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Phlebotomy Today

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January, 2016

In this issue:

CMS Puts the Smackdown on 758 Hospitals
The Empowered Healthcare Manager: Respect for your time
Product Spotlight: Phlebotomy Central new member discount 
Laboratory Industry Ripped for Lack of Oversight
This Month in Phlebotomy Today
Survey Says: infant heelsticks
What Should We Do?: To tattle or not to tattle
Tip of the Month
: Mind the Gap


CMS Puts the Smackdown on 758 Hospitals

Shocked man with paperworkEvery year at the Phlebotomy Supervisor's Boot Camp we solicit volunteers from the audience to act out what happens when healthcare facilities don't control healthcare-acquired infections (HAIs). Last month it became a reality for over 750 U.S. hospitals.

In a report released last month, the U.S. Centers for Medicare and Medicaid Services (CMS) punished 750 facilities for failing to make progress in preventing the frequency of HAIs among their patients. The fines constitute a one-percent payment reduction to all Medicare discharges over the next year. That equates to a collective loss of $364 million in healthcare reimbursements in 2016. Those penalized represent the worst performing 25 percent of hospitals in the U.S. in reducing HAIs. Approximately 54 percent of those on the list were also on last year's list of worst performers.

Healthcare-acquired infections (formerly referred to as nosocomial infections or hospital-acquired infections) kill 75,000 patients in the U.S. every year.

A complete list of hospitals on the list can be found here.


The Empowered Healthcare Manager: Respect for your time 

Every month, Phlebotomy Today-STAT! reprints one of the prior month's posts to The Empowered Healthcare Manager blog, written by Dennis Ernst. 

Clock2Empowered healthcare managers don't have a lot of time to squander. That's because you're doing far more than just waiting for the next crisis. You're building, creating, solving, improving, and empowering others. You have an open-door policy because you want to be accessible, but there are strings attached.

Everyone on staff knows not to enter your offices with a problem unless they are prepared with a possible solution. The staff knows they don't wander in just to visit, or to communicate something that could have been transmitted by email. They know their entrance into your office needs to be purposeful, important, and brief. If you wanted pointless intrusions you'd leave your email program open all day. But you don't. You employ the Dr. Pepper approach to emails, checking for new messages only at 10, 2, and 4, then getting back to work.

When someone squanders your time, one of two possibilities exists: 1) they don't know they're squandering your time or 2) they don't respect your time. The first is easier to fix than the second.

Make sure everyone on staff knows what constitutes an acceptable drop-in, e.g., the building is on fire, a customer demands to see a supervisor, an immediate decision or action is needed, a dispute is out of control, or someone needs to be fired on the spot. If an issue can't be handled by email, a request by email for an appointment to discuss the issue is preferable to an unannounced drop-in. Anyone who thinks it's better to ask for forgiveness than permission is guilty of willful disrespect.

After defining a legitimate interruption, you will be tested. "Next time, just send me an email," is a sufficient response. Only when the boundaries to your time are repeatedly violated can you conclude there exists a lack of respect for your time. When it becomes obvious, it's time for a heart-to-heart. Ask why intrusions continue despite your plea for alternative forms of communications. Re-establish how disruptive the intrusions are, that it makes you feel your time and authority are not being respected, and lay out the consequences for the continued squandering of the only non-renewable resource you have.

Starting today, tally the number of unexpected drop-ins. Each one breaks your concentration and causes you to unplug from the task at hand. Depending how deeply involved you were, ramping back up to the same level of concentration may cost you fifteen minutes or more. Over a week, month, or year, what you lost can be staggering.

If the number astounds you, set the staff straight. Re-establish you have an open-door policy for good reason, but your availability has strings attached. Those strings are what keep you productive, effective, focused, and empowered.

Squandered time wants to demote you to ordinary.

 Subscribe to The Empowered Healthcare Manager.


