%tracker%

A FREE monthly newsletter for those who perform, teach and supervise blood collection procedures.

Phlebotomy Today
STAT!

©2012 Center for Phlebotomy Education, Inc.
All rights reserved.
Click here to view our copyright policy.


 

September, 2012


Feel free to forward this newsletter to a friend!

If this issue was forwarded to you from a friend, subscribe here.

Phlebotomy.com Survey Summaries (Part I)

Each month, the Center for Phlebotomy Education posts a survey question inviting readers and visitors to its website and Facebook page to participate, and then publishes the results in the following issue of Phlebotomy Today-STAT! This month, we begin recapping responses from some of the more intriguing surveys conducted over the past 18 months. Topics include Internet and cell phone use on the job, limits on the number of venipuncture attempts, circumstances for drawing a discard tube prior to a coag sample, and measures taken to reduce blood draw volumes in susceptible patients. Links are provided to the archived issue of Phlebotomy Today-STAT! that discusses the results at length.

Management

Facility Policies: Help or Hindrance?

When asked how policies at their facilities impact personal job performance, 83 percent of respondents said that the protocols in place help them perform at their highest level, while 17 percent consider facility policies a deterrent to carrying out their duties. In terms of adhering to their facilities’ policies, 94 percent of survey participants believe in playing (and working) by the rules, affirming that they follow facility policy without exception. Nearly two-thirds of respondents stated that policies at their facilities are strictly and consistently applied. In contrast, 35 percent indicated that violations often go unaddressed or policies are randomly enforced.

Phlebotomy Today-Stat! 6/11

Workplace Connectivity

This survey provided insight about cell phones and Internet surfing in the workplace, and whether or not employers have established policies against them. Eight percent of those surveyed indicated that they read or send personal text messages while on the clock. Six percent stated that they place or accept personal calls during work time, with 16 percent browsing non-work-related websites while on the job. The majority of those surveyed reserve such activities for break time, with over a third of respondents stating they do not engage in these pursuits in the workplace. When asked if specific policies against such activities exist, the results were as follows:

  • Policies against texting                   
    Yes: 84%      
    No: 16%
  • Policies against cell phone calls          
    Yes: 86%     
    No: 14%
  • Policies against surfing the Internet
    Yes: 88%
    No: 12%

Phlebotomy Today-Stat! 8/11

Duties Beyond Phlebotomy

This survey confirmed what we’ve long suspected: those who draw blood wear a lot of hats and have quite a few job titles. The overall results are provided, along with responses by job title.

At your place of employment, is blood specimen collection your primary duty?

Yes: 65%
No: 35%

Job Title Yes No
Phlebotomist 79% 21%
Medical or Lab Assistant 58% 42%
Phlebotomy Supervisor/Manager 62% 38%
Laboratory Manager 33% 67%
Clinical Lab Scientist/Medical Technologist 33% 67%
Medical Laboratory Technician 50% 50%

Phlebotomy Today-Stat! 10/11

Patient Complications

Reducing Blood Draw Volumes

Our survey about efforts to reduce blood-draw volumes from patients susceptible to anemia showed that over 41 percent of facilities responding have not yet taken action. However, of this group, 27 percent noted that their facility does use previously collected samples for “add-on” tests, where appropriate.

At facilities where measures have been instituted to prevent oversampling, considering previously collected samples was the most prevalent practice reported (62%), followed by use of pediatric-size evacuated tubes for susceptible patient populations (41%). Education also plays a role with 24 percent of survey participants indicating that in-services on phlebotomy overdraws are/were conducted for clinicians. Monitoring blood volumes drawn from susceptible patients (required by CLSI) and having triggers in place that prompt action when blood volume limits are exceeded were noted by only 14 percent of respondents. The collection of capillary samples was reported by 10 percent of survey participants as a means to decrease blood sampling volumes. 

Phlebotomy Today-Stat! 9/11

Fainting Patients

When it comes to the faint of heart, we asked survey participants three questions: 1) is every outpatient asked if he/she has a history or fainting?; 2) are ammonia inhalants are being used in outpatient draw stations?; and 3) is a reclining phlebotomy chair, cot or gurney available for those outpatients who feel faint?

Do you ask every outpatient if he/she has a history of fainting?
Yes: 30%
No: 70%

Are your outpatient draw stations stocked with ammonia inhalants?
Yes: 34%
No: 66%

In your outpatient drawing area, do you have a reclining phlebotomy chair, cot or gurney for patients who feel faint?
Yes: 84%
No: 16%

Phlebotomy Today-Stat! 12/11

Safety

When to Don Gloves

For this survey, we asked visitors to our website and our Facebook page what their facility’s written procedure says about gloving in relation to drawing blood, and at what point they actually put on their gloves.

