April, 2008

Copyright 2008 Center for Phlebotomy Education, Inc.
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Professionalism: Attitude

Everyone carries emotional baggage. Emotions ebb and flow within us as the dramas of our own lives unfold. Sometimes it's more than we can handle to keep an upbeat and positive attitude. As healthcare professionals, the degree to which we meet the definition of a professional depends upon how successful we are at pushing down whatever negative emotions we might have at the moment. The more we suppress them, the more professional we appear to patients and co-workers.

     Even though we only spend a few minutes with each patient, the impact we can have on the patient's hospitalization experience can be profound. Very few of us carry anxiety into a patient’s room that exceeds their own. The health of every patient who presents for a blood test is somehow threatened or being monitored for threats. To them, little else could be more urgent than to eradicate them. Quite likely, patients don't care what we're going through; they have their hands full in dealing with their own problems. They just want us to perform our function skillfully, without feeling like they are a burden. 

Patients have a right to quality healthcare. When it comes to phlebotomy, those rights include:

  • to have their blood drawn safely;
  • to have their blood drawn, transported and processed in a manner free from errors that can alter results;
  • to have their blood collected according to the standards;
  • to be properly identified;
  • to be treated fairly and with compassion.

     Negative emotions threaten these rights. As difficult as it may be on our most trying days, when we arrive to work in that noble calling that is healthcare, we must reach deep within and find that inner compassion---the same virtue born within us that drove us to our profession in the first place---and deliver the confidence and expertise every patient so anxiously hopes we will reveal. To do so takes a sense of professionalism that goes beyond mastering the mechanics of phlebotomy. It considers the entire realm of the patient's experience.

     In our good moods and our bad, caregivers who maintain core courtesies every patient deserves can have a significant impact on their patients experience and, perhaps, the healing process. Courtesies such as a genuine smile, an explanation of the procedure, a heartfelt "please" and "thank-you " when manners dictate, an air of compassion, and the overall impression that they were given the preferential treatment we reserve for family and dear friends.

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This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 8th year of publication, are reading about this month:

  • Feature Article: Studies Shed Light on ED Hemolysis, Decentralized Phlebotomy
  • Ask the OSHA Expert!: an OSHA consultant addresses these burning questions:
    • What precautions do I need to take when drawing blood from cancer patients who are taking cytotoxic drugs?
    • What substances we should use to keep our hands from drying and cracking, but that don't compromise the protective barrier of our gloves??
  • Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in March including these stories:
    • Phlebotomist Held in Daughter's Death
    • Excessive Restraint During Venipuncture Indicated in Patient Injury
    • HIV Patient Scolded by Phlebotomist
    • Phlebotomist Accused of Sexual Battery
    • Botched Blood Draw Reduces Drunk Driver's Sentence in Girl's Death
    • Ban on Tube Holder Reuse Upheld
    • Scientist Perfects Fruit Fly Phlebotomy
  • According to the Standards: Order of draw and citrate tubes
  • Tip of the Month: Catch Me If You Can
  • CEU questions (institutional version only).

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, visit www.phlebotomy.com/PhlebotomyToday.html. The current month’s issue will be emailed to you immediately upon subscribing.

Recognizing Phlebotomists During Lab Week

Phlebotomy is the most commonly performed medical procedure with 1 billion venipunctures performed every year by some estimates. In most cases, it's the phlebotomist who provides the only impression of the laboratory the patient will have. Within the phlebotomy ranks at every facility are individuals who demonstrate a deep passion for their role in healthcare, ownership of the procedure they perform for the laboratory, and a dedication to their own continuing education. Yet many feel like the neglected stepchildren of the laboratory.

     For phlebotomists to feel valued by the laboratory, they need to be recognized. One way to do this is to set aside a day during Medical Laboratory Professionals Week just for phlebotomists. Teach them. Mentor them. Coach them. Thank them. Take a phlebotomist to lunch. Go out of your way to include them in your technical discussions. Tell them how much you appreciate their dedication to proper specimen collection and the expertise they bring to their role in clinical testing. The Center for Phlebotomy Education encourages all laboratories to set aside Tuesday of Medical Laboratory Professionals Week as Phlebotomist Appreciation Day.


Free Phlebotomy Today Archives

As a special to PT-STAT! readers, all new subscribers to Phlebotomy Today, the Center's full-length monthly e-newsletter, will receive a CD containing archives of all back issues. The disc includes 93 issues in all, beginning with the inaugural February 2000 issue through December 2007. The entire library is searchable all by keyword. Type "hemolysis" in the search window and you'll be presented with links to 19 specific back issues that discuss this common threat to specimen integrity. Enter "potassium" and you'll find links to 26 issues that discuss potassium problems you are likely to relate to. The archives are in printer-friendly PDF format and will require Adobe Acrobat 7.0 to view and print. (A link to Acrobat is provided on the CD.) The CD also includes all of the editor's popular "On a Personal Note" essays. The special applies to individual as well as institutional subscriptions. (To view a sample issue of Phlebotomy Today, visit www.phlebotomy.com/Newsletter.html.)     