Product Spotlight:  Phlebotomy Central Membership


PhlebCentLogoDo you wish there was one place online you could go to look up anything about blood sample collection and find an authoritative answer? Are you frustrated with the lack of good in-house CE exercises for your staff? Have you ever needed support defending your position on a heated phlebotomy topic? 

If so, you should join Phlebotomy Central.

We've been building it for years; now it's enormous. It's become the most comprehensive collection of blood specimen collection information on the Internet. Join Phlebotomy Central and your facility will not only receive an Institutional subscription to Phlebotomy Today, our flagship newsletter, but you'll have 24/7 access to the most comprehensive body of knowledge on blood specimen collection ever assembled online. Sections include:

  • PCTVlogin_screenshotPhlebotomy Today archives--- almost 200 back issues going all the way back to 2001;
  • The Manager's Toolbox – a growing list of documents, SmartCharts™, competency checklists, literature reviews and procedure templates that managers and educators can use to enhance their understanding of preanalytical processes and manage their staff more effectively;
  • FAQs – Answers to hundreds of the most frequently asked questions, searchable by keyword or phrase;
  • To The Point® download articles – 18 in-depth detailed articles in PDF format covering a wide range of specimen collection topics for inhouse credit (quizzes included; answer keys available upon request);
  • ATMs---21 short articles to satisfy your monthly inhouse CE requirement (quizzes and answer keys included).

If purchased separately on our web site, it would cost over $1300, but as a Phlebotomy Central member, you get them all for only $399/year. Subscribe by January 31, 2016, well give you a special welcome rate of $339 for your first year. That's 15% off our regular membership rate.

It's often been said the next best thing to knowing a fact is knowing where to find it. Phlebotomy Central, you'll find it here. For more information on what we've packed into your Phlebotomy Central membership, click here, or call us toll free at 866-657-9857. To secure your discount, enter Coupon Code PC60 when you join online or include it on your facility's purchase order. (New members only; renewals not eligible.)


Laboratory Industry Ripped for Lack of Oversight

Chart_1_SSA scathing investigative report published in November impugned the laboratory industry for being self-regulated and failing to protect patients from serious injury and death. The report, published in the Milwaukee (Wisconsin) Journal Sentinel, highlighted lapses found during a spot inspection by federal regulators that led to the closing of one part of the laboratory.

Three months after the facility passed an independent inspection by the College of American Pathologists (CAP), federal regulators found expired blood bank reagents used for compatibility testing, evidence of improper training, violations in proficiency testing, inadequate competency assessments, and a lack of documentation that employees were qualified for their positions. Federal regulators inspect less than two percent of laboratories that subscribe to private accrediting organizations like CAP.

A Journal Sentinel report published in May of 2015 was also highly critical of the laboratory industry's lack of control over routine testing. To underscore the devastating consequences of the problem, the article highlights one patient who received a false-positive HIV result that subsequently destroyed his relationship with his wife. His samples were not labeled in his presence. In another case, an inaccurate prenatal screening test failed to detect a blood incompatibility between the mother and the baby. The lack of a diagnosis deprived the infant of prenatal care that could have prevented the infant's death at 3 weeks. 


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
The Art (and Magic) of Centrifugation, Part 3

On the Front Lines
Nasal Swabs in Outpatient Areas

From the Editor's Desk
Good Riddance, 2015!

Sticks, Staph, and Stuff
Wanted: Germaphobes

High-powered Talent
What it Looks Like

Movers & Shakers
George Fritsma

What's Wrong Here?
A monthly image to test your powers of observations

Subscribe to Phlebotomy Today and get this issue immediately.


Survey Says: Infant heelsticks

  Lady listening
Over the last two months we've been soliciting your comments about how you perform infant heelsticks. Thirty-nine percent of those who responded to the question about the type of device they used indicated an incision device, i.e., one that slices the skin. Forty-nine percent use puncture devices that perforate vertically. Eleven percent didn't know.