For non-isolation patients, when in the sequence of blood specimen collection does your facility's written procedure instruct you to don gloves?

The majority of survey participants indicated that their facility policy requires gloving to occur after identifying the patient (42%). Ten percent of respondents reported that their facility provides no written instruction on gloving. Of this group, 20 percent represent facilities outside the U.S.

We also asked survey participants to share their actual gloving practices. Overall, the habits reported by survey participants mirror facility policy. Interestingly, approximately 6 percent of respondents whose policies call for gloving before the cleansing step reported they choose to glove earlier in the procedure, after identifying the patient. Of the 4 percent who responded that they do not wear gloves during phlebotomy procedures, 3 percent represent facilities outside the U.S.

Phlebotomy Today-Stat! 11/11

Limits on Venipuncture Attempts

This survey set out to determine if a “statute of limitations” exists in facilities for the number of times a venipuncture may be attempted.

Where you work, does facility policy limit the number of venipuncture attempts?
Yes: 94%
No: 6%

We also asked survey participants about the maximum number of venipuncture attempts one collector is permitted:

  • 87% indicated that two sticks is the individual limit
  • 6% reported three attempts are allowed
  • 4% stated a maximum number of attempts per collector is not defined

In terms of the total number of venipuncture attempts allowed per patient, 44 percent said this is not defined in facility policy. Of those with a limit in place, 19 percent reported four sticks is the maximum, with 13 percent stating the per-patient limit is two attempts.

Phlebotomy Today-Stat! 2/12

Discard Tube

Drawing a Discard Tube

Participants had a lot to say about the circumstances for drawing a discard tube prior to collecting a sodium citrate (coag) tube on their patients. Nearly half (46%) responded that they only draw a discard tube prior to collecting a coag tube when using a butterfly set in combination with a tube holder. Two percent of those surveyed indicated that they only draw a discard tube for special factor assays, while 21 percent reported that they draw a discard tube for special factors assays and also when using a butterfly with a tube holder. For 15 percent of survey respondents, always drawing a discard tube prior to filling a coag tube is standard practice. At the other end of the spectrum, 13 percent stated that they do not draw discard tubes for coag samples under any conditions.

Phlebotomy Today-Stat! 7/11

Want to improve the message you’re projecting to your patients?
There’s an ATM for that!

Featured Product

Train-the-Trainer Workshop Scheduled

  • Are gaps in your training program responsible for customer service and sample quality problems?
  • Is your training program producing outstanding phlebotomists or mediocre employees?
  • Is your curriculum as comprehensive as it should be?

Whether you are new at training phlebotomists or a seasoned educator, the Center for Phlebotomy Education is conducting a two-day workshop designed to help managers and educators refine their training programs to optimize their staff’s expertise. A faculty of world-class instructors will cover topics essential to every healthcare professional who draws blood samples including:

  • Preanalytical errors affecting specimen quality;
  • Nurturing professionalism & responsibility;
  • Understanding different learning styles for maximum effectiveness;
  • Measuring student & staff competencies;
  • Mentoring students & new staff...and much more.

The workshop is scheduled for Thursday and Friday, November 29th & 30th, 2012 from 9am to 4pm EST. Each attendee will receive a portfolio filled with resources, tips, and tools they can implement immediately.  Besides learning how to be a more effective trainer, participants will be able to network with their peers and share ideas, strategies, and solutions to their most perplexing problems.

The workshop qualifies attendees to receive 12 P.A.C.E. continuing education credits. The workshop will take place at the Center for Phlebotomy Education’s offices in Corydon, Indiana, just 30 minutes west of Louisville, Kentucky. 

Registration is $399 and seating is limited. Accommodations are available at Holiday Inn Express in Corydon at the special workshop rate of $69.99. For more information on this unique opportunity to learn from the most respected authority in the industry, visit www.phlebotomy.com/Train-the-Trainer.html or call: 866-657-9857 toll-free.

New Webinar Series Kicks Off

The Center for Phlebotomy Education announces its 2012–2013 Phlebotomy Best Practices webinar series beginning in November. The series, consisting of five webinars, each one hour in length, will cover a wide variety of preanalytical topics and is developed for phlebotomists and all other healthcare professionals with blood collection responsibilities. The 2012–2013 schedule is as follows:

November 15, 2012
Ending Hemolysis in the ED... and Everywhere Else

December 11, 2012
Assessing Phlebotomy Competency

January 15, 2013
The Four Pillars of World-Class Phlebotomy

February 21, 2013
Industry Update

March 7, 2013
Phlebotomy C.S.I. (Challenging Sticks Investigation)

All webinars begin at 1pm, Eastern Standard (Daylight)
Time (GMT-5) on the dates listed.

