March, 2016
by Dennis Ernst
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Study Establishes Phlebotomy Productivity Benchmark
Product Spotlight: Phlebotomy CE Day
Movers & Shakers: Dr. Amy Baxter
Center Announces Boot Camp VIII
The Empowered Healthcare Manager: Big Wheels
Free Webinar on Urine Collection
Can Drones Transport Blood Samples?
This month in Phlebotomy Today
Survey Says: Supernatural phenomenon
What Should We Do?: Leg draws
Tip of the Month: Ten Things You Should Never Say to a Patient
Study Establishes Phlebotomy Productivity Benchmark
Jones and her team set out to establish the distribution of phlebotomy "cycle times" at various hospitals. One hundred and ten phlebotomists were observed performing four to six phlebotomies at four adult acute care hospitals in Calgary. The phlebotomists were separated into groups according to their experience.
The average time to perform the required steps of a routine, uncomplicated venipuncture was 4:19 per patient with a standard deviation (SD) of 52 seconds. There was no statistically significant difference between experience levels or hospital location.
"We were somewhat surprised that the observed cycle times were independent of phlebotomist experience and hospital location," said Christopher Naugler BScH MD MSc CCFP FCFP FRCPC, who co-authored the study. "However, this also gave us confidence that the times we observed would be applicable in other settings."
Each procedure required the successful completion of 14 steps, including hand hygiene (before and after), applying pressure post-venipuncture, and donning gloves. Transit times going to and from the patient and laboratory were not included. According to Christine Lemaire, who co-authored the study with Naugler, the 52-second SD they calculated allowed them to recommend an acceptable range for performing a venipuncture to be between 3:16 and 6:44 (representing two standard deviations). "It's a guideline and indicator for the phlebotomist and the laboratory leaders to ascertain training needs and productivity."
Based on these results, Naugler was able to recommend phlebotomies at his facility to be performed at a rate of ten patients every hour, not including travel to and from the patient's location. "This study filled an important gap in our knowledge. We anticipate that it will be useful in training, process excellence and performance expectations."
Product Spotlight: Center Announces Phlebotomy CE Day
CE Day will take place on Saturday, August 13, 2016 at the Embassy Suites in Walnut Creek, California. Six P.A.C.E.® credits will be issued to those who attend the full day of lectures. Half-day credit is also available. Four lectures will be presented, each 90-minutes in length, by international lecturer and author Dennis J. Ernst MT(ASCP), NCPT(NCCT). Titles include:
- What's New in Phlebotomy
- What You MUST Know About the New Venipuncture Standard
- What Would You Do? (case studies)
- Phlebotomy C.S.I.
This will be the Center's 3rd annual CE Day. Prior events have all been conducted in northern or southern California to help the state's 30,000+ phlebotomists meet their biannual CE requirements to remain licensed in the state. Prior events have drawn attendees from across the U.S. as well.
Registration is open on the Center's web site.
Movers and Shakers recognizes individuals in the industry who are making a ruckus. Passionate visionaries, activists, and change-agents who are working to improve patient care by increasing the quality of blood samples collected and the caliber of those who draw them through innovation, education, legislation, and leadership. They do so tirelessly, often without any compensation besides the satisfaction of making healthcare better at delivering good health.
Many physicians treating children grow accustomed to the wailing and tantrums that naturally occur whenever a procedure requiring a needle is necessary. Not Amy Baxter.
As an emergency pediatrician and pain researcher, Dr. Baxter believes needle procedures shouldn't have to be traumatic, so she set out to find a way to put a patient's fears at ease by developing a device that replaces chaos with composure, paranoia with peace, and trauma with tolerance. She called it Buzzy®, and it's been making needles tolerable to children and needle-sensitive adults for seven years.
The genius of Buzzy employs the well-established pain reduction benefits of cold and vibration. The device, which resembles a ladybug or friendly bee, is placed around the arm where, for example, a venipuncture is to be performed. Its non-latex band can even double as the tourniquet. The wings of the device, which are kept in the freezer until needed, are attached and the vibration feature unit turned on. Both sensations physiologically overwhelm the pain nerves so that the insertion of the needle is masked almost imperceptibly to the child or adult."For a profession that swears to do no harm, we forget that needles hurt," says Baxter, "and can cause phobias that decrease preventative care for a lifetime."
