Phlebotomy Making Headlines
Preanalytics is far from a sleepy industry. Between new technololgy, school scams, and phlebotomists in the news, there's plenty of headlines we thought our readers need to know about. This article summarizes how those who play in the preanalytic sandbox are creating a buzz.
Tech Startups Focusing on Phlebotomy Innovations
An article published on the Biospace web site listed the following six companies as high-tech darlings that could revolutionize clinical laboratory testing:
Genalyte---a blood-testing system using silicon photonic biosensors to perform multiple tests on a single drop of whole blood in about 15 minutes.
Athelas---has developed a technology that tells consumers what their cell counts are. Patients who've purchased the instrument collect a drop of fingerstick blood and insert it into an instrument. Within moments, they know their white and red blood cell counts. It's being marketed primarily to cancer patients who want to monitor their white blood cell counts for chemotherapy. [Editor's note: Phlebotomy Today wrote about this company in the November issue of Phlebotomy Today-STAT!.]
Karius---this San Francisco Bay Area company has developed a system capable of detecting more than 1,000 infectious diseases by analyzing DNA fragments from blood obtained by venipuncture.
Day Zero Diagnostics---this company is developing a rapid, whole genome sequencing-based diagnostic assay to identify the strain and antibiotic resistance profile of a bacterial infection from a blood draw.
Orphidia--developing portable single-drop blood-testing technology that runs 40 common tests within 20 minutes.
NOWDiagnostics---has developed an approved device for pregnancy testing the company claims is more accurate than urine tests and doesn't require a lab. Tests for cardiac and toxicology analytes are already available in Europe, and the company is developing tests for sexually transmitted disease, food intolerance and common infectious diseases such as pink eye.
Read the full article.
Students claim school swindled them
Students attending a 10-week phlebotomy course at Moss Point Career and Technical Center in Moss Point, Mississippi claim they never took the certification exam promised to them as part of their tuition. According to a story broadcast on WLOX-Biloxi, students graduated and were given a certificate, but never took a certification exam that would make them marketable in the healthcare industry. Several students claim they never did any job shadowing or internship. Nor have they ever seen the inside of a laboratory. They were seeking complete reimbursement for their $350 tuition, but, according to WLOX, the school offered to refund only their $90 certification exam.
Read the full story.
Another school facing scrutiny
Phlebotomy students enrolled in a program offered by Protrain claim they plunked down $2000 but had to fight for clinical rotations that turned out to be far from home and short in duration. ProTrain, a North Carolina-based company conducted the program on the campus of J. Sargeant Reynolds Community College in Richmond, Virginia under a contract with the Community College Workforce Alliance. According to an investigative report that aired on 8News, a former instructor admitted most students two years after graduation are still waiting for their clinical rotation assignment.
Read the full story.
Phlebotomist-legislator identifies as a nurse
According to a report in North Carolina's Outer Banks Voice, a state representative campaigned and promoted herself last month as a struggling single mother who worked her way up to become a registered nurse. That is, until the North Carolina Board of Nursing notified her she wasn't. Beverly Boswell, who is actually a medical assistant and phlebotomist said a staffer made the claim on her campaign website and Facebook because she misunderstood the representative's job.
Boswell corrected her election material the next day, and her Facebook page a few days later.
Read the full story.
Order of Draw pens
National Medical Laboratory Professionals Week
April 22-28, 2018
This month's featured sponsor: Comprehensive Drug Testing, Inc.
Experienced Phlebotomists Needed for Athlete Drug Testing
Comprehensive Drug Testing, Inc. (CDT) is a company specializing in biological sample collection from professional athletes for the purposes of testing for prohibited substances ("drug screening"). CDT seeks to contract with experienced independent phlebotomists to provide mobile services in select regions throughout the United States and in Canada. CDT has an immediate need for phlebotomists in the following areas:
- California (Los Angeles and Oakland/San Francisco);
- Georgia (Atlanta);
- Texas (Dallas and Houston);
- New York (NYC);
- Massachusetts (Boston)
- Florida (Miami and Tampa).
For over 28 years, CDT, Inc. has managed drug-testing programs for major professional sports organizations, nationwide. CDT excels in the drug and alcohol testing industry by adhering to strict quality control, procedural management, and exceptional customer service. Our philosophy is to provide the highest level of quality drug and alcohol testing services, exceeding the expectations of our clients.
Phlebotomists chosen to be independent contractors must follow specified procedures, maintain confidential information, and demonstrate respectful and professional behavior. They must demonstrate the highest level of skill, competence and ethical behavior in all duties pertaining to sample collection and ensure that the chain of custody of samples for which they are responsible is maintained.
For more information and the complete job description please contact CDT at firstname.lastname@example.org.
Venipuncture-related Injuries Get CAP's Attention
The College of American Pathologists recently turned the spotlight on the risks patients are subjected to when phlebotomy standards are not taught and reinforced. In the February issue of CAP Today, senior editor Amy Carpenter Aquino authored Procedures Up to Date? Fighting Injury in Phlebotomy, which details the extent to which patients can be injured when phlebotomy personnel aren't aware of the newly revised venipuncture standard, released a year ago by the Clinical and Laboratory Standards Institute.
