Why You Should be Certified

Millions of healthcare workers around the world are drawing blood from billions of patients every year. The vast majority aren't certified in the procedure. Are you one of them?

In most U.S. states, you have to be certified to style hair, but not to insert surgical steel into someone's arm, navigate it around arteries, nerves, tendons, and bone to obtain venous blood samples in a manner that does not change its composition before it's even tested, which can lead physicians to treat, diagnose and medicate their patients into oblivion. Style hair incorrectly and someone has a bad hair day; draw blood incorrectly and someone dies. Since sensibility usually escapes legislation, you should take it upon yourself to obtain your certification. In fact, it speaks higher of you if you seek certification on your own accord than if it were legally mandated.

Do those who are not certified perform at a lower level than those who are? Absolutely not. Many if not most phlebotomists and other healthcare professionals who draw blood possess the same or higher expertise than those with credentials. Certification doesn't make one's expertise; it only proves it. Why not prove it for yourself?

Whether you're a nurse, medical assistant, medical laboratory scientist, laboratory assistant, phlebotomist, or one of the many other healthcare professionals with blood collection responsibilities, becoming certified proclaims your  proficiency in this highly defined procedure.

Chances are, your skills are already well-honed and you are good at what you do. You undoubtedly take pride in your ability to draw specimens properly and painlessly. In fact, some patients prefer you, don't they?  They probably even ask for you by name. So why aren't you certified? Certification tells them and your coworkers that your knowledge of blood collection procedures has been measured by an independent organization that assesses this skill and has found you to possess an expertise worthy of being recognized. It says you have taken the initiative to pursue a grasp of your skill that most have not, and that you have been found to possess a knowledge of phlebotomy that commands recognition.

There are lots of reasons not to pursue certification. But there are no good reasons. Which one of these excuses is yours?

• "Certification is too expensive"—Wrong. It costs less than $100 to take most certification exams, but the benefits are well worth it. If your employer doesn't offer to pay part or all of the exam fee, have a bake sale, sell some junk, or work a few extra shifts. There's money to be had out there.
• "I won't get paid any more than I do now"—That's not true. Certified phlebotomists get paid a lot more. More respect, more self-worth, more marketability, more knowledge, more authority, and---if you find the right employer—more money.
• "It's not the law"—You're right. There is no law that says you have to improve yourself.
• "I don't have the time"—The average person watches 16 hours of television a week. You have the time.
• "I'm not smart enough"—Oh, c'mon. If you can read this, you can read an examination review book. Find a study-buddy and hunker down. If you can find time to complain about how little respect your getting, you have time to earn some. Inside of you is a certified phlebotomist desperate to be let out. She's that nagging voice you hear now and then that tells you that you're better than most people give you credit for being, and that all she needs is to be recognized. She knows she won't be recognized as a certified healthcare professional unless you take her to sit for the exam she knows you can ace with a little book work.
• "People will look at me differently if I'm certified"—That's the point. Remember, you're tired of being looked upon as just a phlebotomist, aren't you? When your name badge includes the designated certification initials after your name, people will look at you differently. Patients may not tell you, but rest assured they feel better knowing you have completed a formal process in which your knowledge of what you are about to do to them was put to the test. Think about it. If you're a patient, would you feel more comfortable being treated by a self-taught shaman or a board-certified physician? Then you'd probably be reassured if you knew your phlebotomist was certified, too. Your co-workers, family, and friends notice, too, and hold you in higher esteem.

Certification says something that only certification can say. It may not be mandatory where you work, but if you take it upon yourself to obtain such recognition, it not only reflects your passion for your work and your pride in your performance, but inspires others to do likewise. If you want to be part of something bigger than yourself, get certified. Then challenge everyone who works with you to do the same. The next thing you know, you've improved the quality of care countless patients will receive well into the future.

Research: Drawing a Discard Unnecessary for Blood Cultures

Everyone knows that when we draw blood from a vascular-access device (VAD) such as a central line or PICC line, a discard volume must be withdrawn prior to collecting the samples to be tested. This step is necessary to prevent contamination of the samples by infusing fluids. However, many studies and guidelines indicate it isn't necessary when drawing blood cultures.

One of the most common misperceptions is that there is a potential for infusing fluids to prevent bacterial growth if the discard step is omitted, especially if the infusate contained antibiotics. However, the literature is awash with contrary evidence. The current consensus is that the amount of antibiotic in an infusing line that could end up in blood culture bottles is too low to matter. Additionally, since most draws through VADs are flushed with saline prior to sample collection, antibiotic concentrations are reduced if not eliminated. Lastly, most blood culture bottles contain an additive that removes antibiotic contaminants.

