Nursing Group Nixes Draws During IV Starts and Line Draws
The revised standards from the Infusion Nurses Society (INS) instruct nurses and IV therapists to perform venipunctures instead of obtaining blood samples from existing lines or during the insertion of short peripheral catheters. The new standard is a dramatic departure from the prior standard, published in 2011, that advocated draws during IV starts and from vascular access devices (VADs).
"This is a huge development," says Center for Phlebotomy Education's Director, Dennis J. Ernst MT(ASCP) NCPT(NCCT). "Drawing during IV insertions was never a good idea, and often created more problems than it solved." Ernst is referring to the frequency of hemolysis when drawing from IV catheters. "Four years ago, the CDC made it a Best Practice perform a venipuncture instead of drawing during an IV start. I'm thrilled the INS has worked it into their standards." Ernst was a member of the CDC's Evidence Review Panel that made the Best Practice recommendation.
Infusion Therapy Standards of Practice cites hemolysis as the main reason venipunctures should be performed instead of draws from IV sets. It specifically states the standard applied regardless of the sampling device attached to the IV catheter. However, it suggests practitioners consider obtaining a blood sample from an indwelling short peripheral catheter for pediatrics, patients with difficult veins or bleeding disorders.
"When we draw blood from an IV catheter, we could be using a medical device for a purpose for which it was not intended," says Ernst. "Not all IV devices have FDA approval to be used for drawing blood. If it's not in the catheter manufacturer's Instructions for Use, it shouldn't be used for that purpose."
One study showed draws through IV devices hemolyze samples eight times as frequently as when collected by venipuncture.
Center Tapped to Provide CEs to NCMA
The National Certification Medical Association (NCMA) and the Center for Phlebotomy Education recently announced their collaboration to provide NCMA members with continuing education materials developed by the Center.
NCMA, based in New Jersey, certifies a variety of healthcare professionals including phlebotomists, clinical assistants, ultrasound technicians, and EKG specialists.
"We expect all of our certified Healthcare Specialists to stay up-to-date with continuing education," says NCMA National Director, Ruth Patterson. "The Center for Phlebotomy Education is an internationally respected authority in phlebotomy and the industry leader in phlebotomy education. With this new association we can rely on the industry's top authority to provide the high caliber continuing education our members deserve."
"We're very selective about who we work with," says Dennis Ernst, the Center's Director. "NCMA shares our passion for accurate laboratory test results through quality blood-collection personnel. It's an honor to provide our educational materials to their members. We're determined to help them become among the most well-informed in the industry."
According to Patterson, "Dennis is recognized in our industry as one of the world's leading experts in Phlebotomy and we are delighted to have our membership learn from him and maintain the highest standards in specimen collection."
Movers & Shakers: Anne-Marie Martel
Movers and Shakers recognizes individuals in the industry who are making a ruckus. Passionate visionaries, activists, and change-agents who are working to improve patient care by increasing the quality of blood samples collected and the caliber of those who draw them through innovation, education, legislation, and leadership. They do so tirelessly, often without any compensation besides the satisfaction of making healthcare better at delivering good health.
We've known Anne-Marie Martel as an industry mover and shaker for quite some time. Ms. Martel oversees scientific affairs at the Ordre professionnel des technologistes médicaux du Québec (OPTMQ is Quebec's regulatory college for Medical Laboratory Technologists) where she is heavily involved in Canadian standards development for clinical laboratories and personnel. A passionate advocate for reducing preanalytic errors, she spearheaded development of Canada's standard for specimen collection by chairing the Canadian Standards Association's (CSA) technical sub-committee that developed CSA's preanalytical standard, Z316.7.
Ms. Martel's interest in laboratory standards doesn't stop at the Canadian border. She's currently serving as Vice Chairholder for the Clinical Laboratory Standards Institute's venipuncture standard (GP41), and a member of CLSI's Expert Panel on Quality Management Systems and General Practices. Internationally, she is a member of the International Standards Organization's (ISO) Working Group 1 on Clinical laboratory testing and in vitro diagnostic test systems (ISO TC212).