The universal beauty of Buzzy is that its applications go well beyond venipuncture. The device can be used to minimize the pain of immunizations and other injections, IV insertion, and muscle soreness. Healthcare professionals use it for diabetes, dentistry, travel immunizations, fertility shots, finger testing, splinter removal, and flu injections.
"Fascinatingly, vibration vasodilates," says Baxter. "Two studies found easier phlebotomy when using Buzzy, so even adult hospital units are using it."
Dr. Baxter's device is redefining the dreaded needle experience for millions of pediatric patients and adults with an aversion to needles. So much so, her contribution to pain management qualifies her as a bona fide Mover & Shaker. As further proof, she has been featured in publications no less prestigious than Forbes, U.S. News & World Report, Wall Street Journal and Free Enterprise. She's also appeared on Fox Business News, TedMed, TedX Peachtree, and CNBC's Shark Tank. Buzzy is now in use in over 5000 hospitals and clinics and becoming known worldwide as the go-to technique to minimize the trauma of needle events.
Recently, Dr. Baxter has made the monumental decision to give up her position as a pediatric emergency physician to devote herself full time to growing her company, MMJ Labs. Since launching Buzzy, MMJ Labs has released a line of companion products. DistrACTION® is a line of posters and cards Dr. Baxter developed to distract pediatrics and needle-phobic adults from a needle event by providing counting and finding tasks that take the patient's mind off the procedure.
"Adults who feel dizzy or nauseated with needles learn that by focusing elsewhere, they decrease the negative sensations, "says Baxter. "To help kids learn this lesson, we discovered that providing a visual and cognitive distraction is a critical part of improving the blood draw process. Our DistrACTION cards have cute counting and finding tasks. Amazingly, three independent studies showed the cards decrease venipuncture pain by half."
Every healthcare professional with blood collection responsibilities dreads drawing from pediatrics and needle-phobic adults. Thanks to Dr. Baxter's dedication, Buzzy and DistrACTION offer cost-effective and proven strategies to make the experience less traumatic on both sides of the needle. Phlebotomy Today commends her on her work. We are so impressed with the products coming out of Dr. Baxter's company, MMJ Labs, we hope to include them in our catalog and on our web site soon.
BONUS: Listen to a podcast of our recent interview with Dr. Amy Baxter.
Boot Camp VIII Date, Location Announced
Answer: Attending the most empowering, transformative seminar you've ever attended.
At least that's what past attendees to the Phlebotomy Supervisor's Boot Camp have said about the event. "I had a staffing challenge with a trainee when I returned from Boot Camp," said Karen McKinney of Cameron Hospital in Angola, Indiana. "I am happy to say that without the tools that were provided during this seminar I would not have had the courage or confidence to do what needed to be done."
Benjamin Galay from UCSF in San Francisco said "I only regret not inviting other lab supervisors to join me. The information and material were great. I feel I have something new that will not only impact our productivity but create a better work environment and culture."
According to Laura Singley from Rogue Valley Phlebotomy School in Medford, Oregon, "You have done a phenomenal job with this Boot Camp. Very inspiring!" Jim Harrington from Cape Cod Hospital in Hyannis, Massachusetts said "The Center for Phlebotomy Education has truly outdone themselves with this program. I enjoyed every moment spent!"
Boot Camp VIII takes place November 8-10, 2016 at the Embassy Suites--Ayersley, in Charlotte, North Carolina. The same location as Boot Camp VII. "The venue is "suite," puns Dennis J. Ernst MT(ASCP), NCPT(ASCP) who will give the keynote and presentations on coaching customer service, reclaiming your lab's squandered resources, and avoiding preanalytical litigation. "The reviews from our attendees about this hotel were over the top. This property is new and the staff is exceedingly polished and professional."
