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

Phlebotomy Today
STAT!

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November, 2013


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“Preanalytical Errors:
Real Patients, Real Suffering” Video Debuts

Have you been wishing there was some way you could put a human face on what happens when phlebotomy is not taken seriously? Your wish just came true.

The Center for Phlebotomy Education has just released “Preanalytical Errors: Real Patients, Real Suffering,” a poignant expose on the devastating consequences that patients suffer when blood collection personnel abandon the standards and underestimate the importance of performing venipunctures properly.

“It doesn’t matter who draws the blood; when people cut corners or are not trained properly in the first place, patients suffer,” says Catherine Ernst RN PBT(ASCP) the Center for Phlebotomy Education’s Vice President who wrote and produced the video. “And I don’t mean they get a bruise. We’re talking disabling injuries, medical mismanagement, even death. There’s nothing simple about a “simple blood test.”

The 6-minute video can be accessed on the Center’s YouTube site and at www.phlebotomy.com. Visitors are encouraged to imbed the video on their facility’s own web site.

Phlebotomy.com Survey Summaries

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 summarize responses from some of the more intriguing surveys conducted over the past 14 months. Topics include bullying, conflicts between phlebotomists and techs, gossips, laboratory/nursing relations, and more. Links are provided to the archived issue of Phlebotomy Today-STAT! that discusses the survey results at length.

Patient/Sample Misidentification

We asked facilities what their policy is on patient/sample misidentification. Nearly two-thirds (64%) of respondents specifically stated sample recollection would be necessary. Twelve percent said that the specimen would have to be rejected/discarded, while 7% mentioned extenuating circumstances where testing of irretrievable samples, such as CSF is allowed. Twenty-one percent described the disciplinary action taken against the collector, which ranged from verbal notification to immediate termination. Almost one-fifth (18%) referenced how the error would be investigated and/or documented via an incident report.

November, 2012 Phlebotomy Today STAT!

Can’t We All Just Get Along?

We conducted four surveys in the last year about inter- and intradepartmental relations.

Have you ever been bullied at work?
Yes: 87% 
No: 13%

Verbal abuse and outbursts were the most frequent form of bullying respondents noted, but profanity and work sabotage also made the list.

Have you ever witnessed bullying of another employee while at work?
Yes: 85%
No: 15%

If you don’t read the full article in any of the surveys summarized here, you should read this one. Not because you need it, but because you need to hear the astounding testimonials people provided.

December, 2012 Phlebotomy Today STAT!

Lab/Nursing Relations

Are you aware of any instances in which patient care was directly affected by strife between the laboratory and nursing department? How do you and/or your facility work to overcome barriers to cooperation between the laboratory and nursing departments?

In fact, 53% of those who took our survey admitted that patient care has been directly affected because of interdepartmental strife. Most involved delayed results.

February, 2013 Phlebotomy Today STAT!

Preanalytical/Analytical Warfare

Is there friction in your laboratory between those who draw samples and those who test them that affects morale and cooperation? What behaviors have you experienced that keep this barrier to cooperation in place?

A whopping 81% of those who participated in the survey admitted to friction between the analytical and the preanalytical professions. Fifty-two percent could state examples of it affecting patient care. The most common impacts were delayed test results.

March, 2013 Phlebotomy Today STAT!

Is There a Gossip in Your Midst?

We asked the following questions: Is gossip a problem where you work? How do you personally react to gossip? How does management respond? How would you like management to respond?

Not surprisingly, 69% said gossip was a problem. Those who responded expressed frustration, disgust, and hopelessness that the problem will ever go away. Others felt their employers curtailed gossip effectively. Those who participated in the survey reported a wide variety of strategies they use personally when confronted with gossip in the workplace. Respondents also had plenty to say about how their managers handle gossip, most of it unfavorable.

April, 2013 Phlebotomy Today STAT!  

Reducing Pediatric Pain

Approximately one-third (33%) of survey participants indicated that no pain reduction strategies are used when drawing this from patient population. Interestingly, 17% of respondents reported using no pain reduction methods on older pediatric patients. For those who do, parental holding was the clear favorite (83%), followed by distraction methods, such as toys, music or TV (58%), the use of anesthetic cream (25%), and application of an ice pack/vibration device (8%).

For adult patient draws, 50% of those surveyed indicated that no pain reduction methods were necessary, while 50% reported using distraction techniques such as music or TV. Eight percent reported using an ice pack/vibration device. When it comes to infant bottle- or breastfeeding during blood collection procedures, the survey responses were evenly split on the subject. Almost half of the facilities represented allow infant feedings during venipuncture procedures (46%), while just over half permit infants to nurse or bottle-feed during capillary collections (56%).

January, 2013 Phlebotomy Today-STAT! 