We can attest to her expertise and passion through our interactions on CLSI's venipuncture standard, chaired by our Director.
"Anne-Marie has been instrumental in shaping this important standard," says Dennis J. Ernst, Chairholder of the committee revising the document. "The depth of her expertise and her skill in cultivating consensus from a diverse group of professionals has made her indispensable to my committee."
As a testimony to her contributions to the industry, she earned the CSA's Award of Merit in 2015 in recognition of exceptional knowledge, dedicated advocacy and valued collaboration in the development of standards relating to medical laboratory practices. Is there any wonder why we consider her an industry mover and shaker?
We recently asked Ms. Martel what motivates her to be such a passionate advocate for standards and the laboratory professions.
"The preanalytical phase is of major interest to me since patients are not aware of everything that can go wrong through the many steps involved in sample collection and handling that can ultimately affect the care they receive," says Martel. "That is why we need to keep their best interests in mind and be their voice when creating these standards and guidelines. I also strive to make laboratory professionals aware of the standards so that they can achieve a high level of quality in their work."
She cites the breakneck speed of technological developments as another reason laboratory personnel must keep current.
"Technology is getting smaller and closer to the patient. Genomics is playing a major role in almost all new technologies being produced. Standards will be outdated at a faster rate than before because of the rate of these advancements. Laboratory professionals will need to have basic knowledge of genomics to be able to work in these future labs."
Ms. Martel is particularly jazzed about her latest project at OPTMQ, a series of on-line modules for the French-speaking province that will cover all activities of the preanalytical phase as well as injection of substances.
"The exciting thing about this project is that we were able to stir up the interest of all of the other professionals involved in sample collection. This means that with their help, every healthcare professional in our province who collects samples will have access to the same, high quality continuing education. We are hoping to standardize these activities, promote interprofessional collaboration and allow patients to have access to optimal quality of care, no matter which professional is collecting and handling their sample.'
A mover and shaker, indeed.
NSurvey Says: What other duties do you perform?
Recently, we asked our subscribers and visitors to our web site what other procedures and tasks they perform besides drawing blood samples.
Eighty percent of those who responded said phlebotomy was their primary duty. Ten percent said it was their only responsibility. Of the 90 percent who had other tasks, collecting nasal and throat swabs, performing point-of-care testing, and collecting drug screens were in the greatest percentage (58%, 51%, 48% and 41% respectively). Thirty five percent collected naso/pharyngeal swabs, while 32 percent performed EKGs.
Nineteen percent perform bleeding times. Another nineteen percent performed TB skin tests. Sixteen percent conduct breath alcohol testing. The same percentage collect arterial blood gases. Seven percent assist with bone marrow aspirations, while six percent make blood smears in the patient's presence.
Some additional comments:
I also am rooming patients, assisting providers, performing quality control, calibration, running in house lab tests, preparing send out lab tests, proficiency testing, analyzer maintenance, and checking provider order entry for errors.
I insert IV lines and assist with fine needle aspirations
Skin scraping, urine and faecal specmen, urea breath test, calcium absorption test, glucose tolerance tests, short synacthen test, cortisol midnight swab, blood cultures, PICC line, etc.
X-ray, immunizations, physicals, casting
Height and weight
Retinal scans, H. Pylori Breath Tests, Chain of Custody collections, Sweat Chloride collections.
Urea breath testing for Helicobacter Pylori. Bladder Cancer urine (Cxbladder) collection. Buccal mouth washouts for genetic testing.
This month, we're wondering what you're using for bandaging puncture sites. Gauze and tape? Spot bandages? Coban-type wraps?
Take the survey.
Boot Camp 2016
One person said it was the best seminar she's attended in her 35-year career. Another said the event gave her the courage and confidence to tackle a staffing problem. A third said attendance should be required for anyone training phlebotomists.