According to the Clinical and Laboratory Standards Institute's blood culture guideline, neither flushing the line nor discarding a volume of blood prior to blood culture collection is necessary to remove infusing fluids or heparin from the line.

But what about drawing off a discard to remove bacteria that is colonized around the tip of the IV canula, but not necessarily a threat to the patient? Studies show colonized bacteria cannot be eliminated by withdrawing a discard volume prior to removing the sample to be cultured. Because colonized bacteria threaten to contaminate every blood culture drawn through a VAD, other sets in the order should be drawn by venipuncture so the physician has comparative results to interpret.

Center Names Online Education Director

The Center for Phlebotomy Education welcomes Lisa O. Ballance, BSMT(ASCP) CLC(AMT) as its Director of Online Education. In her new position, Ms. Ballance will coordinate the development of online continuing education exercises, webinars, and other distance learning activities as well as assist in writing and editing the Center's newsletters.

      "We are thrilled and blessed to have the caliber of Lisa's talent on our team," says the Center's director, Dennis J. Ernst MT(ASCP). "She fills a void we've had for a long time. The phlebotomists and other healthcare professionals we serve are the ultimate benefactors, though. Lisa will enable us to provide the online educational offerings they've been asking for."

Ms. Ballance comes to the Center with an impressive command of the preanalytical phase of clinical laboratory testing developed during her service as a Regional Consultant for the Laboratory Improvement unit of the North Carolina State Laboratory of Public Health. Prior to her consulting position, she served as the Laboratory Manager at the Cumberland County Health Department in Fayetteville and Assistant Chemistry Supervisor at the Womack Army Medical Center in Fort Bragg, North Carolina.

She has served as a volunteer member of several CLSI working groups that revise blood collection standards, given numerous presentations at state and national laboratory conferences, and authored over a dozen articles published in a wide variety of laboratory publications.

She was twice named Laboratorian of the Year by the North Carolina Public Health Association, Inc. and was recently certified as a Laboratory Consultant by American Medical Technologists.

Ms. Ballance and her family are relocating to Corydon, Indiana this month, where she will assume her position the first of the year at the Center's administrative offices.

This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 10^th year of publication, are reading about this month:

• Feature Article: How Blood Collection Errors Threaten Patients
• Center Names Online Education Director
  
• Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in November including these stories:
• Officer-Drawn Blood-Alcohol Levels Ruled Inadmissible
• Union Strike Limits Phlebotomy Services in Ireland
• Urine Sample Collected by Phlebotomist Thrown Out as Evidence
• According to the Standards: Repalpating a cleansed site
• Tip of the Month: Having a Pathogen Potluck?
• CEU 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.

Featured FAQ: Hemolysis and Butterfly Sets

Q: I am an IV therapy educator. We have a physician who is requesting we only use 21-gauge needles when we draw blood because 23-gauge butterflies cause hemolysis. Most of our patients have chronically poor venous status, which does not allow for use of such a larger-bore needle. We have no supportive documentation that indicates any needle-specific hemolysis. Do you?

A: This claim is likely based on mere speculation rather than solid evidence. No evidence exists in the literature supporting the claim that 23-gauge needles hemolyze specimens any more than 21-gauge needles, or that butterfly needles hemolyze specimens more than any other blood collection needle. I doubt the physician making this request can provide any supportive evidence, either.

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 web site. For information on joining Phlebotomy Central, click here.

Survey Says: How I Identify Patients

Last month’s survey asks two questions: Do you routinely ask inpatients to state their name as verification of their identification bracelet? Have you ever found an identification bracelet attached to the wrong patient? Fully 92 percent of those responding indicated they asked their patients routinely to state their names as part of their patient identification protocol.

Among the comments:

• ... also their date of birth.
• It is extremely important that both components are checked. Too many times, the wrong band has been on the wrong patient which could lead to disaster.
• ... AND ALSO DATE OF BIRTH.
• We ask the patient their name and date-of-birth while also checking the name band   
  We require the patient to state their name and dob.   
  ... AND DOB.
• We request the patient state his or her name and date of birth.
• I also ask them to state their date-of-birth since hospitals will sometimes not include the fact that the patient is a Junior or a Senior.
• The Date of Birth is also very important, for same first and last name patients.
• I always ask any patient to state their name and birth date.
• Absolutely all the time. We ask for the name and the DOB. Not asking would feel awkward.
• Staff is observed for this and patients are randomly asked if the phlebotomist has done this.
• I ask for the patient to recite their date of birth and state and spell their last name.
• Always. Of course, sometimes patients are unable to speak depending on the condition.
• Also ask for the d-o-b if they are to answer or if they seemed confused then look at the wrist band and checked against their label with the med. record number.
• I/We call the patients back by name, and I usually ask them to recite their date of birth. If it does not match the wristband, then I have them look at the band or tell me their name.