"The new venipuncture standard is the most comprehensive revision in the document's 40-year history," says Dennis J. Ernst MT(ASCP), NCPT(NCCT), who chaired the revision and was interviewed for the article. "I'm thrilled CAP Today brought this to their subscribers' attention." Ernst, who regularly reviews legal cases involving phlebotomy-related injuries, can't emphasize enough how important it is for labs to update their procedures. "Facilities that have not yet updated their SOPS to reflect GP41-A7 risk operating beneath the standard of care. Trust me, attorneys representing patients claiming to be injured are going to check to see what version your SOPs reflect. If it's not GP41, you're in for some sleepless nights."
The article reveals common lapses from the standards that have lead to permanent patient injury and litigation including drawing from risky areas, improper patient positioning, and inserting the needle at an excessive angle. Actual cases were shared in the article by Nancy Erickson PBT(ASCP), a product specialist for Greiner Bio-One North America who also serves as an expert witness in phlebotomy litigation and has reviewed over 30 cases. She cites nerve injury and arterial laceration as some of the common injuries she sees, and a lack of education and failure to follow the standards as the common contributors.
Editor's note: A compelling video of our director's experience as an expert witness is available for viewing on our web site. By special arrangement with CLSI, the Center for Phlebotomy Education makes GP41-A7 available for immediate purchase (hard copy or download). Click here to order or for more information.
Product Spotlight: SmartCharts
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 set of five SmartCharts™ include:
- Blood specimen handling and processing; (3 pages);
- Investigating elevated potassium results; (5 pages)
- Analyte stability; (3 pages)
- Blood sample collections during IV starts; (6 pages)
- Blood Collection Errors and their Impact on Patients; (2 pages)
- Dead-space volumes of Commonly Used IV Catheters. (2 pages)
SmartCharts are available as individual downloads or as a complete set. To purchase and immediately download and for more information.
From the Editor's Desk
It's not often I get a behind-the-scenes tour of a laboratory that processes more than 165,000 laboratory specimens per day. In fact, I would say never... until last month. By special invitation from Dr. Dorothy Adcock, LabCorp's Chief Medical Officer, I received a VIP tour of the company's main laboratory in Burlington, North Carolina, the largest laboratory in their system and one of the largest clinical testing laboratories in the world. It was massive, mind-boggling, and a marvel of automation and robotics. But that's not what impressed me the most.
As an organization, LabCorp processes over 500,000 specimens per day at its nationwide network of primary, specialty and STAT laboratories. It's fleet of 3000 couriers log 435,000 miles/day, making 75,000 stops to pick up samples at 1800+ locations. Besides the U.S. Postal Service, I don't know too many companies that have to move so many pieces so far so fast. The USPS may process more pieces of mail, but they merely deliver one way. LabCorp not only receives samples from around North America, but then tests them and sends back the results to the appropriate provider, usually within 24 hours of collection. But that's not what impressed me the most, either.
On the front end, LabCorp has perfected the preanalytic process as much as automation and software allows without robots replacing its staff of 13,000 phlebotomists who currently draw 2.5 million samples per month. Robotics may have made substantial inroads into the laboratory industry, but neither you nor I will see robots performing venipunctures in a clinical setting in our generations. The key to LabCorp's preanalytical standardization is a dynamic software application they refer to as "Touch," which is deployed at nearly 2000 of LabCorp's Patient Service Centers (PSCs) and over 5000 office-based phlebotomy locations.
From the moment a patient scans his/her ID, Touch takes over, directing every action and activity like the conductor of a symphony. If that conductor has a name, it's Kevin DeAngelo, VP of Corporate Operations and logistics guru. With the help of his team, DeAngelo designed, developed, tweaked and maintains Touch to coordinate the steps of every draw and standardize every patient's experience. Touch prompts the phlebotomist to scan the patient's ID and labels, ask the patient to confirm his/her ID, what tubes to draw, how many times to invert them and when, scan the labeled tubes, what rack to place them in and more. No stone was unturned to standardize the collection process and make it intuitive for all users. Although the phlebotomist still has to select the best vein, choose the most appropriate device combination, manage post-venipuncture care, etc., all according to the standards, Touch eliminates many error points. For all the streamlining it brings into the preanalytic process, Touch is still not what impressed me the most.
I don't know about you, but my impression of big-box labs has always been that of massive operations that turn massive numbers of blood samples into massive quantities of data, the scale of which could not possibly avoid disproportionately compromised quality. I now know that not to be true, at least at LabCorp.
It's not the automation I saw at their largest lab, nor the size of their North American operation, nor the Touch software that changed my impression. It's the people making it all work.
I've been in board rooms before with top-level executives. When it comes to passion, I'm not easily fooled. It has a certain countenance, a feel, a tenor that can be neither suppressed nor feigned. Those I met in Burlington were some of the organization's biggest movers and shakers. Though their responsibilities are substantial and ever-pressing, we talked about sample quality well into the night. They sweat it, and their concern seems engineered into their logistics, operations, and software.
