August, 2010

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Literature Review of Newly Published Studies Part II

This month’s feature is a continuation of the literature review we began last month providing our readers a summary of some interesting studies that have been published since last November.

Here at the Center for Phlebotomy Education, we make it our business to be a dependable source of accurate information on blood collection procedures. Not a day goes by when we don't hear of something newsworthy in the media or peer-reviewed journals. That's how we keep ourselves, our products, and our readers up-to-date in the world of phlebotomy. If it's new and pertinent, you'll find out about it here first.

False elevations of chemistry results due to pneumatic tube transport
Potassium, LDH, and AST have often been reported to be falsely elevated due to hemolysis, which can occur during pneumatic tube transport. Researchers studying results from two leukemic patients with leukocytosis speculate such false elevations could be due to white cell lysis as well, especially when samples were transported through a pneumatic transportation system. The enhanced fragility of leukemic cells was thought to be a contributor. The interference nearly disappeared when serum was tested rather than plasma, and when leukocytosis returned to normal.

LEAN applied to phlebotomy workflow
Researchers at Brigham and Women's Hospital in Boston set out to improve the overall patient experience and optimize the blood collection process in outpatient phlebotomy using Lean principles. As a result, the facility experienced an increased capacity to manage peak-time workloads without additional staff, a reduction of the patient wait time from 21 to 5 minutes, with the goal of drawing blood samples within 10 minutes of arrival at the phlebotomy station met for 90% of patients. In addition, patient satisfaction increased noticeably as assessed by a 5-question survey. The results have been sustained for 10 months with staff continuing to make progress.

Line draws in children
In Israel, researchers wanted to see if there was a difference between results obtained from samples drawn from children through a peripheral venous catheter (with and without a discard volume) versus venipuncture. Non-hemolyzed samples were collected for CBCs and basic chemistry profiles by line draw from 40 of 47 patients. Six percent of test results fell outside the CLSI range of acceptable variance. The authors concluded peripheral venous catheter sampling was a pain-reducing option for obtaining blood for testing some basic analytes, but not glucose.

Barcode technology reduces patient ID errors
In Boston, researchers studied the effect instituting barcode technology and modifications in the patient label printing procedure have on positive patient identification. Implementing a bar code-based patient ID system and eliminating the preprinting of patient tube labels resulted in a reduction of mislabeled and unlabeled samples from 5.45 per 10,000 events to 3.2, with 108 mislabeling events prevented. After implementation, a higher percentage of patients reported having their ID bracelet checked before their blood was drawn.

Physicians in need of phlebotomy training, reducing pediatric anxiety
Researchers at St. George's Hospital in London set out to identify strategies to reduce the adverse physical and psychological effects of venipuncture on children. The parents and children surveyed described venipunctures as extremely distressing. The physicians who performed the venipunctures in the study were found to employ therapeutic measures to reduce stress much less frequently than expected. Only seven of the 25 departments surveyed offered any venipuncture training.


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Featured Product
Fall Webinars

The Center for Phlebotomy Education announces the fall lineup of webinars rounding out its  "Phlebotomy Best Practices" series that began in May. The four upcoming webinars, each one hour in length, will cover a wide variety of preanalytical topics, and are developed for phlebotomists and all other healthcare professionals with blood collection responsibilities. The fall 2010 schedule is as follows:

Sept. 9, 2010
Mastering Pediatric Phlebotomy

Sept. 30, 2010
Potassium Results Your Physicians Can Trust

Oct. 26, 2010
Delivering World-Class Customer Service

Nov. 16, 2010
Successful Strategies for Difficult Draws

All webinars begin at 1pm, Eastern Standard (Daylight)
Time (GMT-5) on the dates listed.

Phlebotomy Best Practices Webinar Series

All content reflects the standards and guidelines of the Clinical and Laboratory Standards Institute (CLSI), and are presented by a faculty of national and international speakers including Dennis J. Ernst MT(ASCP), the Center's Executive Director, and Lisa O. Ballance MT(ASCP), CLC(AMT), the Center's Director of Online Education. The Center has been providing educational materials and resources to healthcare professions since 1998.