For readers who only want the archives CD, it's available for purchase for $49.95 from the Center's 2008 catalog or web site.

     Ever since the first issue of Phlebotomy Today---the paid-subscription parent of PT-STAT!---was published online in 2000, thousands of healthcare professionals around the world have been clamoring for access to the archives. Are you one of them? If so, you'll be happy to know the Center for Phlebotomy Education is releasing all eight years of our back issues on CD.

(Editor's note: Although each issue includes the "Tip of the Month", the single-page, printer-friendly version is not included in the archive CD. That's because the Center is in the process of compiling an attractively designed collection of the Tips for release later this year.)

For more information on the archives CD, visit www.phlebotomy.com/PhlebotomyToday.html#ArchivesDisc


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Survey Says: Reusing tourniquets

Beginning in February, the Center for Phlebotomy Education launched what will become a quarterly survey on its home page asking healthcare professionals to weigh in on different aspects of specimen collection in their facility. Given the widespread attention toward reducing nosocomial infections, the first survey asked visitors to our site about their facility's policy on tourniquets. Here are the results of the survey:

Question: Does your facility have a single-use policy for tourniquets?

Response: Yes:  33.3%      No: 66.7%

     It's difficult to say just how many of the estimated 98,000 deaths attributed to hospital-acquired (nosocomial) infections are due to using the same tourniquet patient after patient. It stands to reason, however, that they may play a significant role. Last year, the Journal of Hospital Infection reported a study that showed 25% of tourniquets were contaminated with MRSA after one day's use. Poor hand hygiene between patients was cited as a contributing factor. The same journal earlier reported the results of a survey on tourniquets in the United Kingdom. The authors of the 2001 study reported the average tourniquet was kept in use for nearly two years.

     Cost is often a significant factor for facilities considering the transition. Some facilities lessen the impact by assigning a tourniquet to each patient upon admission, which will be kept in their room for use on that particular patient exclusively. However, without proper hand hygiene, phlebotomists can quickly contaminate them, negating the benefit.

     The current survey asks the question Have you had an accidental needlestick with a used phlebotomy needle within the last 20 years? If so, did you report it? To respond (anonymously), visit www.phlebotomy.com and click on the link to the survey in the right panel.


Featured FAQ: Fingersticks on older infants

Question: We have read some articles that say once a child is walking, the heel should no longer be used regardless of the infant’s age. Yet other articles strictly prohibit fingersticks unless the child is twelve months or older. Some walking infants get pretty strong by the time they are 12 months old and can kick like crazy. Is the 12-month rule really that hard and fast?

Response: You are wise to be skeptical about any article that says heelsticks shouldn't be performed on infants who are walking. It goes against the CLSI standard, which states that fingersticks should not be performed on infants less than 12 months of age. The concern is with bone penetration. Just because the infant walks, doesn't mean the finger is thick enough for a skin puncture. If you use a prewarming technique on the heels of ambulatory infants less than a year old, you shouldn't have difficulty getting the sample.

     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, visit www.phlebotomy.com/PhlebotomyCentral.html.


Specimen Collection Safety: Unsafe Practices

Safety needles have significantly reduced the accidental needlestick rate among healthcare workers. But safe equipment is only half of the equation. Without simultaneously changing your behavior, your risk of sustaining an accidental needlestick may not be as low as it could be. Ask yourself if you engage in any of these dangerous behaviors.

  • Do I ever recap a needle?
  • Do I ever draw blood without wearing gloves?
  • Do I ever tear off the tip of my glove to help me find a vein?
  • Do I delay the activation of the safety feature on my collection device?
  • Is a sharps disposal unit ever farther away than arm's reach when I remove the needle from the patient?
  • Do I allow sharps containers to fill beyond 75% capacity?
  • Do I use glass blood collection tubes?
  • Do I remove the needle from the syringe or tube holder before discarding?
  • Do I place my index finger above the intended puncture site, and in harm's way, to help anchor the vein?
  • Do I ever force blood into a tube by applying pressure to the plunger of the syringe?
  • When I use a syringe to draw blood, do I fill collection tubes with the same needle I used to perform the puncture instead of applying a safety transfer device?
  • Do I dismantle the safety features on safety needles, tube holders, or syringes before use?

If you answered "yes" to any of these, you are voluntarily increasing your risk of sustaining an accidental needlestick, and inviting one or more of the 20 different diseases into your body that have been found to be transmitted by a bloodborne exposure. Take inventory of those practices that could be putting you at risk and make changes in your routine.


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 "Accurate Results Begin With Me!® t-shirt. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.

Last Month's Case Study:
Finding a Stash

You work second shift at a rural county hospital in the Midwest. Your facility has been using safety needles exclusively ever since it was mandated by OSHA in 2001. When you showed up for your shift today, it was like any other day. You and others working the same shift settle in and start restocking your phlebotomy trays. After the day shift leaves, one of the newer employees with whom you've struck up a friendship pulls you into the stock room, opens a box containing non-safety needles hidden behind other supplies, and whispers, "Do you need any of these?" What would you do?


