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Phlebotomy Today

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July, 2017

ASCP Releases Salary Survey

MoneyIn April, the American Society for Clinical Pathology (ASCP) released the results of a laboratory professions' salary survey it conducted in 2015.

The average hourly wage for staff phlebotomists was $14.97 compared to $15.60 in ASCP's 2013 survey. Lead phlebotomists earned $16.96 on average ($16.71 in 2013), while phlebotomy supervisors earned an average of $21.08. No supervisory wage was reported in the 2013 survey.

Phlebotomists with less than five years of experience earned an average wage of $13.61, with increases of $1/hour for every five years of experience. Wages for phlebotomists with over 20 years of experience seems to cap at $18.00 per hour.

The average annual salary for staff phlebotomists in 2015 was reported as $31,142. Lead phlebotomists earned $35,275, while supervisors earned $43,843.

Staff phlebotomists received the highest average wage in Washington ($18.39) while Michigan paid the lowest average wages at $13.25.

Forty-five percent of respondents worked in the following states: Texas, California, Minnesota, Ohio, New York, Illinois, Pennsylvania, Florida, Wisconsin, and North Carolina. Over 1000 phlebotomists responded to the survey, which also included 13 other laboratory professions.

Read the entire survey results.

Center Releases Phlebotomy Q&A Book

LabDrawCOVER_FINAL_Front_1000wThe Center for Phlebotomy Education has announced it is releasing The Lab Draw Answer Book later this month. Coauthored by Dennis J. Ernst MT(ASCP), NCPT(NCCT) and his wife Catherine Ernst, RN, PBT(ASCP)CM, the book is the retitled second edition of Blood Specimen Collection FAQs, released in 2008. 

The second edition contains over 400 answers to commonly asked questions on blood sample collection and handling, and managing phlebotomy services and personnel. "We've updated all the entries in the first edition and added over 100 more," says Dennis Ernst. "It's highly referenced and fully reflects today's industry standards and guidelines." This title will be his fifth phlebotomy book, and the second coauthored with his wife. 

"I thought it was important to bring a nurse's perspective into this second edition," says Ernst. "Nurses desperately need a reliable reference on drawing blood specimens with their profession represented in the authorship. Catherine provides that kind of insight." The publication heavily references the Standards of Practice of the Infusion Nurses Society as well as the standards of the Clinical and Laboratory Standards Institute.

Prepublication orders are now being taken on the Center's web site with shipping expected to being later in the month.


Standards Update: Securing Butterflies

The newly revised venipuncture standard released by the Clinical and Laboratory Standards Institute in April, 2017 is the most comprehensive revision in the document's history. With over 140 new mandates, facilities have a lot of changes to implement. This series discusses one or more substantive changes each month.

GP41_cover_200wDo you let go of a winged blood collection set (butterfly) after you insert it into the vein? If so, you'll have to change your ways. One of the many new provisions of the new CLSI venipuncture standard is to keep butterfly needles secure throughout the procedure. 

A beveled needle is like a scalpel. It slices whatever it comes in contact with. Because winged blood collection sets tend to flop around when released, the needle can damage the vein when the user lets go of it after insertion. The standard, however, doesn't insist users hold it in place, though. Maintaining its position can be accomplished by taping it to the patient's skin during the procedure. 

"The decision to secure butterfly devices during the draw was not made in a vacuum, no pun intended" says Dennis J. Ernst MT(ASCP), NCPT(NCCT), who chaired the revision. "The committee included representatives from three of the largest manufacturers of winged blood collection sets who were all in agreement."

To comply with the provision, users who hold the device in place with one hand can operate an attached syringe with their free hand. If a tube holder is attached, users can exchange tubes single-handedly with little practice. Alternatively, taping it in place meets the requirement.

Readers are urged to obtain their own copy of the standard as soon as possible and begin implementing all new provisions as soon as possible. The document Collection of Diagnostic Venous Blood Specimens (GP41-A7), is the standard to which all facilities will be held if a patient is injured during the procedure or suffers from the consequences of an improperly performed venipuncture.