The Center for Phlebotomy Education is shuffling the faculty for this year's event, bringing in Rosemarie S. Brichta MT(ASCP), formerly the Education Coordinator at Alverno Clinical Laboratories. Returning for her second Boot Camp by popular demand will be Beth Warning, MS, MT(ASCP), an adjunct instructor with the University of Cincinnati Medical Laboratory Science Program in Cincinnati, Ohio.
Attendees at the 2015 Boot Camp raved about the tour of the Greiner Bio-One tube manufacturing facility." The company is on board for conducting tours again for Boot Camp VIII.
So what are you doing November 8-10th this year? We hope you're going to Boot Camp VIII. For more information and to register, visit www.phlebotomy.com/bootcamp.
The Empowered Healthcare Manager: Big Wheels
Every month, Phlebotomy Today-STAT! reprints one of the prior month's posts to The Empowered Healthcare Manager blog, written by Dennis Ernst.
Down the road from our home lives a fellow who likes to burn rubber. Every Sunday evening, he gets liquored up, jumps in his pickup, and delights in squealing his tires up and down the road. He makes a lot of noise, scars up the pavement, puts himself and other people at risk, and disrupts the peace of those around him all at the expense of his tires and his vehicle. He's a big wheel.
Some employees act like big wheels. They make a lot of noise, put people at risk, and disrupt the peace of the workplace. The scars they leave are emotional (on their coworkers and supervisors) and disabling (on the morale of the team).
The empowered healthcare manager doesn't hire big wheels.
Big wheels don't let on they are big wheels when looking for employment. Once they're in the house and start feeling comfortable with their new surroundings, they start scarring, disrupting, risking, and making noise. It's their nature.
The role of the empowered healthcare manager is to let the air out of their tires. Immediately. The first time big wheels make their true nature known is a test to see if you object. They know their actions are objectionable because behind them is a wide swath of plundered relationships. They're waiting to see which category you fall into: those who object or those who tolerate.
Managers tolerate. Empowered managers object.
There are two ways to let the air out of any tire. You can either depress the valve and let it slowly deflate or you can slash the sidewall and destroy it for good. Use the valve first. Counsel the employee, establish expectations, set consequences, and monitor closely. Empower your staff to be your eyes and ears and let the big wheel know it. If it works, the wheel will help move your department forward along with the others that give you traction. If it doesn't it's time to slash the sidewall with termination.
By depressing the valve first, you've not only done yourself and your staff a favor by applying the necessary motivators, but you've done the problem employee a big favor, too. Life isn't easy when a person is over-inflated. We all know what dogs do to big wheels.
Subscribe to The Empowered Healthcare Manager.
Can Drones Transport Blood Samples?
Drones are used to deliver amazon.com orders, why not blood samples? The technology may be there, but a multitude of questions have to be satisfactorily answered before drones replace courier services. One of those questions was recently answered in Public Library of Science, an open access scientific publishing project.
Researchers set out to establish if test results would be affected when samples are transported by unmanned aerial systems (drones). They collected paired tubes for chemistry, hematology, and coagulation from 56 adult volunteers, transporting one set by drones and the other set by vehicle to the same testing laboratory. Upon arrival each sample was tested for a wide variety of chemistry, hematology and coagulation tests and compared.
The study concludes results from drone-delivered samples were not significantly different from those transported by vehicle. However some analytes transported by drone demonstrated slightly poorer precision (repeatability) for some tests.
Free Webinar on Urine Collection
The webinar takes place March 17 at 1 p.m. EST. Warning will describe the preanalytical requirements for urine and urine culture, identify current practices in analytical testing of urine, and describe the process of urine culture for select patient populations. One P.A.C.E. continuing education credit will be awarded to all attendees.
Registration and more information.
This Month in Phlebotomy Today:
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s flagship newsletter currently in its 15th year of publication, are reading about this month:
Feature Article
Best Practices in Tube Handling, Part 2
On the Front Lines
CBCs and Ammonias on the same tube?
From the Editor's Desk
Some products should never come to market.
Sticks, Staph, and Stuff
Study finds widespread issues with donning and doffing PPE.
