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Phlebotomy Today

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June, 2017

Clowning Around Reduces Pediatric Distress During Venipuncture

Glove balloonsResearchers in Israel set out to see whether medical clowns reduced the distress among pediatric patients during venipuncture.

Fifty-three children ranging in age from 4-15 years were randomly assigned to a study group (with medical-clown intervention) and a control group (no intervention). During their venipuncture procedures, their level of anxiety was measured using two different subjective methods. Children 4- to 7-years old rated their own level of pain and distress by pointing to one of six pictures of faces presented to them depicting increasingly distressed expressions and told to identify the face that represents the pain they experienced. Children seven years and older were asked to mark the point on a line that represented the level of pain during the procedure. One end of the line was labeled as "no pain" while the other end was labeled "worst possible pain." 

To provide an objective assessment, cortisol levels were drawn on each patient since cortisol concentrations quickly increase in the blood under stressful conditions. To control cortisol's daily fluctuation (diurnal variation), patients were drawn only during the evening.

After assessing all patients and testing all cortisols, the authors found a significant difference between the two groups in regards to the objective assessment, but no difference in the objective cortisol levels. Pain scores for all ages without the clown intervention was 7.5 while that of the group exposed to clown intervention was 2.2. The authors concluded medical clowns reduced the distress from venipuncture in children, but not cortisol's response to stress.

New Guideline on Phlebotomy Training Released

GP48_Cover_1000wIn April, the Clinical and Laboratory Standards Institute released a guideline to assist educators and trainers in establishing and improving their in-house and academic phlebotomy training programs.

Essential Elements of a Phlebotomy Training Program provides recommendations of the content that should be included in an effective and comprehensive program that trains healthcare professionals to collect blood and non-blood samples, and perform other functions critical to the preanalytic phase of laboratory testing. Multiple studies have found a comprehensive training program results in fewer hemolyzed samples and samples rejected for other reasons, lower blood culture contamination rates, and greater compliance with the standard protocol

The guideline, the only one in the industry, provides a comprehensive outline to save educators at healthcare facilities and academic institutions many hours of research and curriculum development.

"When I pitched this idea to CLSI, I knew educators in the lab and nursing professions were hungry for something authoritative to help them bolster their training programs, or to create one where one did not exist," says Dennis J. Ernst MT(ASCP), NCPT(NCCT), who was tapped as chairholder of the committee that developed the guideline. "Any facility that implements our suggestions can be confident their program is built on the advice and guidance of some of the most respected educators and authorities in the industry."

This guideline covers all aspects of preanalytics including the collection of blood and non-blood samples, general and technical course content, and clinical and remedial training. It includes 16 content categories essential to every effective program and considerations for an effective clinical practice component. The appendices include an expansive list of questions every educator must ask him/herself when assessing the caliber of their existing programs.

"Those responsible for putting trainees through a phlebotomy curriculum---in-house or academic---need to square their curriculum with this guideline," says Ernst

The guideline is available in print and digital formats from CLSI, and by special arrangement from the Center for Phlebotomy Education. 

Order online or for more information.

Two Documents No Lab or Phlebotomy Program Should Be Without


What Should We Do?: Fainting patient refuses help

IMG_0147Question: I always tell my staff and students not leave a person who feels ill unattended. But what if an outpatient says he/she feels sick and wants to go lie down, but refuses to accept any assistance? Do patients have a right of refusal of assistance? What happens if they refuse to wait, to accept help, or to leave before they are released? If they faint and have an injury, who's liable? I have tried a search but can't find any articles that specifically address that situation.

Our response: Patients certainly have the right to refuse assistance. That does not mean they are withdrawing consent for the procedure, but it does create a predicament because the patient has submitted him/herself to your care, only to then refuse an aspect of it.

Let's look at it this way. If a patient with a history of passing out refuses to be recumbent, drawing them upright violates the standards. You have the right (and an obligation) to refuse to draw the patient if he/she can't be persuaded.

Now, let's say a patient is already feeling faint, but refuses assistance to be relocated to a recumbent position, which is at the core of your question. In our opinion, we think you still have to provide it. Since the patient is in your care, and they submitted themselves to your care by presenting for a blood draw, failure to provide it would be hard to defend in a legal context. If you honor the request and the patient faints, your facility could be sued for performing beneath the standard of care. On the other hand, if you provided it against the patient's wishes, the patient could become irate. Neither outcome is pretty, but I'd prefer the irate patient than the lawsuit.

It's a sticky wicket, and one that should be discussed with your risk manager and/or legal counsel. A policy should be established with their input and the staff made aware of it.

Product Spotlight: One Day, Four Presentations, Six CEs

Empowerment CEday2017_Facebook_628wThe Center for Phlebotomy Education will be conducting its 4th annual Phlebotomy CE Day in Long Beach, California on Saturday, August 5, 2017. Attendees present at all sessions will earn six P.A.C.E. CE credits, which satisfy the biannual requirement for California phlebotomists. All lectures will be presented by Dennis J. Ernst MT(ASCP), NCPT(NCCT), the director of the Center for Phlebotomy Education and editor of the Phlebotomy Today family of enewsletters. Sessions at this year's CE Day include:

  • What you MUST Know About CLSI's Revised Venipuncture Standard
  • Phlebotomy C.S.I. (Catastrophic Standards Infractions)
  • What's New in Phlebotomy... and Unfortunately, What's Not!
  • Your Role in Healthcare

"Everyone who draws blood must know what's changed in the new venipuncture standard," says Ernst. "As of April 30, they'll be hard-pressed to defend errors and omissions in their technique that lead to injury or patient complications. I'm especially looking forward to sharing what's new in phlebotomy in terms of new studies, articles, technology and the development of robotic devices attempting to automate venipunctures."