Live Event Provides CE Credit

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.

What Should We Do?: Excessively soiled arms

Blood Culture SitePrep1We have a regular patient who comes in with arms that are filthy dirty. The last time I had to do a venipuncture on him, I used five alcohol swabs to clean the site. How can I tactfully tell him to wash his arms before he comes in next time without embarrassing him?

Our response: A venipuncture is not a sterile procedure (unless blood cultures are being drawn). But we still want to practice good hygiene. The potential consequences of a drawing from a visibly contaminated site include an increased risk of infection, which could lead to more serious issues. On the other hand, a venipuncture site which is not visibly dirty could be harboring just as many germs and disease as an obviously contaminated area.

The current practice of cleansing an area with an alcohol swab or prep prior to venipuncture is still the proper protocol. For excessively soiled skin, use a soapy antibacterial wipe or scrub that can clean a greater area more deeply. Then follow with a final alcohol prep before performing the venipuncture. If the pad looks dirty, apply another or repeat the friction scrub with a second soapy antibacterial prep. Continue cleansing until an alcohol wipe is not visibly dirty after the prep.

Whether or not you should suggest the patient cleanse his arm before coming in is a tough call. It may not be a personal hygiene issue, but the conditions where he works. If he comes to your draw station after his shift, it's just normal for his arms to be dirty and he gives it no thought. If that's the case, suggesting he cleanse the site before arriving may not be offensive. If it is a hygiene issue, that's a little more delicate. Since the main concern is for the patient's safety, it doesn't matter who cleanses the site as long as it's cleansed thoroughly. Since the patient is a regular, it shouldn't take long to establish a rapport that might make the suggestion easier to phrase properly.

This Month in Phlebotomy Today

Here'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:

PhlebotomyTodayCover_0717Feature Article

Changes to Venipuncture Standard Numerous and Significant

On the Front Lines
Blood culture site prep: allow alcohol to air dry?

From the Editor's Desk
My brain on your desk

Test Talk

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

We, the Jury...
Case studies in phlebotomy-related injuries

Subscribe to Phlebotomy Today and get this issue immediately. 

Survey Says: Patient identification practices

Lady listening

Last month we asked our readers and visitors to our web site all kinds of questions on their policies on patient identification, and if they follow them.

First, let's establish how patients should be identified. The newly released CLSI venipuncture standard requires those who draw blood specimens to ask patients to state their full name and birth date, and to spell their first and last names. The information provided must then be compared with the patient's ID band. If the patient cannot provide the information (e.g., language barrier, cognitive disability, unconscious, sedated, etc.), a family member or caregiver must verbalize the information on the patient's behalf. Outpatients without ID bands must provide another form of identification. 

We understand not every facility has obtained a copy of the revised venipuncture standard, and those who have may not yet have implemented the new provisions on patient ID. But we were amazed at how many of those who participated in our survey have policies that reflect the most current revision. We're not so amazed by those who admit they don't always follow the policy. Here's the stats on the five steps:

  • state full name: 77 percent;
  • state birth date: 98 percent;
  • spell first and last name: 7 percent;
  • seek a third-party when patient is unable to provide the required information: 86 percent;
  • compare information provided with ID band and test request: 89 percent.

We're thrilled that 98 percent of those responding have a policy on requesting the patient's birth date. (The other 2 percent responded they are required to ask for two patient-specific identifiers, onsider: A healthcare system in Houston looked into their database of all patients and found that out of 3.5 million patients, two percent of them had the same first name, last name and birth date of which may or may not be the birth date.) However, only 77 percent said their policy is to only request the patient's first and last names. Here's what the remaining 23 percent needs to cone as at least one other person in the database. That means 7,000 patients in Houston are at risk of being identified as someone else if only the first name, last name, and birth date are requested. 