Then we asked "Does your facility have a policy limiting the number of heelsticks that can be performed on an infant?" Twenty-eight percent said yes, forty-seven percent said no, and twenty-five percent didn't know. We hoped those who didn't know ultimately found out. Some comments:

  • HeelstickVenipuncture is faster and more accurate.
  • 2 times
  • Maximum 2 times.
  • No more than one heelstick.
  • Two punctures per staff member for a total of 4. Our OB department does the majority of collections but I'm not sure they follow the same protocol.
  • Per person, but not a limit of heelsticks.
  • Two per heel, and after two, if phlebotomist is unsuccessful in obtaining adequate sample, supervisor or other staff member is called to attempt
  • Heel stick on other foot.
  • No more than two sticks per phlebotomist, per patient, per collection.

We then asked "When you perform a heelstick, do you "double-stick" (i.e., make two simultaneous punctures/incisions initially)?"

  • Yes: 1%
  • Sometimes: 9%
  • Never: 88%

CapillarySticks 022Comments include:

  • Double-stick is not allowed at our facility.
  • That has not been done for years, since the early days when we used the old steel lancets.
  • If a person is using a lancet with retractable blade that is not possible, unless using two lancets.
  • Outpatient lab does not, but peds sometimes does.
  • Never initially. If I can't get enough sample I will stick near the first site.
  • This is never an appropriate thing to do to a baby's heel.

Finally, we wanted to know how frequently respondents prewarmed infant's heels prior to a heelstick. Seventy-four percent always prewarmed; 11% frequently prewarmed and 15% never did. Their comments:

  • PrewarmHeelIt helps greatly to prewarm the heel.
  • I evaluate by simulating the technique and then deciding based on how quickly the capillary beds refill and skin's temp.
  • 3-5 minutes, making sure heel warmer is not too hot.
  • I get the best results if I leave the heel warmer on the baby's heel for about 10 minutes before calling the parent and baby back for the procedure.
  • I always warm. If the patient is on the large end of heelstick age/weight, has circulation issues, or is just cold, I will use one warmer on the heel and one on the ankle.
  • We require our staff to pre-warm the heel.
  • Not frequently, just sometimes, depending on amount of blood required and warmth of the foot.

This month, we're taking this survey into the realm of the miraculous, otherworldly, and supernatural. Healthcare professionals work on the razor's edge of life. Many experience healing and end-of-life events that cannot be explained. We want to hear your stories.

Take the survey


What Should We Do?: To tattle or not to tattle

Right way wrong way sign 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: I've observed a coworker, who has numerous years of experience over me, leave the tourniquet on after removing the needle from the patient. I saw it twice in the same day, so I know it's part of this person's regular technique. If I'd done this in my phlebotomy program I would've failed the skills check. Part of me wants to call our facility's confidentiality hotline but I know during our annual competency check this would be overlooked. The person who conducts them is the phlebotomist's friend. What should I do?

 Our response: Leaving the tourniquet on after removing the needle is not an inconsequential mistake. It results in bruising, hematoma formation, both of which have the potential for complications. We sense you won't sleep well until you bring it to the attention of someone who can change the individual's behavior.

We suggest reporting it to the individual's immediate supervisor. If that's the same "friend" as the one who conducts the competency assessments, don't assume he/she is incapable of putting patient care ahead of their friendship. Bringing it to his/her attention should prompt the supervisor to discretely observe your coworker's technique, and react appropriately. That would be the proper reaction to an observation anyone on staff brings to a manager's attention in confidence.

If your coworker's supervisor does nothing, or, worse, tells him/her that you ratted on his/her technique, your lab has an entrenched management problem that you will never solve, and will likely suffer from as long as the dysfunctional manager has authority. You will then have to make the difficult decision on remaining employed there. 


Answers just ahead signGot 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

Print and post this month's featured Tip of the Month: Mind the Gap.