High-powered Talent
If you have to tell someone you're high-powered talent, you're probably not.
What's Wrong Here?
A monthly image to test your powers of observations.
Subscribe to Phlebotomy Today and get this issue immediately.
Survey Says: Supernatural phenomenon
I once drew an elderly woman in ICU who was in soft restraints. She pleaded with me to get her scissors to cut the restraints because the angels were there to get her. I did not get the scissors, but she died about 10 minutes later so I guess they really were there!
This is a perfect opportunity for us to share our own. Catherine Ernst, RN, PBT(ASCP)CM, business manager of the Center for Phlebotomy Education, was working as a nurse in San Francisco tending to an elderly woman who was on death's doorstep. Since the patient was alone, Catherine and a nursing assistant stayed at her side as she faded toward death. Moments before her final breath, Georgiana Heyman raised her hand upward at the same time what appeared to be a mist formed above her bed. Catherine and the CNA watched in amazement, as a hand extended from the mist toward Georgiana's outstretched hand. The moment the two hands grasped each other, Georgiana physically levitated up, rising off the mattress, then back down as she exhaled her last breath, leaving a profound expression of peace on her face.
I, your humble editor, recall responding to a stat in the ICU at a rural county hospital in Indiana in 1987. When I arrived, I was astounded at the number of lines, tubes, and hoses leading into and out of the elderly male patient. There were so many, in fact, I questioned how a person depending upon all of it could possibly survive. I had seen extreme measures to keep a person alive before; this was beyond extreme. Nevertheless, I had a role to play in it all, which was to draw blood and provide laboratory test results.
Or so I thought.
As I was drawing his samples, I was suddenly overwhelmed by a strong sense that he was communicating to me, not by speech, of course, but mind-to-mind or heart-to-heart. I can't explain it nearly well enough, but with my needle in his arm, I "heard" strongly that he knew he was dying and deeply troubled by the grief his passing would bring to his wife. I had never experienced anything like it before, or since.
There was no concern from him about his own passing, he seemed to know his body was used up. His concern was only for the impact his passing would have on his beloved wife. The message was impossible to ignore, it was that strong. I had not known this form of communication was even possible before he "spoke" to me, but on that day in I heard Burrell Timberlake loud and clear. It seemed reasonable he could hear me, too.
It felt strange, even foolhardy, but I "told" him, heart-to-heart in like manner, that she's surrounded by those who love her dearly and will comfort her. She would grieve, no doubt, but she would be fine knowing you're finally at rest and free from your suffering. Stranger still, I had no idea if his wife even had anyone to comfort her at all. The message did not come from me, but through me.
I rushed the sample back to the lab, tested it and reported the results. Moments later, I heard over the hospital intercom "Code Blue in ICU." I knew it was Burrell. I rushed to respond, drew a blood gas, and reported the results. They weren't good.
Just then, I heard a sound I had never heard in that laboratory before, one I can only describe as wind rushing through the room. Burrell Timberlake had gone home.
This month, we're asking our readers if you regularly participate in a formal continuing education exercise in phlebotomy, how frequently, who pays for it, and if you find it valuable.
This month's case study: At the hospital where I work, my supervisor will not allow any phlebotomist to perform a lower limb draw even if the physician wrote them in the patient's orders. I think if you are trained adequately I don't see the big issue. It's acceptable in the standards, and would really help us if we had that option for some patients. What should I do.?
Our response: You are correct that draws to the foot and ankle are permitted by the standards with physician's permission. However, it appears to be against the policy where you work, or at least against your supervisor's unwritten policy. If it's not in writing, it should be. Clearly, you want what's best for your patient, and desire to have this restriction lifted for their sake. However, even though the standards permit it, your facility may have good reasons for not wanting feet and ankles to be considered acceptable sites. Perhaps there was an incident in the past you are not aware of that caused serious complications, even litigation.
It seems to us you are entitled to a reason so that you might better understand and accept the restriction, but at the end of the day you still have to follow facility policy. Even when it's a policy you disagree with.
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.
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.)
This month's featured Tip of the Month: Ten Things You Should Never Say to a Patient
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