All content reflects the standards and guidelines of the Clinical and Laboratory Standards Institute (CLSI). Registrations for individual webinars and the entire series are priced with and without P.A.C.E. continuing education credit. 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.

This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 13th year of publication, are reading about this month:

  • Feature Article

    Hematoma Prevention

  • Phlebotomy in the News

    A round-up of articles on phlebotomy and phlebotomists who made Internet headlines in August including these stories:

    • Initiative to Train Tanzanian HCWs in Phlebotomy
    • New Mobile Phlebotomy Start-Up Serves Southwest Florida
    • Study Shows Disconnect Over Providers’ Perception of Care
    • Colleagues Dedicate Bench in Phlebotomist’s Memory
    • Long Wait Times Angers Elderly Outpatient
    • NHS Reports Patient Safety Incidents Up 25%
  • Safety Essentials

    Safety Training Made Fun!

  • Tip of the Month

    Rushin’ Roulette

  • CE Questions

    (Institutional Version Only)

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.

On a Personal Note...

Waiting for the personal note?

If you have a moment, follow me...

 

Featured FAQ

Clotting Time Before Centrifugation

Question

What is the length of time for a red top or SST to sit before spinning once it looks clotted?

Answer

Complete clotting can take up to 30 minutes. Sometimes a specimen looks clotted because it doesn’t flow in the tube when you invert it, but that may not be a good measure that complete clotting has taken place. The clot may still be forming within the partially congealed specimen. Don’t fall victim to the myth that a clot activator accelerates clotting. Activators facilitate complete clotting, not faster clotting. Even though clot activator tubes may gel up quickly, complete clotting can still take up to 30 minutes.

If you find a lot of your specimens have fibrin in the serum after centrifugation, it’s an indication you are rushing centrifugation. Set a clock for 20–30 minutes and see if the problem goes away. Of course patients on anticoagulants or with a coagulopathy may take longer.

Have questions about specimen processing?
There’s a SmartChart™ for that!

Survey Says

Improving Laboratory-Nursing Relations, Part II

As a continuation of our survey on improving relations between nursing and laboratory, this month we asked nurses who read our newsletter or visited our website to share their suggestions. Their comments provide interesting and invaluable insight into the nursing perspective.

NURSING PERSONNEL ONLY: What would you most like phlebotomists and laboratory personnel to understand about you and the nursing service to improve interdepartmental relations?

Sample Comments:

  • “I have great respect for the staff in the lab... I can’t speak to reports of ‘me nurse, you lab, redraw now.’ When I’m told that a specimen needs to be drawn, I ask why so that I am informed. The professionals I work with would never send a specimen back just because they didn’t want to do the work. Our work is high pressure, as is yours, but it is not an excuse to disrespect your team members.”
  • “I think to understand that sometimes it is inevitable that the blood gets drawn more than once per day. Lab service should be 24/7.”
  • “I would like to know if you have a problem obtaining a blood sample from a patient, so I can communicate this to others. I would also like to know if there was any adverse event from the venipuncture, i.e. large bruise/hematoma as I am the one who gets asked by relatives and medics for information relating to this, and must document and complete any incident forms.”
  • “We work together as a team for positive patient outcomes. Timing of draws for certain tests such as heparin assays and cortisol levels are crucial. Also, learning the phonetic alphabet—alpha, bravo, charlie—civilian vs. military.”
  • “I have been an Emergency Room RN for 6 years and prior to that I was a Lab Tech/Phlebotomist and have seen both sides. I have always advocated for the Lab when I hear nurses and other ER personnel say ‘The Lab hemolyzed our specimens again’ always stating that it is not the Lab but the way the blood was drawn (i.e. during IV insertion). I feel that more education needs to be done by both Nursing and Laboratory educators to assist with this lack of education regarding hemolysis. Another point I would like to address is the critical time frame in which ER specimens need to be collected and/or analyzed. I very often have to call the laboratory to find out ‘where are my results’ only to learn that the ER specimens were batched with routine specimens, or worse, forgotten in the centrifuge or testing machines! Please be aware that time is often of the essence and may be a matter of life or death in the ER. Please adhere to your facility’s protocol of turnaround times for ER STAT specimens. Also, please respond to requests for phlebotomy in a timely manner when we call for a Lab Phlebotomist and not state you are ‘too busy.’ It is because our own staff was unable to obtain a specimen and we are in dire need of a professional, competent phlebotomist!”
  • “I do not know the tubes required for certain tests. I have memorized them once but in the grand scope of practice this information has been forgotten. I want to collect the lab work once, send it, and move on to my patient’s other needs. I do not want a labeling, signing, or packing error to cause this to be recollected. When I ask for directions and guidance in collection paperwork I want simple straightforward answers; not a bunch of numbers. With electronic orders being performed sometimes tubes arrive for line draws with orders but no directions. Simple guidelines for how much blood needs to be collected and how the samples should be packed would be helpful. Order times: Things happen and issues arise and I don’t get the medications in when I needed to. This pushes back your draw time. When I call to let you know, don’t be mad at me that I didn’t take it out of the system first. If things changed at the last minute I would want to be called in case the change of order gets missed. When labs are ordered prior to starting any treatment, I would like at least a nod from you that you are finished. If you just walk away I am not sure if you got it or need more supplies. We get busy and are unable to do your line draws. Please ask another nurse to do it… Stop chewing things when on the phone. You have a larger and more foreign vocabulary to me and I need to you to speak clearly so I can understand you. We value what you do! We don’t have the time to understand the entire scope of your practice. We get yelled at all day long by doctors, patients, and families. When we call you and sound irritated it is not usually you we have the issue with. But if you counter us with rudeness then we will surely love to use you as a method of venting. I would love to hear the words ‘What can I do for you?’ instead of ‘What you need to do is...!’”

