questions?”
Statement: “Do you feel okay?”
Statement: “Once again, my name is (name). Here’s my card with my extension number in case you have any questions after I leave. Thank you, Mr./Mrs _____.”
Patients base their impression of the quality of the laboratory on the quality of the one who draws its specimens. As more facilities adopt scripting techniques, it is reasonable to assume that laboratories in general will be held in higher esteem because of the better impressions patients get from those who follow well-drafted scripts.
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 10th year of publication, are reading about this month:
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: ER blood culture contamination & hemolysis
Q: Our ER has been drawing blood for about three years now and we continue to have trouble with blood culture contamination and hemolysis. I educate and train their techs that will be drawing blood, but the problem seems more with nursing. How do you handle education with emergency room staff?
A: Every ER shares your frustration. A study reported in the Journal of Emergency Nursing describes a similar issue at a hospital like yours where the authors, all nurses, investigated the lab's claim that they were hemolyzing specimens during collection in the ER. The nurses didn't believe they were responsible and conducted their own study to prove it. The results showed the lab was right: their draws were more hemolyzed than laboratory phlebotomists' draws.
Don’t be overly critical of the nurses, however. In the ER, everything has to happen quickly, and they give a priority to expediency. That’s the driving force behind draws during an IV start. Unfortunately, such expediency is at odds with a good specimen, which is the laboratory’s priority. Understanding the difference in priorities is key to working together. Try explaining how draws during IV starts can be more detrimental to the patient than beneficial, especially when the diagnosis and treatment are delayed because of a hemolyzed specimen that has to be recollected by venipuncture.
As for blood culture contamination, the same force is at work. Reinforce that whether the antiseptic is iodine or chlorhexidine, it requires at least 30 seconds of contact in order to decontaminate the site. Expediency here cuts that time short and you end up with skin flora growing inside the culture bottles and presenting a misperception of the patient’s condition.
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, exclusive to Phlebotomy Today® Premium subscribers. For information on joining Phlebotomy Central, visit www.phlebotomy.com/PhlebotomyCentral.html.
Our latest survey asked Phlebotomy Today STAT! readers: What tricks and techniques have you developed to help you draw blood that aren't in the books? Responses include the following:
This month’s survey question: Does your facility provide outpatients with an identification band prior to a blood draw?
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 To the Point® 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.
Surprisingly, this scenario was not uncommonly encountered by those who responded. Reactions varied widely. Thirty-three percent said they would report the snoozing employee to their supervisor. Sixteen percent would issue their coworker a warning, and report a second offense. Another sixteen percent said they'd find someone else to shadow. One respondent admitted that taking a nap was permitted where they used to work. Some comments:
Phyllis H. of Colorado tells how she handled this very situation successfully.
"I have actually encountered this situation. My first reaction was to check on my fellow worker to make sure they were feeling okay. After determining that my coworker was fine, I politely explained that this is an unacceptable behavior and we had responsibility and accountability. I would not tolerate this behavior and report it to a supervisor if it occurred again. It worked well and never happened again."
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