In this issue:
Theranos: Revolutionary, Renegade or Both?
The Empowered Healthcare Manager
This month in Phlebotomy Today
Survey Says: body art
What Should We Do?
Tip of the Month: Just a phlebotomist
Theranos: Revolutionary, Renegade or Both?
If you haven't heard of Theranos, you're not alone. Since 2003, the Palo Alto (California) company has been quietly reengineering the way diagnostic blood samples are collected and tested. Only recently has company founder and CEO Elizabeth Holmes come out of her lab to talk about her vision for the future of laboratory testing and Theranos' progress toward it.
"Over the last ten years Theranos (combined from "therapy" and "diagnose") has worked to redevelop all of the tests run in the traditional laboratory to be able to take... a few droplets of blood instead of the big tubes that are traditionally drawn from an arm," said Holmes in a recent USA Today interview, "and we've made the tests from these few droplets of blood available at prices that are unprecedented."
Already operating at 41 Walgreens stores in and around Phoenix, Arizona, Theranos' web site boasts an impressive test menu of, and jaw-dropping prices for, over 120 assays and panels. According to Holmes, a thousand more assays are in the pipeline. All Theranos testing is performed on capillary samples collected into a patented "nanotainer" about the size of a dime.
Does that spell the end of venipunctures and those who perform them? Maybe, maybe not. "Goodbye big bad needle" is a marketing phrase used to promote Theranos testing on a Walgreen's web page promoting the service, but a footnote reads "Blood may be drawn by a finger stick or venous draw performed by a Theranos- trained technician for Theranos testing performed in their CLIA-certified laboratory."
In a Medscape.com interview, Holmes describes the goal of Theranos as that of increasing patient access to critical blood testing. "Ultimately our goal is to be within five miles of every American's home across the country."
At Theranos wellness centers within Phoenix-area Walgreen's (and one in Palo Alto), samples are collected by pharmacists and other healthcare professionals. "We have trained and certified phlebotomists and/or other appropriately state-certified personnel, but we're also leveraging the expertise of the pharmacist," says Holmes.
Despite what seems to be a potential to revolutionize the laboratory testing industry, the company seems a little shy about playing in the traditional laboratory sandbox. Trade shows, industry publications, and scientific assemblies---traditionally THE landscapes for trailblazers like Theranos to explode onto the marketplace---have been devoid of a Theranos footprint.
Instead of dancing with entrenched industry behemoths like Quest and LabCorp, Theranos seems to prefer a more organic approach to gaining prominence and market share. Their strategy for growth seems to revolve around building partnerships with retail pharmacies and other companies that can offer patients the kind of street-corner accessibility Theranos wants them to have to laboratory services and test results.
By executing this end-around run, Theranos competes by not competing. That makes them a renegade for sure, but being a revolutionary requires a revolution. While forty-one Walgreens in Phoenix does not a revolution make, Theranos seems to be a change agent determined to bridge the gap between patients and their lab work. That's enough to revolutionize the industry.
The Empowered Healthcare Manager: Rehiring your staff
Every month, Phlebotomy Today-STAT! reprints one of the prior month's posts to The Empowered Healthcare Manager blog, written by Dennis Ernst.
Think about every member of your staff and ask yourself this question: If he/she wasn't already working for me, would I hire him/her?
If the answer is yes, you did an excellent job hiring, empowering, and maintaining that person as an asset. If the answer is no, you're maintaining a liability.
If you find you're maintaining liabilities you have three choices. 1) turn the person into an asset; 2) terminate the liability; 3) let the liability continue to be a drag on your spirit, your department and your team.
The first option should exhaust you, the second should sadden you, and the third should embarrass you.
Subscribe to The Empowered Healthcare Manager.
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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:
Your 2015 Resolutions
On the Front Lines
Excessive syringe use
Sticks, Staph, and Stuff
phlebotomy tray placement
From the Editor's Desk
The Empowered Manager
Taking inventory of your staff
If it's published, it must be true
Study Finds Training in Technique Not Enough to Assure Compliance
For subscription rates and to subscribe to Phlebotomy Today, click here.
Survey Says: Body art
In last month's survey, we asked visitors to our web site and friends of our Facebook page about their employer's policies about body art. In the 6 years we've been conducting surveys, this one brought the second highest number of responses. Clearly body art in the work place is something people are anxious to talk about.
Our first question asked about their employers' policies on earrings. Fifty-six percent said a policy regulating earring use was on the books, 44 percent said there wasn't. Of those who had a policy, 29 percent said their policy put the limit at one per ear. Nine percent allowed two earrings total, but permitted them to be both on the same ear. Forty-six percent reported a policy limiting earrings to two per ear. Five percent allowed three per ear, three percent permit four per ear, and another five percent permitted no more than six per ear. Here are the comments from those whose facilities had policies beyond just the number of earrings:
- No long dangling earrings
- Have to be studs or very small hoops no bigger than a dime
- No dangles, the number doesn't matter
- No limit for amount but the earring cannot be longer than 1.5 inches.