Hundreds of healthcare managers and educators from some of the most prestigious institutions around the world have graduated from the Phlebotomy Supervisor's Boot Camp since 2012. It's time you do, too.
The 2016 Boot Camp will take place in Charlotte, North Carolina on November 8-10. Not only will you have three days of intensive instruction, interaction and training, Boot Camp includes a special guided tour of Greiner Bio-One's state-of-the-art manufacturing facility in nearby Monroe where attendees will see how blood collection tubes are made.
Last year's event set a new record for attendance; so far, the registration rate this year is up 30 percent. For the seminar agenda and more information, including registration options, visit www.phlebotomy.com/bootcamp.
The Empowered Healthcare Manager:
The sprinkler or the hose?
You just caught wind from a reliable employee that another staffer is badmouthing you behind your back. You don't like confrontations, so you decide to make a general announcement at the next staff meeting that you're aware "some people have issues" with you, and that you expect they bring them to your attention, not everyone else's. You insist it won't be tolerated.
What's wrong with this approach? For starters, you just tolerated it. You just told your staff that someone is badmouthing you, and they aren't being disciplined. Instead, you put the entire group, loyalists included, on notice. You took the "sprinkler" approach hoping the guilty party would feel the wettest. Maybe he/she does, but you've also dampened the spirits of those who don't deserve the blanket accusation.
When you have the facts, the sprinkler approach is the worst approach. It's telling your team you feel they are all capable of holding you in contempt when they're not. Casting aspersions to the entire team for one person's transgression demeans your top performers, demoralizes your champions, and weakens your ability to lead. (Who wants to be led by someone who thinks you're capable of malfeasance?)
When you are certain of the fact, but not the offending party, the sprinkler may be the default approach. But when you have the facts and verified the guilty, get out the hose and douse soundly. Soak the offender and no one else with your written policy, your intolerance of deviations, and your expectation of future compliance with consequences for failure.
Then give him/her a towel and help with the drying. The empowered healthcare manager is foremost a servant.
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.
What Should We Do?: Relabeling dilemma
Dear Center for Phlebotomy Education,
We have samples coming in from a wide variety of outreach locations, (Home Health, Nursing Homes, Doctors' Offices etc.). Some of the samples have printed labels and others have hand written labels. We have worked on this process for a long time and have implemented check points and even the "Final Check" (last 3 numbers) but we still have ID errors with specimen relabeling. I would like to hear from you all about what works and what does not. What should we do?
Our response: Your relabeling necessity is introducing an opportunity for error into the process. The problem is not that samples are being relabeled improperly, it's that they have to be relabeled at all. So we really need to talk about process improvement to eliminate the need for relabeling before something catastrophic happens.
Some research into the current labeling practice is necessary to assess why tubes require relabeling. Your goal needs to be to eliminate all relabeling. Start by establishing your benchmark percentage on how many draws require your staff to relabel. You have to know the magnitude of the problem in order to gauge progress. Your ultimate goal is zero.
You should also log the reason relabeling was necessary, and the name of the individual who labeled the sample originally. Attack the problem where it lives most of the time with aggressive in-services and remedial training. When you do, you'll have to be careful how you present it. The individuals in remedial training have to know this is a process problem, not a people problem. If they sense you feel they are the problem, you've lost their cooperation. Instead, explain how the process is broken, the consequences and potential outcomes, and the plan to fix the process through them and with them. Cooperation is essential, and you only have one chance to present your solution properly.
You shouldn't need administrative support for this unless you run into resistance. Process improvement is rarely resisted, so present it professionally and you should be able to win the day for your patients.
Don't forget to track progress toward your goal, and report it to all those involved in the strategy. People tend to rally behind positive momentum. Employee feedback is required so that everyone sees the progress, or lack thereof. Rewarding every individual's diligence is another essential component of process improvement.
This is a huge problem with potentially devastating consequences when not aggressively attacked. You are to be commended for wanting to eliminate your relabeling issues.
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.)