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Phlebotomy Today

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May, 2015

Industry Urged to Standardize Tube-stopper Colors
The Empowered Healthcare Manager: A sense of impending triumph
Phlebotomy Central Membership Now Includes CEs
ASCP Posts Podcast on Blood Culture Contamination
Product Spotlight: DVD on preanalytical errors affecting K+
Definition of "Fasting" Under Scrutiny
This Month in Phlebotomy Today
Survey Says: The value of certification
What Should We Do?: Stuck in the middle of a rainbow
Tip of the Month
: the Wizard of Ahhhs!


Industry Urged to Standardize Tube-stopper Colors

Tubes4Poster 009The European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) is urging companies that manufacture blood collection tubes around the world to standardize their stopper colors. Authors of an article published in Clinical Chemistry and Laboratory Medicine affiliated with EFLM cite the risk to patients when tubes from one manufacturer are replaced by those for another with different color-coded stoppers. 

While color-coding is harmonized by manufacturers supplying the North American healthcare industry, stopper colors vary considerably around the world. In the article, stopper colors from 7 tube manufacturers were compared. EDTA, coded as lavender-stoppers in North America, are red in other countries. Heparin tubes, green stoppers in North America, are  orange elsewhere. Clot activator tube can be red (North America), white, brown or gold. The various tube manufacturers were not identified in the article.

The authors report a four-fold increase in the frequency of collection errors when facilities change tubes to a manufacturer that uses a different color code, and samples are drawn in the wrong container.


The Empowered Healthcare Manager: A Sense of impending triumph 

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

When you go to work, what's the prevailing question in your mind? Is it "What kind of fiasco will I have to deal with today?" or "I wonder if I can accomplish [your goal here] today?"

Do you have a sense of impending doom or triumph?

A sense of impending doom is not sustainable. You'll burn out long before you can make any lasting contribution. Make this the last day you go to work feeling pessimistic. Spend 15 minutes identifying what, or who, is maintaining the dark cloud over your head.

If it's a person who hasn't been properly managed, abandon your old style and apply one that works. If it's someone who refuses to be managed, terminate them. Nobody should have that kind of power over you.

If the person is above you on the ladder, it's time for a heart-to-heart or a new job. Impending doom is not sustainable. Become an empowered manager today, even if it means empowering yourself.

If the cloud of doom is being maintained by something you haven't conquered yet---high blood sample rejection rates, crippling staff turnover, rampant inter- or intradepartmental friction, or a Systemic Staff Disorder (SSD) such as gossip, low morale, apathy, non-compliance with policies/procedures---put it on project status. Start obliterating the obstacles that keep the cloud from dissipating. Tomorrow is too late.

If you start your day with a sense of impending triumph, good for you. You are blessed beyond words. Now go out and find someone with a sense of impending doom and show them how to get where you are.

 Subscribe to The Empowered Healthcare Manager.


Phlebotomy Central Membership Now Includes CEs

PhlebCentLogo_400wPhlebotomy Central, the Center for Phlebotomy Education's online membership site, now contains 19 To The Point continuing education exercises for managers and educators to implement in-house. Members simply share the exercise of their choice with their staff, request employees read the article, answer the quiz questions provided with the article, and submit their answer sheet back to the manager/educator for grading and filing.

"It's just another way for managers and trainers to put highly researched and impeccably accurate material in front of their staff to meet their facility's continuing education requirements," says the Center's director, Dennis J. Ernst MT(ASCP). "This idea came from one of our customers, and we thought it was such an excellent suggestion that we implemented it immediately."

Phlebotomy Central members also enjoy a multitude of other documents, management tools, templates, an institutional subscription to this newsletter, and answers to commonly asked questions. "Phlebotomy Central is the most comprehensive database of blood collection information on the Internet," says Ernst. "We're aggressively pursuing ways to add new material, including multimedia content to this members-only area of our web site."

Institutional subscribers to Phlebotomy Today can become Phlebotomy Central members for only $100 more than their current subscription. If purchased separately, the 19 in-house CEs would cost facilities $230. 