We're not so thrilled that so many survey participants admitted they don't always follow their facility's policy. Perhaps that's why there are over 160,000 adverse patient events in the U.S. every year caused by those who draw blood samples but do not properly identify their patients or samples. Here's the percentages of those who know their facility's policies on the five steps, but don't follow them every time:

  • have the patient state his/her full name: 14 percent don't always comply;
  • have the patient state his/her birth date: 5 percent don't always comply;
  • have the patient spell his/her first and last name: 48 percent don't always comply;
  • seek a third-party when patient is unable to provide the required information: 11 percent don't always comply;
  • compare information provided with ID band and test request: 7 percent don't always comply.

These statistics are especially concerning since 48 percent of those responding admit to having found an identification bracelet attached to the wrong patient.

School Marketing Pics 015Among those who admitted they don't always ask patients to state their name, seven percent said they only ask if they don't know them. Here's why that will result in patient death or serious medical consequences someday. All the patients a healthcare professional might draw blood from during the course of any given day will fall into one of three categories: 1) patients who are total strangers, 2) patients they know with solid confidence (regular patients, friends, family, etc.) and 3) those with whom they are somewhat familiar. The patients in Group 1 are not at significant risk because most healthcare professionals are going to follow protocol for patients they've never seen before. Patients in Group 2 are not at great risk, either, because of the high level of familiarity. Make no mistake, there is some risk for both groups. Some people make exceptions to the policies even for strangers, and some have a false sense of familiarity with patients, and make exceptions as well. 

However, those in the third group, patients who are somewhat familiar, are at the highest risk of being misidentified and suffer potentially tragic consequences. That's because the healthcare professional's familiarity with the patient is not certain. Depending on other variables, collectors may talk themselves into being sure when they really aren't for the sake of expediency, simplicity, or ill-conceived rationale. 

One survey respondent commented "We will check spelling of unusual names." This strategy, however, won't prevent Eve Snyder from being transfused with blood intended for Eve Schneider. Nor will it save John Smith from being mistaken for Jon Smith, John Smith for John Smythe, and Jon Smith for Jon Smythe. However, if the standard protocol reflects the CLSI standard and is applied to every patient, whether they appear familiar or not, nobody gets misidentified. Because patient identification cannot be automated, humans have to automate themselves by consistently applying the standard protocol in every regard without exception.

What these survey results tell us is that a significant portion of patients are at risk of transfusion-related death, medication error, misdiagnosis, and general mismanagement due to lax adherence to facility policy, and facility policy that does not reflect the standard by which all facilities are being held  as of April when the GP41 revision came out.

This month's survey: This month, we're asking supervisors what single attribute would they like to see their staff as a whole improve upon? Putting the shoe on the other foot, we're also asking non-management personnel what single attribute they'd like to see their supervisors improve upon. Need to vent? Now's your chance.

Take the survey.


Global Preanalytic Summit



The Empowered Healthcare Manager: Why?

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


It's every child's most common question... and most important. Answers to "why?" reinforce learning. They provide logic, understanding, rationale, and comprehension. Merely knowing what to do and how to do it isn't enough. Why makes the how and the what make sense.

Answers to why? aren't just for kids learning about hot stoves, electrical outlets and running with sticks. Learning at any age doesn't work well without knowing why. Try telling your blood collection staff what the order of draw is and how to follow it without explaining why it's necessary. Those who don't know additives carry over and contaminate the next tube aren't likely to think the order in which tubes are filled really matters. Directives without reasons don't stick as well as those that do.

The same goes for explaining why they shouldn't leave the tourniquet on longer than one minute (causes hemoconcentration), tell patients to pump their fist (falsely elevates potassium results), or chill blue tops after filling (cold changes the test result and leads physicians to reduce blood thinner dosage with disastrous consequences). 

Even when we know the why, it doesn't always modify behavior. Children will still touch the burner to see if it's really hot. (It looks the same as it does when it's cold.) Those who draw blood will still have patients pump their fist. (They've always done it that way and nobody's ever suffered from the consequences before... that they know of.)

Whenever instruction includes the what, how and why and still doesn't change one's behavior, there's only one response left for those in positions of authority. It's the same response our parents used when their answers weren't good enough. 

"Because I said so."


Tip of the Month: Conversation With a Lab Coat

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