Not surprisingly, every reader who responded recognized the folly of using non-safety needles. Sixty-nine percent said they would correct the phlebotomist. Some said they'd accept the new phlebotomist's offer, only to discard of her "hidden treasure." We particularly liked this comment: "Upon seeing the non-safety needles, I would respond with 'Yes, I do need these'. At that point I would take the needles and dispose of them in the nearest sharps container. I would inform my new friend that I needed to save someone from herself this afternoon, or my day would not be complete."

     Although the scenario seemed inconceivable to some readers, others said they've experienced it first hand. "I've had this very thing happen in our laboratory," commented one phlebotomy supervisor. She was kind enough to share how she reacted to the scenario.

     She was notified by some of her phlebotomists that others (who didn't like the lab's switch to safety needles) were pilfering non-safety needles from the nursing unit. She drafted a "Notice of Compliance" every phlebotomist had to sign that stated: "I understand that under no circumstances shall any safety device be removed for any purpose, and that safety devices provided shall be used. If any deviation occurs, disciplinary action or immediate termination could result." One phlebotomist failed to comply and after repeated counseling, was terminated for having non-safety needles on his tray. She's had no problems with the use of non-safety needles since.

     Another reader from the United Kingdom attested this to be a common practice: "This is something that goes on ALL the time in the UK!!! The phlebotomists on the wards have a tendency to stash needles that they are not allowed to use by keeping them in a bag in their lockers. Some of these girls have had needle stick injuries from using needles that they are not allowed to use, and still continue to use these dangerous non-safety needles!!"

     Twenty-three percent of those who responded said they'd suggest that the phlebotomist dispose of the non-safety needles. Thirty-one percent would dispose of them themselves, then report it to their supervisor. The most diplomatic response came from Elizabeth D. from Wisconsin.

"I would politely tell them that these needles are unsafe, obsolete and unacceptable for use according to OSHA and our hospital. I would immediately discard the needles in the nearest sharps container. I would kindly re-educate the new phlebotomist as to how and why we need to use the safety needles provided. I would try to involve him/her in the process of finding any of these needles and help me to report to the phlebotomy coordinator that these needles may exist elsewhere. As not to allow any mistrust between myself and the new employee, it is crucial that I make them feel as though they have done a good thing for the lab."

For her tact and diplomacy, Elizabeth will receive a free "Accurate Results Begin With Me!®" t-shirt.


This Month’s Case Study:
Callers Who Cuss

You answer the phone and find yourself on the receiving end of an angry physician who wants to know why he hasn't received the results of his patient's stat lab work yet. His language is extremely vulgar. You maintain your composure and assure him that you will look into it, but it seems to only enrage him further. He amplifies the volume and frequency of his expletives, and starts attacking your character even though you had nothing to do with the draw. What would you do?

Tell us what you'd do in this case. Submit your response by the 20 th of the month and send it to this address and this address only: WWYD@phlebotomy.com. Submissions sent to any other address will not be considered. Keep your suggested solutions less than 100 words. Although you don’t have to be an English scholar to be considered for inclusion, submission with proper grammar and punctuation will be given priority. If you’re not sure of the appropriate solution, check your facility’s procedure manual or ask your manager. Who knows, you might be presented with the very same dilemma tomorrow.



Featured Product: Phlebotomy Central™ upgrade

Last month, the Center for Phlebotomy Education completed the first major upgrade of Phlebotomy Central, the most exhaustive and authoritative database of blood specimen collection information on the planet. First launched a year ago, the database includes eight years of Phlebotomy Today back issues, nearly 300 specimen collection FAQs, a growing list of over 15 lengthy articles on various phlebotomy topics, and the "Manager's Toolbox," which contains documents, charts, and checklists for those who manage specimen collection personnel. The recent upgrade implemented the following enhancements:

  • a thorough review and edit of every FAQ and To the Point™ article to assure they remain current in light of the recent revision of the CLSI venipuncture standard (H3-A6) released in November;
  • new FAQs;
  • the addition of "If Tubes Could Talk"—an article adapted from a popular series that originally appeared in Phlebotomy Today—to the To the Point™ article library;
  • the inclusion of a "Post-Venipuncture Care" card for managers to customize for distribution to their patients;
  • the modification of the "Hemolysis and IV Starts" literature summary to include newly published studies.

Further enhancements to Phlebotomy Central under development for 2008 include a potassium troubleshooting guide, a full-length article on pain management for infant and pediatric phlebotomy, and other enhancements.

To become a Phlebotomy Central member, visit: http://www.phlebotomy.com/PhlebotomyCentral.html

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Copyright 2008, Center for Phlebotomy Education, Inc. All rights reserved. Newsletters may contain links to sites on the Internet owned and operated by third parties. The Center for Phlebotomy Education, Inc. is not responsible for the availability of, or the content located on or through, any such third-party site. Information in this document is provided "as is," without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability, fitness for a particular purpose and freedom from infringement. The user assumes the entire risk as to the accuracy and the use of this document. We will not be liable for any damages of any kind arising from the use of this information, including, but not limited to direct, indirect, incidental, punitive, and consequential damages.