ASCP Posts Podcast on Blood Culture Contamination 

PodcastIconThe American Society for Clinical Pathology continued its series of podcasts featuring Center for Phlebotomy Education director Dennis J. Ernst MT(ASCP) with a discussion on preventing blood culture contamination. In the eight-minute audio, Ernst coaches managers on strategies to reduce contamination rates facility-wide. Key concepts include galvanizing the staff to wage war against contamination, winning administrative support for launching an ambitious campaign, and maintaining low rates once they've been achieved. The podcast can be accessed on the Lab Medicine podcast archive page.


Product Spotlight:  DVD on preanalytical errors affecting K+ 

PotassiumDVD_200wNEWNew this month, the Center for Phlebotomy Education just released the fourth in its new Applied Phlebotomy Lecture Collection DVD series.

Potassium Results Your Physicians Can Trust discusses why this is the one analyte most likely to be altered by those who draw and process blood samples improperly. As a result, patients can be over or under-medicated, misdiagnosed and mismanaged with disastrous consequences.

Over a dozen preanalytical errors affecting potassium results, plus a multitude of patient-dependable and drug-induced variables are discussed that will help those who draw blood samples and their supervisors and educators to prevent the process of drawing and handling blood samples from changing the result before it's even tested.

Access to an online exam for inhouse use and to obtain P.A.C.E. CE credit is included.

Watch a preview and get more information.


Definition of "Fasting" Under Scrutiny

One bad apple spoils the restThe Working Group on Preanalytical Phase (WG-PA) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently highlighted global disparities in what laboratories consider to define fasting in regards to testing diet-affected tests. The authors cite wide diversity among healthcare facilities on how long a patient should refrain from intake, and whether water, tea, or coffee should be allowed. As a result, two fasting laboratory results may not be comparable if drawn by facilities that define fasting differently. 

In a report published in Clin Chem Acta, the authors detail discrepancies on fasting requirements for different tests posted on LabTestsOnline.org, a consumer-information website maintained by laboratory professionals and produced by the American Association of Clinical Chemists (AACC).

WG-PA recommends fasting for all blood tests should be 12 hours, and that water should not be restricted. Smoking and ingesting caffeine should be restricted in the morning prior to the draw. Fasting samples should be drawn between 7 a.m. and 9 a.m. 


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 Phlebotomist's Role in Reducing HAIs

On the Front Lines
Cited for using clean gauze

Sticks, Staph, and Stuff
Your right to bare arms

The Empowered Manager
Why people get fired

Bending the needle

What's Wrong Here?

For subscription rates and to subscribe to Phlebotomy Today, click here.


Survey Says:  the value of certification

Lady listeningCertification in one's field of work has many rewards including recognition, prestige, a sense of accomplishment, and personal pride. But does certification in phlebotomy make a person a better phlebotomist? We asked our subscribers and visitors to our web site what value they placed on phlebotomy certification. 

Are you certified?---Seventy-six percent of respondents who said they draw blood samples regularly identified themselves as certified. Twenty-nine percent of managers who responded said every phlebotomist is certified in their facility. None cited state regulations as being the reason for a fully certified workforce. The remaining 69 percent said some of their staff was certified, but not all. 

Do you feel certified phlebotomists perform better than those who are not certified?---Among certified phlebotomists, 58 percent said 'yes." Those who were not certified phlebotomists felt more strongly as a group that certification does not a phlebotomist make. A whopping 91 percent said certified phlebotomists performed no better than those with credentials.

Managers tended to agree with the non-certified phlebotomists, but to a lesser degree. Sixty-seven percent said certification did not make phlebotomists better performers. Among educators, 57 percent thought certified phlebotomists performed better than their non-certified counterparts.