Not surprisingly, 47% said their policy was randomly enforced. Twenty-four percent said their policy was not enforced at all. "If you're a favorite, you can get away with it," said one. "Depends on who you are," chimed in another.
Sixty-six percent of those who participated in the survey said their employer has policies on non-earring piercings, too. Nearly 80 percent said their policy restricts piercings beyond the ear. Here's how the rest stacked up. (Click to enlarge.)
Nine percent of those responding said their non-ear piercing policy was not enforced. Thirty-two percent said it was sometimes enforced. Some comments:
- I think they really only enforce it if a complaint comes in from a patient or they are looking to fire a person
- Again, it depends upon the manager
- Strictly enforced!
Hair colors and styles
When it comes to hair colors and styles, fewer facilities have policies than for piercing. Fifty-three percent said their facility has policies limiting hair colors. Thirty-one percent limit styles. Those who limit colors limit them to "natural" hair colors only (58%). Others leave the limitation up to supervisory discretion (42%).
Hair styles are not a matter of policy at 69 percent of facilities among those employees surveyed, but of those who do place style limitations, 59 percent indicate a "neat, trimmed and groomed" style. Forty-one percent leave policy on styles up to supervisory interpretation. Comments include:
- Pulled back if long
- Must be kept up and out of the face
- Hair up if longer than shoulder length
- Long hair tied back
- Safe hair styles always
- As long as hair is pulled back
- Hair should be neat and tidy. Prefer that long hair is tied back away from the face.
- hair must be above the shoulder or tied back
Respondents indicated only 45 percent of facilities enforce their policies on hair style and color.
Sixty-two percent of those participating in this month's survey said their facility had a policy on tattoos. Of those, seventy-two percent said their policy was to keep all tattoos covered during work hours. The remainder permitted minor exposure. Some comments:
- Tattoos can be no more than 2 inches in length. Non offensive and try to cover if possible.
- Small, non-offensive only
- Offensive tattoos [must be] covered; new visible tattoos need approved by manager.
- Only if tattoos are not offensive
- No tattoos showing on the neck, arms or face
- Exposed arm down must be covered up. This is personal art, not public art.
- I am old school and find tattoos on a female gross; [I find] any facial or wrist-like tattoos stupid also, but today's generation does not think so.
- Only small can be visible. But that is open to interpretation. I'm male and have sleeves. Of course I'm discriminated against.
Like the other categories in this month's survey, just over half of facilities with policies on tattoos enforce them.
This month we are conducting our first-ever salary survey. Whether you're a manager, educator, phlebotomist, nurse, CLS or any other healthcare professional with blood collection responsibilities, we'd love for you to participate. We do not ask or collect any personal or facility-affiliation information.
Take the survey
What Should We Do?: Capillary draws from a patient without fingers
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: We have a patient who comes in for capillary blood gases. Due to an accident he has no fingers except for his thumbs. From what I understand, the thumb has a pulse, which means an artery passes through it and is at risk for puncture. The standards discourage the big toe and earlobe. What should we do?
Our response: First, let's clarify the Clinical and Laboratory Standards Institute's (CLSI) position on punctures to the great toe. CLSI does not say the big toe should be avoided in its skin puncture standard. It's just not listed as a recommended site for capillary punctures. Here's why: the last time the standard was revised (2008) the committee (chaired by Dennis J. Ernst) felt there were enough other options for capillary punctures without mentioning the great toe, so it was dropped from the list of "recommended" sites. Not because it's not recommended, but because it is rarely required. We know of no risk involved in drawing from the great toe, so it may be your preferred option.
CLSI's skin puncture standard does not recommend the earlobe because its thickness. Should the sharp penetrate through the other side and into the collector's finger as he/she is supporting the earlobe, a sharps injury may occur. Additionally, the earlobe might prove difficult to obtain adequate sample volume for capillary blood gas testing.
You are correct about the thumb having a pulse, making it risky for fingersticks. We suspect the vasculature of the thumb varies considerably, making it difficult to purposely avoid the artery. Given all this, we would give the great toe priority.
It's a toss up to me about which comes next, the earlobe or the thumb. We've never heard of punctures to the thumb's artery causing problems, but excessive bleeding is not the only concern. Given you'll be collecting a capillary blood gas, the potential for arterial blood to enter the sample can lead to a misinterpretation of results and alter the way the patient is treated.
You and your staff will need to weigh the options carefully, and consult with the ordering physicians about the risks involved. Depending on why the physician is ordering capillary blood gases, a pulse oximeter or point-of-care test that requires a lesser volume of blood may yield the desired information without the risk.
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:
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: Just a Phlebotomist
Click here for this month's featured Tip of the Month from our rich library of archived Tips.