This month’s survey question
What is your facility’s policy on patient/sample misidentification?

Last Month on Facebook

During the month of August, fans and visitors to our Facebook page shared their thoughts on the following topics:

  • Continuing education budget cuts
  • Revision of CLSI’s venipuncture standard

Looking for an online community to post questions or to simply satisfy your desire for phlebotomy talk between newsletter issues? Visit and “Like” our Facebook page and you’ll never miss out on another discussion or one of our special Facebook offers. Your peers need your input, and you need theirs. www.facebook.com/CPEInc

Follow us on...

Our Facebook Page Our Director’s Twitter

What Should We Do?

What Should We Do? gives you the opportunity to ask our team of technical experts for advice on your most pressing phlebotomy challenges. Whether technical or management in nature, we’ll carefully consider solutions and suggestions based on the industry’s best practices so that you and those in other facilities with the same problem can benefit, all the while maintaining your facility’s anonymity. What Should We Do? is your opportunity to ask us for suggestions on the best way to handle your real-life dilemmas.

This Month’s Case Study
Frustration Over Fibrin

One reader writes
We have a patient with terminal cancer. No matter how many times we centrifuge his red tops, the serum continues to gel up with fibrin. We rim it out with applicator sticks and recentrifuge, but it continues to gel. It’s impossible to get a liquid serum sample for the chemistry department to test. This doesn’t happen when we use a heparin tube, but the chemistry panel the physician orders requires serum. We suggested to our manager that we draw a heparin tube and test that, but there is concern that the sodium in the tube would render an inaccurate sodium result. What should we do?

Our Response

Depending on the methodology validated for the tests ordered, plasma may or may not be an acceptable alternative. The testing personnel should be consulted about the suitability of heparinized plasma for the tests, and the difficulty in obtaining an adequate serum sample. Some facilities are hesitant to employ a sodium heparin tube when panels that include sodium are ordered because of the potential for the sodium in the anticoagulant to increase the reported result. However, studies suggest any increase is insignificant. The use of lithium heparin instead may mitigate any concern for exogenous sodium contamination, but the instrument must be validated for the use of this additive.

Another concern for substituting plasma for serum on this patient is for the reference ranges. If they have been established for serum samples, and the test is performed on plasma, the physician is likely to misinterpret the results. The reported results of many analytes can be significantly different when plasma is tested versus serum. Sodium is not one of them, especially when lithium heparin is used, but potassium and total protein are just two that demonstrate significant differences.

It is imperative that accurate results are obtained in this complicated scenario, and that the reference ranges accompanying the result are appropriate. Working with the testing personnel to assess the appropriate sample must take into consideration all the variables that threaten accurate results and their interpretation.

Got a challenging phlebotomy situation or work-related question?

Email us your submission at WSWD@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)

Notice: Do not respond to this e-newsletter.

Responding to the email address from which this newsletter is sent will result in the deletion of your address from our mailing list. If you would like to send an email to the editor, send it to phlebotomy@phlebotomy.com.