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Phlebotomy Today

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July, 2016

Compliance With Standards Linked to Workplace Factors

Standard on blocksHow closely do you adhere to the standardized phlebotomy procedure? It may depend on the size of your facility and how long you've worked there.

Researchers in Sweden set out to determine why some healthcare professionals adhere strictly to the established protocol and others don't. Questionnaires were completed by 164 healthcare professionals with blood collection responsibilities at 25 primary care centers asking them to self-assess their adherence to the established venipuncture procedure in regards to patient identification and sample labeling. Phlebotomy is Sweden is performed primarily by nurses, and clinical chemistry laboratory staff.

Participants were asked to rate their compliance with the following steps:

  • Item 1: Always ask patient to state name and civic number (national identification number)
  • Item 2: Never neglect asking for ID
  • Item 3: Always compare patient ID with ID on test request
  • Item 4: Always make sure test request and test tube label ID numbers are consistent

It was clearly articulated to all respondents to state how they usually performed venipunctures, not if they knew how it should be performed. Their response options were never, seldom, often, and always.

When the results were evaluated, females assessed themselves as more likely to be compliant with the suggested step than men on Items 1, 2, & 3. Those who worked for their employers for a for shorter time period assessed themselves higher than long-term employees, and participants working at larger facilities scored themselves to be more compliant than those at smaller work places. Those in urban settings also scored themselves higher than those in rural settings, as did those in federal facilities as opposed to private institutions. Those performing phlebotomy every week or less were more likely to adhere than those who draw blood daily.

The size of the facilities employing those who participated were classified as follows:

  • Small---1-19 employees
  • Medium---20-34 employees
  • Large---35+ employees

The authors speculate those who were employed at their facilities five years or longer demonstrated lower self-assessment scores on patient identification procedures because they have had more time to interact with coworkers and develop their own shared policies contrary to the established protocol and degree of acceptance of their collective divergence. According to the authors, long-term employees "had plenty of time to develop their own sets of prevailing truths" about the venipuncture procedure.

Read the full study.

Phlebotomists Invited to Gather in California

CEdayFlyer_2016 half_1000w

The Empowered Healthcare Manager

EmpoweredDE_130wThe Art of the Interview

 Questions mere managers ask phlebotomy applicants:

  • How much phlebotomy experience do you have?
       Check the resume. This question wastes time.

    • Where were you trained?

    • Are you available to work weekends?
       This question should be asked long before the interview.
  • Why did you leave your prior position?
       Interesting, but you may not get the real reason.

    • Can I call your references?
       This should be requested on the application.

    • What is your biggest weakness?
       There are better ways to learn about character besides asking this clichι question.

    • Do you have reliable transportation?
      This is worth asking, but really, who's going to say "no"?

    • What hourly wage are you looking for?
       Another question for the application.

    • Where do you see yourself in five years?
       Everyone expects this, so add some kind of twist.

Blocks spell interviewQuestions empowered managers ask phlebotomy applicants:

  • What do you see yourself doing in five years and what are you doing to meet those goals?
       If the applicant isn't working toward the goal, then it is just wishful thinking and he/she might not be motivated.
  • Tell me about a time you wish you had handled something differently.
       If the applicant can't think of anything, he/she's not telling the truth.

    • What did you like least about your prior job?
       Red flags go up if the applicant talks badly about her prior employer.

    • Tell me about a time you were on a team and someone wasn't pulling their own weight.
       If there's no answer, beware. The applicant could have been the slacker.

    • What grade would you give your last supervisor and why ?
       If the applicant throws her prior supervisor under the bus, be careful. You could be next.

    • List five words that describe your character.
       If the applicant provides only glowing characteristics, he/she has an unrealistic self-view.

    • What is your idea of the difference between good and exceptional?
       If the applicant can't articulate the difference, can he/she have good customer service skills?

    • How would you feel about working for someone who knows less than you?
       If the applicant doesn't feel compelled to help the other person learn more, he/she is probably not a team player.