For the record, this is an unsolicited testimonial from which I neither require nor expect any gain. You've known me long enough to know I don't work that way. From where I sit, I see a lot of dysfunctionality, which I keep to myself. But when a person, company, or organization impresses me, I'm compelled to bring it to your attention. Not as an endorsement, but so that you might have hope. There is a lot to be concerned with about the laboratory professions and industry, i.e., the diminishing of our expertise, oppressive government regulations, the dearth of qualified applicants, and more. I'm here to attest to you that, in many regards, the glass is not half empty, but half-full and rising.
Dennis J. Ernst MT(ASCP), NCPT(NCCT)
A Video Tribute to Phlebotomists
If you haven't seen the Center for Phlebotomy Education's A Video Tribute to Phlebotomists, this month is the perfect time.
As the industry celebrates National Medical Laboratory Professionals Week April 22-28, laboratories far and wide will share the video with their preanalytic staff in recognition of their unique contribution to healthcare.
"Phlebotomists are the most under-appreciated professional in healthcare," says Center for Phlebotomy Education's Director Dennis J. Ernst MT(ASCP), NCPT(NCCT). "This video intends to change perceptions." The tribute video defines the profession as one that requires significant technical expertise and a grasp of preanalytical science that most don't appreciate.
"Without phlebotomists, healthcare cannot function," says Ernst, who narrates the seven-minute video. "Lab results obtained from the samples they draw are used to orchestrate the activities of nearly every healthcare professional involved with every patient they draw.
Since its release in 2016, the video has been viewed thousands of times in laboratories around the worlds.
The video can be viewed on the video page of the Center's web site and YouTube channel.
Standards Update: Patient positioning
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.
Patient falls during or immediately following a blood collection procedure is one of the most common causes of phlebotomy-related injuries. Fractures, lacerations, paralysis, even death have been known to occur because the patient was not properly positioned for the draw. Because these injuries are so easily preventable, lapses in attentiveness and positioning errors that precipitate such incidents are difficult to defend in a legal proceeding.
The standards have always required healthcare professionals with blood collection responsibilities to be vigilant for the signs of an imminent loss of consciousness including pallor, perspiration, hyperventilation, anxiety and a sudden change in personality. The standards have also always required those who draw blood specimens to remain attentive and close to the patient. Leaving the area or turning one's back on the patient can be easily argued to violate the standard in this regard.
A new precaution in the recently revised standard now mandates patients with a prior history of fainting must be recumbent during the procedure. The standard does not suggest patients should be asked if they've ever passed out for a blood draw, but rather ask if they've ever had any "problems" with prior draws. Studies have found asking patients questions about prior experiences using the term "faint" almost triple the likelihood that they will lose consciousness during or following the draw.
Editor's note: Readers are urged to obtain their own copy of the standard as soon as possible and begin implementing all new provisions immediately. 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. It can be obtained from CLSI or the Center for Phlebotomy Education, Inc.
Read an interview by CLP Magazine with Dennis J. Ernst MT(ASCP), NCPT(NCCT) about the revised standard.
Registrations Open for Preanalytical Summit
October 15-18, 2018
Charlotte, North Carolina
What Should We Do?: Hand-vein orders
Dear Center for Phlebotomy Education:
Our Cancer Center is requesting we draw only from hand veins on patients who will have chemo that day and when their other arm is unavailable because of mastectomy, lumpectomy, or other reasons. This is the first time anyone has ask us to completely avoid all draws in the median area of the antecubital. My concern is that if we draw the hand and have an issue, are we
violating the standards in regards to vein selection? What should we do?
Our response: First, physicians can't order you to deviate from the standards without putting you at risk of operating beneath the standard of care. Your lab assumes the responsibility and owns the outcome. That said, there's nothing against the standard to draw from a hand vein when an antecubital is available. It's a low-risk draw. We've never seen a legal case involving a hand vein. However, hand veins have been found to be 2.6% less successful, and more likely to be hemolyzed by the same percentage.
The reason for this request by the Cancer Center is that many chemotherapy drugs can cause "extravasation" of the drug into the tissues surrounding a prior venipuncture should the puncture not seal completely. This can cause extreme and debilitating damage to those tissues, which, in severe cases, has caused the need for amputation of the limb. Work with the Cancer Center to the best of your ability, and notify them if you are unable to comply with their request for a hand draw. That way, they will be forewarned about the potential for extravasation in a particular area. It's all about communication to keep our patients safe.
If you have to go this route, make sure your staff doubles their diligence in applying pressure and observing for hematoma. Keep in mind, the order will result in more syringe and butterfly draws, both of which will increase the risk of needlesticks.
Got a challenging phlebotomy situation or work-related question? Email us your submission at WSWDpanel@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)
Tip of the Month: I'm a Professional. I'm a Perfectionist. I'm a Phlebotomist!
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