Some comments:

  • I believe that some people have the knack and others don't. For years, I was not certified and I have always been the one that goes in when others could not get the blood. I just don't believe that the certification makes or breaks a phlebotomist.
  • [Certified phlebotomists] have a deeper understanding of the process
  • I feel that by having a certification, you are more likely to perform at your best because that is what is expected.
  • Certification just shows employers that you went the extra mile, and that you understand the book work. It tells nothing about your skills, compassion, empathy for the patient, or enjoyment in what you have learned and love to do.
  • Some [certified phlebotomists] act more superior.
  • You can "pass the test" in writing but that doesn't make you a better phlebotomist, it just means you can pass computerized tests.
  • Just because someone is "certified" does not make them a better or smarter Phlebotomist.
  • [Certified phlebotomists] seem to care more about patients and themselves
  • Certification is only a piece of paper. Experience, actual skill, knowledge, concern, attention to detail, professionalism & patience all make for a better phlebotomist. 
  • Many of our very experienced phlebotomists have no qualification but have been "grandparented" as they met the criteria of certification because of the experience obtained before certification was required. As a result these people perform better or at least as well as those with less experience but with certification.
  • My certification doesn't make me perform any better than a non-certified phleb with same education, experience and desire to obtain a quality specimen in the safest and most pain free manner.
  • Not all uncertified phlebotomists have a lower skill level, but standardization is the best way to ensure that all persons performing the job are able to do so with at least an acceptable amount of skill, accuracy, and appreciation for the details of the task. Registering phlebotomists also brings a higher level of respect to the profession, and appreciation for the amount of skill that is required to perform the job well.
  • I am a Med Tech and have been drawing blood for over 45 years. I attend seminars and training sessions on phlebotomy and consider myself as accomplished as one with certification. I am sure I am better than many who are certified.
  • Skill and knowledge are not determined by a certification. I have seen many staff certified that have no idea what they're doing. They often don't know proper order of draw or anatomy. 
  • Book smart does not equal technical ability.
  • A certification is just a piece of paper. It does not determine your skill.
  • Job performance is driven by personal motivation & ethic, not credentials.

 This month, we are asking our subscribers if they submit underfilled tubes for testing, if underfilled tubes are ever rejected by the lab, and the steps they take if a tube doesn't fill properly.

 Take the survey.


What Should We Do?: Stuck in the middle of a rainbow

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: Sometimes my staff will draw extra tubes from ER patients in anticipation of additional orders. Even though our formal policy is to only draw those tubes that are ordered, I trust my staff's judgment when they draw more tubes than required. Now my administrator is coming down on me to enforce the policy because of the cost of drawing unnecessary tubes. I worry my staff will be despondent, even defiant when I have to tell them our policy trumps their judgment. What should I do?

 Our response: As a healthcare professional, your first responsibility is to the patient. You also have an equally important responsibility to your superiors. The two should not conflict. When they do, the disharmony puts you in the uncomfortable position of having to choose between two equally compelling loyalties. Your staff will feel the same way.

Unless there's an attempt to restore the harmony between administrative and patient demands, the fallout  will erode team unity, morale, and the ability for the job satisfaction you and your team now enjoys. Here's how you restore the harmony of needs among those you serve and those your staff serves.

CashFirst, find out just how big the problem is by assessing the number of extra tubes that are drawn every day, week or month. Then assess how many are never tested. One facility found only four percent of extra tubes were actually used, costing them $200,000/year in wasted tubes and processing time. Your use-rate may be higher since your staff is selectively using their better judgement instead of drawing rainbows on everyone. Then try to monetize the cost of drawing rainbows so your administrators have accurate data to force this issue, or to accept the status quo. 

Once your administrators know the cost of drawing extra tubes, your job will be twofold. You'll need to articulate to them the value drawing rainbows has to the ER physicians, and ultimately the patient, in the form of timely turnarounds. Studies find recollections for stat samples adds 54 minutes to getting the result to the physician. No physician appreciates this; no patient deserves it.

Simultaneously, you'll need to work with your staff to find out what parameters they are using to decide whether rainbows are really necessary. Ultimately, you'll want everyone making the same decision for the same situations. You'll also need to make sure they know just how much of a drag it is on your facility to continue the practice without modification and tight controls. 

Once the professional judgement among your phlebotomists have been standardized, and your administrators have the real cost---in dollars and frustrated patients and their physicians---a more detailed policy can be drafted that reunites the harmony of needs necessary for serving two masters. Then it will have to be rigorously enforced. If you've articulated the need for this policy revision effectively, it shouldn't be a problem.

[Editor's note: for more preanalytical management strategies, consider attending this year's Phlebotomy Supervisor's Boot Camp.]

 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:


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

Click here for this month's featured Tip of the Month: The Wizard of Aahs!