In  "Phlebotomy C.S.I.," Ernst will give attendees a chance to serve as jurists deliberating the guilt or innocence of healthcare professionals involved in  phlebotomy-related litigation. In the closing presentation, attendees will think about their role in healthcare in ways they might not have considered.

Registration is open to healthcare professionals throughout the U.S. and Canada. Conducted in collaboration with AUMT Institute, The Phlebotomy School.

Ernst to Moderate, Present at New Global Conference

Dennis J. Ernst MT(ASCP), NCPT(NCCT) will be moderating the first Global Summit on Best Practices in Preanalytics taking place this October in Charlotte, North Carolina. The 3-day event, organized and conducted by Greiner BioOne North America, immerses laboratory directors, phlebotomy supervisors, nursing supervisors and other healthcare professionals in high-level strategy sessions designed to help them improve patient outcomes through proper preanalytic technique and effective management.

The Summit agenda includes 23 presentations separated into two tracks: Overcoming Preanalytical Issues and Managing Your Staff to Success. Round table and panel discussions will also be conducted addressing challenges common to laboratory managers around the world. This year's panel discussion will explore and propose solutions on phlebotomy staff turnover.

Besides moderating the event, Ernst will also present "A Review of CLSI Standards and Most Recent Updates" in which he'll discuss recent changes to the industry's venipuncture standard (GP41). "The Global Summit picks up where our Phlebotomy Supervisor's Boot Camp left off, expanding it beyond our wildest imagination," says Ernst. "This takes preanalytical seminars to a whole new level."

To register and for more information.


The Empowered Healthcare Manager: Customer Service

EmpoweredManagerWelcomeScreenShot_500wEvery month we run an excerpt from our editor's popular blog, The Empowered Healthcare Manager.


In the U.S., the reimbursements healthcare facilities receive from the government to care for Medicare patients are now tied to, among other quality indicators, patient-satisfaction survey results. That's really the wrong reason to put patients on a pedestal.

Your staff won't be motivated to master customer service skills in order to make their employer's ledger more black than red. That's not why they came to work for you and it won't work to motivate them.  Motivation to provide world-class customer service has to come from within, and should be easy to tease out. 

Before you challenge your staff to master customer service, ask yourself this question: What stands between my staff and delivering world-class customer service

  • Do they know what it looks like? If not, it's time for a role-playing inservice.
  • Do they feel patients don't notice? Share your satisfaction surveys.
  • Do they see how you interact with customers? If they don't they should. Empowered managers model the behaviors they expect.
  • Do they strive to match the lowest common denominator performed by the rest of your staff (and tolerated by you)? If so, someone has to lead them out of mediocrity. 
  • Are individuals rewarded for going beyond their own personal norm? Reward, or at least recognize, everyone's "personal best."

Media partners puts out one of the best customer service videos in healthcare. It's expensive, but not as expensive as delivering mediocre service.


Subscribe to The Empowered Healthcare Manager. 

This Month in Phlebotomy Today

0617_PT_Cover_400wHere's what subscribers to Phlebotomy Today, the Center for Phlebotomy Education's flagship newsletter currently in its 17th year of publication, are reading about this month:

Feature Article

BD Redesigns the Needle, Gel-separator Tube

Second Feature
ISD Shows Promise in Reducing Blood Culture Contamination

On the Front Lines
Drawing from the opposite arm as infusing fluids

From the Editor's Desk
Lecturing in Banff and moving mountains

Test Talk

An update on an article from the inaugural issue of Phlebotomy Today

We, the Jury...

Subscribe to Phlebotomy Today and get this issue immediately. 

Survey Says: Lab-Week recognition

Lady listening

Last month we asked our readers and visitors to our web site how their facility celebrated National Medical Laboratory Professionals Week in April, and if phlebotomists were recognized in some unique way. To our utter surprise, 30 percent of those responding said their profession was not celebrated. Of those whose facilities did celebrate Lab Week, 38 percent indicated phlebotomists at their facility received special recognition. Among those employed at facilities that celebrated Lab Week, 62 percent said it had no effect on how they feel about their profession. Six percent said it made them feel worse. Among those who said Lab Week was not celebrated where they work, lack of appreciation was cited most frequently as the reason. Some comments:

  • The Lab staff decided to recognize the week. We brought in food and snacks each day for the entire clinic to enjoy. Handmade posters announcing the week were hung in several places that week.
  • Not much thought was given to outpatient/outreach phlebotomists, the inpatient staff had much more in the way of celebration. We all received a t-shirt, but ours arrived after lab week.
  • There are three phlebs that work for our ASC. We are pretty invisible to the rest of the staff. Pretty sad.
  • For all the lab does we are mostly forgotten.
  • It was like no big deal, but to us it was a big deal because we love what we do.
  • Sweets day. Luncheon provided by pathologist group. T-shirt gift.
  • Phlebotomists are not appreciated in our facility.
  • My facility in particular doesn't do anything fancy and it is a shame. The majority of the hospital is not aware of the week or what we do.
  • We are only recognized for two days out of the whole week.
  • We celebrate lab week every year, but it mostly has turned into coworkers just wanting the free food. It's a shame but the Phlebotomist are really not included. Yes, they receive free food just like anyone else, but they are considered the unwanted part of the lab. The reason I know this is because before I became an MLT, I was a Phlebotomist. They majority of the lab techs only treat you with respect if you are "one of them." It's so terrible because the phlebotomist's are the front line to accurate testing.
  • All lab employees had opportunities to participate in all activities.
  • The lab celebrated as a whole.

This month we're asking readers and visitors to our web site what their facility's policy is on identifying patients, and if they follow their policies. Take the survey.


Tip of the Month: Bother my Nurse

Click here for this month's featured Tip of the Month from our rich library of archived Tips.