Permission and Risks

Does your facility policy require you to ask patients for their verbal or written permission to draw blood? Are you required to tell patients about the risks of a venipuncture?

Sixty-three percent of those who responded to the first question said that they are not required to solicit consent from patients in their facilities, but that consent was assumed. Thirty-seven percent work in facilities that do not require the collector to obtain consent. Of those who work in facilities that require phlebotomists to solicit patient consent, 20 percent obtain verbal permission while 17 percent require written permission.

March, 2013 Phlebotomy Today STAT!

Certification

Do you work in a state that requires certification for phlebotomists? If not, does your employer require certification? Are certified phlebotomists at your facility paid more than non-certified phlebotomists?

Twenty-six percent of those who responded in non-certification states said their employer requires certification even though the law does not.
Sixty-four percent of those who responded said that their employers do not pay certified phlebotomists any more than non-certified phlebotomists.

June 2013 Phlebotomy Today STAT!

Single-Use Tourniquets

Sixty-three percent of those responding indicated they work in a facility that has a single-use policy for tourniquets. We also asked “after how many patients or shifts do you typically discard a tourniquet?” Fourteen percent said “I can’t remember the last time I threw away a tourniquet.” Eleven percent indicated they discard after one shift. In response to our question about what type of tourniquet was in use where they worked. The majority said nitrile (60%) followed by latex (15%), elastic fabric (13%) and vinyl (11%).

July, 2013 Phlebotomy Today STAT!

Labeling Tubes Someone Else Draws

If someone were to send you or hand you filled blood collection tubes and labels (unattached), under what circumstances would you label them?
Overwhelmingly, those who responded are on the right side of the issue. It’s the others we worry about. A full 55 percent responded they would not label a sample drawn by someone else under any circumstance. Every patient should hope their samples are drawn by someone like-minded. Forty-seven percent said they would label the sample if they witnessed the collection, including proper patient identification. Five respondents (1.7%) indicated they would label a sample “if the person handing me the samples and labels was reliable.” Three (1.0%) said they would label the samples under most circumstances.

August, 2013 Phlebotomy Today STAT!

Mechanism for Monitoring Blood Draws on Infants

According to the survey results nearly half of those who responded do not comply with the standards (47%). Only 11 percent indicated they monitor blood volumes drawn from susceptible patients and have triggers in place that prompt action when limits are met. All others indicated they take some action to prevent iatrogenic anemia, but don’t monitor volumes.

September, 2013 Phlebotomy Today STAT!

Patient Injury

In your capacity as a healthcare professional with blood collection responsibilities with any employer, are you aware of any patient ever having serious complications from a blood draw? If so, what was the nature of the complication?

Nearly fifty-seven percent said they were aware of complications. The majority of complications observed were nerve injuries (53%) and non-fatal injuries from passing out (41%). Other injuries include massive hematomas that required medical attention (23.5%), improper medical diagnosis, medication, and/or treatment due to sample or patient misidentification (17.6%), improper medical diagnosis, medication, and/or treatment for reasons other than sample or patient misidentification (17.6%), non-fatal transfusion reaction (12%), and fatal injuries from passing out (6%).

October, 2013 Phlebotomy Today STAT! 

Featured Product

Preanalytical Smart Charts™

Are preanalytical errors robbing you and your staff of productivity? Are they costing you the hard-fought credibility among physicians you strive to maintain? Are you an educator looking for documents that summarize key preanalytical concepts at a glance and reinforce what you teach?

SmartCharts™ are yet another way the Center for Phlebotomy Education helps you and your staff reclaim your productivity, report more accurate results, renew physician confidence in your laboratory’s reports, and teach key concepts every student and new-hire must grasp. These four documents give managers, educators, and healthcare professionals concise summaries on the most common preanalytical processes that impact test results and require continuous quality improvement.  SmartCharts are designed for posting where specimen collection and processing personnel frequent and as reference materials to provide information and instruction on a variety of error-prone preanalytical processes. The four SmartCharts currently available include:

  1. Blood specimen handling and processing;
  2. Investigating elevated potassium results;
  3. Analyte stability;
  4. Blood sample collections during IV starts.
SmartCharts are available as individual downloads or as a set.

For more information, click here.

Passiment Participates in ACA Forum

Elissa Passiment, Executive Vice President of the American Society for Clinical Laboratory Science, represented the laboratory profession last month in a healthcare forum broadcast by C-SPAN. Passiment joined physicians, nurses and pharmaceutical representatives discussing ways in which the Affordable Care Act may affect patients and providers. The panel was a part of the National Journal Countdown to Transformation Forum: A Roadmap to Health Care’s Next Era – 90 Days Out held in Washington, DC. The panel discussion can be seen in its entirety on C-SPAN.