    • What are the qualities of a good leader?
       If the applicant doesn't know, he/she is not one. That's okay. Not everyone needs to lead. Good followers are just as critical.

    • Tell me about a time you felt you were treated unfairly.
       If the applicant has a long list, you may be in the presence of a professional victim.

    • Tell me more about yourself.
       Empowered managers do more listening than asking.

Each month, Phlebotomy Today-STAT! shares one of the gems from the archives of The Empowered Healthcare Manager blog, written by Dennis J. Ernst MT(ASCP). View more of the archives and subscribe here. 

Product Spotlight: 22 months of inhouse CEs

Do you struggle every month to find good material to put in front of your students or specimen collection staff? Those days are over.

We've just packaged 22 months of our popular Abbreviated Teaching Modules (ATMs) in one download, and priced it well under what you've budgeted for continuing education this year.

Our ATMs are short 1-2-page articles on a wide variety of phlebotomy topics your collection staff should know. Simply distribute one exercise to your staff each month, collect their answers to the accompanying quiz, grade it, file it, and get on with your day.

The 22-module set is downloaded immediately after your online purchase as zipped PDFs with answer keys for each exercise. That's almost two years of monthly in-house CE exercises for you to administer to your staff at a fraction of what you've been paying. Titles include:

  • ATM_CompleteSetThe Order of Draw
  • Hematoma Prevention
  • Tourniquet Time
  • Needlestick Prevention
  • Hemolysis
  • Patient Identification
  • Acceptable Sites for Venipuncture
  • Blood Cultures Done Right
  • Hemoconcentration: What is it?
  • The Aggressive Patient
  • Infants and Toddlers in the Healthcare Environment
  • Communicating With Elderly Patients
  • Give Your Patients Their Personal Space
  • Tips for Successful Capillary Collection
  • Non-verbal Communication: What Message Are You Projecting?
  • Phlebotomist's Guide to PICC Lines, Central Catheters, and Imbedded Ports
  • Therapeutic Drug Monitoring
  • Customer Service Excellence
  • Bloodborne Pathogens Review
  • Are You a Pathogen Parade?
  • Drawing From Young Children

    Stop scouring the Internet for mediocre resources just to meet your monthly staff requirement. All ATMs are highly researched and reflect industry standards and guidelines. 

Sample ATM and more information.

This Month in Phlebotomy Today

PT_logo-2012_400Here'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
If Tubes Could Talk: Interview with a blue top

On the Front Lines
Draws above a heparin drip

From the Editor's Desk
It's nature against man at my house

Customer Care Corner
Are patients really customers?

Test Talk
All about Hemoglobin A1c

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

Subscribe to Phlebotomy Today and get this issue immediately.

Survey Says: Calling all Patients!

Lady listeningIn May, we asked our subscribers and visitors to our web site about the practices in place where they work for summoning patients from a waiting room, and confirming their ID once they arrive at the draw station. 

Thirty-six percent said they announced the intended patient's first name aloud. Fourteen percent announced the last name, and 31 percent announced the combination. Eleven percent announced a unique identifier, while eight percent displayed a unique identifier for patients to respond to. 

Some comments:

  • When a patient is registered they are given a beeper with a number on it. Their face sheet prints to the outpatient lab and they are paged back.
  • Each person must get a number at the registration desk so we sometimes go by numbers, depends on if someone at desk collecting orders as patient comes in lab or if only the phlebotomist is there.
  • We use a number system. They take the number at the front of the stack of numbers. The phlebotomist takes that number from the patient and puts it at the front of their stack of numbers. The phlebotomist goes into the waiting room and calls the next number due (which is the number in her room + 1). This is to retain the blood request form with the patient for their privacy and ensure fairness in the queue.
  • They are given a beeper before being registered. when we beep them, we check their armband against the person we beeped.
  • We ask "who is next? Please come in". Our patients hold on to their forms until it's their turn, so they don't get mismatched. People don't often "queue jump."
  • We use a pager system to call the patient in.
  • If there are two persons w/the same 1st name, we have them verify the last name.