When asked if they have ever found an ID bracelet attached to the wrong patient, 74% said they had. Respondents had this to say:

• Two times I have found a patient to have the wrong bracelet, and many times I have found the patient w/o any ID.
• 1 TIME IN THREE YEARS.
• I MYSELF HAVEN'T BUT I HAVE HAD COWORKERS FIND ERRORS.
• Also different name on each arm.
• This happens very infrequently and we immediately notify the nurse or supervisor. It is corrected and we do not allow staff to draw inpatients unless the band is on, and correct.
• Asking the date of birth revealed a patient I was about to draw was not properly identified by the hospital. Both he and his father were patients of the hospital and the ID band he was wearing was actually for his father. The date of birth information was his father's, and the only way to distinguish the two.
• Funny that the patient didn't even notice.
• I told the nurse, it was cut off and a correct one was placed before I would draw the patient.
• [This is] A frequent occurrence in paediatrics where adolescents get bored and swap wrist bands to wind up the staff.
• When a patient has the wrong ID bracelet on or no bracelet at all, I instruct nursing staff to reband the patient before I perform the venipuncture.
• Especially in the ER when they are totally busy and not following the hospital policy.
• Two gentlemen with the same last name had their bands backwards. i.e. Raymond's band was on Charles and Charles' was on Raymond.

As reported in the September issue of Phlebotomy Today-STAT!, The Joint Commission recently dropped its requirement to actively involve the patient when identifying him/her prior to a blood draw. Two identifiers are required, both of which may come from the same, possibly erroneous, identification bracelet. The Center for Phlebotomy Education has been actively opposing this deletion, and encourages healthcare professionals and patients alike to urge the agency to reinstate the active patient involvement requirement as an Element of Performance (EP). Share your concerns with The Joint Commission by completing their online contact form.

Featured Product: Phlebotomy Answer Book

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.

Although last month's case study seemed to some readers to be implausible, it actually happened. In fact, it was the physician who provided the restraint in reality. They're out there. Surprisingly, eight percent of those who responded to last month's case study would have participated in the assault. Most readers (54%) would have refused to draw blood from the patient restrained against his will while15 percent would not only refuse, but would report the physician's inappropriate request. Here's one of our favorite responses; this one from Candice B.:

"In this month's case, I would inform the physician of the refusal, however, when the physician responded in the inappropriate manner mentioned, I would also inform the physician that the patient's rights would be violated and that the physician would be responsible for assault and battery charges if and when the patient filed a lawsuit. I would further request that the physician check with the risk manager of the facility before acting further. I would also remove myself from the situation and report the occurrence as an "incident" to my supervisor.... I would not give the appearance of insubordination to the physician, but I would quietly and quickly report the incident to my immediate supervisor in hopes that the supervisor would take the immediate and appropriate action, as well."

Thirty-one percent said they would ask the physician to speak to the patient before acting on his request for restraint. This solution was typical of others in this category:

"The policy at our facility is that any competent patient can refuse treatment. If a patient refuses to be drawn, we inform them that the physician will be notified of the refusal and excuse ourselves.  We do not "restrain" any patient, except when we are collecting a child and have the parent assisting by holding the child.  I would inform the physician of the refusal and remind him that we cannot by policy collect or treat a patient against his will.  I would then ask him to speak to the patient and let us know if or when to return for the collection."

The majority of those who responded demonstrated an understanding of the patient's right to refusal, and what violating it can mean to the facility. While cognitively impaired patients may not have the understanding required to refuse, they are usually accompanied by caregivers or family members who may provide permission to restrain. Likewise for children. However, adult patients who are not cognitively impaired have rights that the physician in this case study was about to trample on.

Our favorite response came from Brenda P. of ?

"Most people are afraid of correcting a Doctor.  They are trained that the Doctor is the ultimate authority for everything.  I have never been one of the people afraid of questioning a Doctor on his/her order.  I would just remind the Doctor. that there is no possible way that I would restrain or have someone restrain the patient for my own safety.  I would remind him/her that if I was to do what he/she ordered that I would be going against the law.  I would then ask the Doctor or the nurse to see if they may be able to talk to the patient & get them to understand the reason for the tests.  Doctors are as busy, if not more, than we as phlebotomists are & they get frustrated too.  Sometimes we just need to remind them of the ramifications that are caused from the actions they are asking us to do.  I would explain to the Doctor that I will not do anything for anyone that is illegal or immoral."

Because of her well-articulated response, Brenda will receive a free download from the Center for Phlebotomy Education’sTo the Point® library of articles.