Registrations are being accepted for individual events and are priced per site. Multi-site and healthcare network discount pricing is also available. For more information, contact the Center through their website at www.phlebotomy.com/webinars or call toll free 866-657-9857.


AMT Announces Phlebotomist of the Year

Phlebotomist of the Year, Kimberly Meshell, RMA, RPT, COLT, AHI, was among the national award winners recognized by American Medical Technologists (AMT) during the certification agency’s national meeting last month. AMT’s Phlebotomist of the Year award recognizes extraordinary service and contribution at all levels within the organization, and to the phlebotomy profession and total care community. Ms. Meshell, who was certified in 1999, is the phlebotomy/medical assistant program coordinator at Angelina College in Lufkin, TX.


This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 11th year of publication, are reading about this month:

  • Feature Article: Hand Hygiene – What Every Phlebotomist MUST Know, Part I
  • Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in July including these stories:
    • Jack Shea Law Closes DUI Loophole
    • Needlestick Prevention Advocate Elected President of ANA
    • Former Phlebotomist Goes Hollywood
    • Phlebotomist Named in Funeral Fraud
    • Partnerships Key to Kenya’s Strategic HIV Plan
  • According to the Standards: Specimen labeling errors
  • Tip of the Month: Winning One for the Home Team
  • CE questions (institutional version only).

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.


Center Being Followed

The Center for Phlebotomy Education, and its director are being followed... on Facebook and Twitter. In fact, hundreds of PT-STAT! readers and other healthcare professionals have been following their postings since their presence on both social networking sites was announced in last month's issue.

The Center's Facebook page provides those who perform, manage, and teach phlebotomy with a place to join discussions, leave comments or questions, post suggestions, learn about upcoming events, meet the staff of the Center for Phlebotomy Education, and keep current with day-to-day developments and newsworthy events that can impact the industry, the profession, and the way blood collection procedures are to be performed. The Center's Facebook page has already hosted lively debates on wearing gloves and managing patients who demand a butterfly be used for their draw.

To get connected visit the Center's Facebook Page and click the "Like" button. After you "Like" our page, you can post on our Wall, participate in Discussions, and get Updates from the Center in your News Feed. The page will be monitored and updated regularly, providing you a forum with not only the most reliable authority on blood collection procedures and specimen collection management in the industry, but with other phlebotomists and healthcare professionals who share your interests in the most commonly performed medical procedure in healthcare.

Our Facebook PageCenter for Phlebotomy Education on Facebook
Our Facebook PagePhlebotomy Today Editor on Twitter

Featured FAQ
Acceptable number of mislabeled samples

Q: I have been a Medical Technologist for over 30 years and misidentification was a problem when I first began and it continues to be one today. One of our facilities is being told that limiting a phlebotomist to two validated patient identification errors of major consequence is too stringent. They allow up to five errors of minor consequence.

I find this very frustrating. Are there are any standards that address the number of mislabeled samples that can be considered acceptable? Do you have any specific regulatory references that would assist this facility?

A: The acceptable number of mislabeled samples is zero. One hospital that adopted a “zero tolerance laboratory sample labeling” process, experienced a 75% reduction in labeling errors.(1) The facility would be hard-pressed to find one reputable supervisor, authority, text, article or regulation that states it acceptable to have even one mislabeled specimen. Regardless, all incidences of sample misidentification need to be documented. The frequency and type of labeling errors may warrant further investigation to identify the root cause and provide training or other corrective action, as appropriate. I think it is imperative that you hold to your high standards and apply them facility-wide. You may well be some patient’s last line of defense. Every patient, present and future, is counting on you to stand firm so that they may be protected.

As to the number of errors an employee is allowed before termination, that is up to the facility. CLSI in its patient and sample identification guideline recommends considering disciplinary action only after all of the processes are closely examined and revised to remove possible sources of error.(1) No precedent exists in the literature, nor are there any limits established by any regulating agency to my knowledge. I would call upon your risk manager for reinforcement.

1.) CLSI. Accuracy in Patient and Sample Identification: Approved Guideline. CLSI document GP33-A. Wayne PA: Clinical and Laboratory Standards Institute; 2010.

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 website. For information on joining Phlebotomy Central, click here.