The follow-up question asked "When the outpatient summoned enters the draw station, how do you confirm his/her identification?" The most popular form of verification was to compare the order or labels by requesting the patient to verbally provide specific information" (75 percent). Nearly six percent asked the patient who responded to the summoning to affirm  specific information the phlebotomist provides. Three percent indicated no verification takes place in their draw stations. Seventeen percent used other methods, including:

  • Verify the order/labels with their ID band and ask them to give their name and DOB.
  • Patient is asked first and last name and date of birth.

Finally, we wanted to know if and how those who draw blood specimens confirm the tube was properly labeled after the draw, as required by the standards.  Surprisingly, 22 percent did not verify the labeled tube. Two respondents said they only confirmed tubes used for transfusion testing. Of those who regularly confirm tubes are labeled properly, 21 percent compare the tube(s) with the patient's ID band, while 39 percent show the labeled tube to the patient for confirmation. The remainder employ other techniques including:

  • Compare tubes against the orders on lab slip
  • Have them look and confirm the tubes are labeled properly and sign the preprinted form that states "I have verified that my specimen(s) have the correct name and date of birth on the label"
  • We print tube labels by entering the patient's unique NHI number. This label includes a lab registration number. We check the details of the lab labels matches the patient sticky labels used by the outpatient doctors.
  • I always have the pt verbally identify that it is his/her name and D.O.B. on the tubes.
  • Comparing the tube label information to the lab order information.

This month, we're asking what other patient procedures phlebotomists perform where you work besides venipunctures and capillary punctures (e.g., nasal swab collection, POCT, arterial collections, etc.). 

Take the survey.

What Should We Do?: Fixing the mixing

Looking at tubeQuestion: Our NICU performs all of their lab draws. We're receiving more than clotted specimens than from other units. They are convinced the lab is clotting the specimen when we receive it. What should we do?

Our response: It's always the lab's fault, isn't it? Everyone knows labs hemolyze samples, add clots to tubes with anticoagulants upon arrival, and contaminate blood cultures. Those rascals!

When people engage in the blame game, it points to a much greater problem than just tubes that aren't properly mixed upon collection. A mixing problem is easy to fix; ending the blame game is not. We suspect the nursed know deep down the lab isn't purposely corrupting samples just so they don't have to test them. But why they would make that their defense? It's hard to tell for sure, but it's likely felt they were being blamed for purposefully allowing tubes to clot. They reacted by simply firing back with the same accusation. 

What needs to happen here is the nurses have to know that you don't feel they are the problem, but that the process is the problem. Which sounds more accusatory: "Your nurses aren't mixing the tubes" (blaming the person), or "there's something about how the tubes are being mixed that needs attention" (blaming the process).

Focusing on the process rather than the person (or department) is far more likely to rally everyone toward a solution. Regardless of who is being blamed, a clotted tube still has to be recollected. Go back to the unit and have a frank conversation with the nurse in charge. The conversation should start something like this: "I'm sorry if I gave you the impression that I felt your nurses were the problem with the clotted samples. I certainly don't believe anyone's doing it on purpose. The problem isn't your staff, it's more likely they were never given the information they needed to prevent clotting. That's not their fault." 

Then explain the lab doesn't want tubes clotted any more than they do. Make sure she knows that a clotted tube makes extra work for everyone involved, delays test results, and, worst of all, the poor child has to get stuck twice. If it's the microcapillary tubes that you're having to recollect, explain how they are one of the more susceptible tubes for clotting, and how mixing has to be conducted even during collection sometimes. If the tubes have a scoop design, tapping it on a hard surface every now and then during the collection might help. If it's a closed system that uses a straw or capillary tube, gently flicking the bottom of the tube once in a while can start the mixing process. Regardless of the device, mixing after the draw has to be immediate, gently, and purposeful. 

Suggest a quick inservice, one you can conduct or the nurse supervisor. It should only take a few minutes per group. Working it into a regular staff meeting might be the most effective. That would also be the perfect opportunity to show everyone you're focused on the process, not the person.

Got a challenging phlebotomy situation or work-related question? Email us your submission at WSWD@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)