MLO Retraction Forthcoming
on Tube-Pouring Error

In a response to a reader’s question the November issue of MLO magazine suggests it may be acceptable to combine the contents of a clot-activator tube with a heparinized tube before clotting is complete under certain circumstances.

The Center for Phlebotomy Education immediately notified the editor and the “Tips from the Clinical Experts” columnist of the error.

“One of the risks of permitting unorthodox practices under one narrow circumstance, especially to a readership the size of MLO’s, is that people will start applying it to all circumstances,” said Dennis Ernst, MT(ASCP), the Center’s Executive Director, in a letter to the columnist. “They will forget the exceptions, the consequences, and the literature that advises against it. The next thing you know, people are pouring EDTAs into red tops with potentially devastating consequences to patients.”

Ernst received assurances that the December issue would contain a retraction, but received no confirmation of whether the error would be corrected in the online version of the November issue.

“Trainers and managers of those subscribing to MLO magazine should address the error with their staff proactively,” says Ernst. “They may never see the December issue or the retraction. Worse yet, they could start pouring red-tops and green-tops together at the bedside during difficult draws today thinking it’s suddenly acceptable under certain circumstances. It’s too dangerous to let this go unaddressed.”

This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 14th year of publication, are reading about this month:

  • Feature Articles

    Benchmarks, Part 3: Patient/Sample ID Errors
    Getting Over Your Identity Crisis

  • Playing it Safe

    Student PPE

  • Phlebotomy in the News

  • Tip of the Month

    Label or Liable

  • CE Questions

    (Institutional Version Only)

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, click here.

On a Personal Note...

Did you hear about the man who won his wife in a raffle? It’s true, and it happened to someone you know. If you have a moment, follow me.

On a Personal Note blog

Featured FAQ

Drawing From Patient Sitting on Exam Table

Question

Is there any documentation about drawing blood from ambulatory patients sitting on an examination table? I know that this is not appropriate draw procedure, but I am looking for documentation that states it explicitly.

Answer

Most textbooks make a reference to positioning patients so that they won’t be injured if they faint. Although it may be hard to find specific mention of exam tables, I think it’s easy to find the language you need in the CLSI venipuncture standard.1 It states that patients should be seated in chairs suitable for venipuncture and that they should have arms to prevent falls should the patient lose consciousness. Keep in mind that passing out is a risk of phlebotomy that all who collect blood specimens should guard against. Drawing patients who are sitting upright on exam tables suggests the collector is not anticipating a loss of consciousness, which is a known risk of the procedure.

Reference

  1. CLSI. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard—Sixth Edition (H3-A6). Wayne, PA 2007.

Survey Says

My Gift

This month’s survey question: Due to the overwhelming number of responses, we are keeping this survey open another month.

Suppose today is the birthday of every one of your co-workers. What is the one gift you would like for them all to receive today? (Examples: a pay raise, the day off, respect, truffles, easy veins...)

Take the survey.

Last Month on Facebook

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

  • Fingersticks on 6-month old babies
  • Phlebotomy lectures in Portland, Maine
  • Robotic phlebotomy
  • “Too experienced” to work in a lab?
  • Capillary punctures to the thumb
  • CEUs for phlebotomists
  • Podcast on decentralized phlebotomy

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

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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
Stuck on Labeling Challenge

One reader writes:
At our facility phlebotomists label the tubes first and then draw samples. I have pointed out that it is a wrong practice and it should be done reversely but to no avail. I am told that there are pros and cons for both practices and our facility is OK with our current one. Also that many other facilities follow the same practice. Is it okay to continue with this or should it be stopped?

Our Response

You are right to question this practice. The CLSI venipuncture standard clearly states tubes are to be labeled after collection, not before. The Joint Commission has the same requirements. We don’t know any facility at which it is an acceptable practice to pre-label tubes, but the panel is in agreement that facilities that permit it are clearly operating below the standard of care and would not have a plausible defense should a patient suffer as a result.

Labeling in advance opens up the risk of sample misidentification should the draw be unsuccessful, or tubes may not be filled. Should the patient pass out, suddenly withdraw consent, or be a difficult draw and no blood is obtained, the labeled tubes could be used on the next patient. Stranger things have happened. Labeling it in the presence of the patient also gives the patient the confidence that the sample is properly labeled. The question is: does your facility want to keep this risk, or eliminate it. Pre-labeling is pointless and saves no time.

Each month, our “What Should We Do?” panel of experts collaborates on a response to one of the many compelling problems submitted by our readers. Panelists include:

Dennis J. Ernst
MT(ASCP)

Catherine Ernst
RN, PBT(ASCP)

Lisa Steinam,
PBT(ASCP)

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.)

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