Survey Says
Exposing Your Exposure Control Plan

Our latest survey polled visitors to our website regarding the availability and location of a written exposure control plan (ECP) in their facilities. The results are below:

1. Does your facility have a written exposure control plan (ECP) in place?

  • Yes: 55%
  • No: 17%
  • Don’t know: 28%

2.  If so, could you immediately locate it without assistance?

  • Yes: 56%
  • No: 19%
  • Not sure: 25%

3.  If available, how often do you review it?

  • Annually: 43%
  • When changes are made: 29%
  • Annually, with additional reviews as needed: 14%
  • Upon initial employment and when I have a question: 14%

According to OSHA, written plans must be accessible to all employees either online or in hard copy format in an area where they are available for review during all shifts. Of those surveyed who did not have a plan in place, all were from the U.S. Of the 28% who didn’t know if their facilities have an ECP, 60% were from outside the U.S. For facilities subject to OSHA regulations, the ECP must be reviewed and updated at least annually and whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure, and to reflect new or revised employee positions with occupational exposure.

A customizable model exposure control plan is available at http://www.osha.gov/Publications/osha3186.pdf. OSHA’s requirements for the written ECP may be found at 29 CFR 1910.1030(c)(1) and can be accessed at www.osha.gov.

This month’s survey question:
How would you describe your glove use during phlebotomy procedures? Do you ever pull the fingertip off your glove to palpate a vein?


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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 download from the Center for Phlebotomy Education’s library of articles. 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:
Pediatric Bleeding Time

A pediatric surgeon who is new at your facility has ordered a bleeding time on an 18-month-old inpatient who is scheduled for surgery tomorrow. Because the test leaves a permanent scar and your lab offers an alternative blood test, bleeding times are no longer performed at your facility. You explain the alternative, but the physician insists you perform a bleeding time instead.
What would you do?


According to those of you who responded to last month’s case study, what you wouldn’t do is perform a bleeding time on the 18-month old. All respondents indicated that they would refer the pediatric surgeon to a pathologist, the lab director, their immediate supervisor or a senior laboratory staff member. Well done.
Sample Comments:

  • “Our lab does not perform the bleeding time test. If the surgeon insists on performing the test, I would ask him to call our Lab Director.”
  • “I would have the physician contact the pathologist. The pathologist would be able to better explain the alternative test and benefits to both the Dr. and patient...”
  • “I would contact someone in the lab at the same professional level as the pediatric surgeon, or the most senior staff in the coagulation laboratory and leave the issue with them to deal with as they see fit.”

Here’s how Dondi described her approach: “We don’t have pediatrics at our facility. However, we do get an occasional request for a bleeding time. Our response is that we no longer perform the test at our facility. If further explanation is required, we simply explain that, due to the infrequency of requests and the fact that the result is highly technique dependent, there is no one proficient in performing the test. If the physician insists on having the test performed, he is referred to our hematopathologist. She will discuss alternative tests with the requesting physician...”

Donna in Montana shared the following perspective: “I was never as happy as when we were able to stop doing bleeding times. This procedure was fraught with too many variables to satisfy my Medical Lab Science soul. Plus the biggest factor was Do No Harm…a scar is harm and I have seen arms riddled with those little white scars over the years. In this case I would not argue with the physician but go directly to my medical director. There needs to be an explanation of why a pediatrician wants a bleeding time on an 18-month-old when there are alternatives. The medical director has the authority to deny the test as well as being able to explain the alternatives and rationale for not doing an out-dated test.”

For her passion for accuracy, compassion for the patient, and tact in responding to the surgeon’s request, Donna will receive a free download from the Center for Phlebotomy Education’s library of download articles.



This Month’s Case Study:
Family First?

Your sister delivered her first baby at the hospital where you work. The baby is jaundiced and is having bilirubin levels drawn at regular intervals. Your sister is very anxious about the baby having to remain hospitalized and has asked you to find out what the last total bilirubin result was.
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.




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PT STAT! is a free, monthly educational service provided by the Center for Phlebotomy Education, Inc., the most respected authority in phlebotomy. For a complete company profile and product list for all healthcare professionals who perform, teach or manage specimen collection procedures, visit us on the Internet at: http://www.phlebotomy.com.
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Copyright 2010, 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.