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Phlebotomy Today

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October, 2015

"Phleboto-cops" Drawing More Than Their Weapons
The Empowered Healthcare Manager: Team Leader or Zookeeper?
Product Spotlight: "Blood Collection Errors" SmartChart
Are We Losing the War Against Hemolysis?
This month in Phlebotomy Today
Survey Says: the order of draw
What Should We Do?: Limits on multiple heelsicks
Tip of the Month
: Spotting a Winner


"Phleboto-cops"  Drawing More Than Their Weapons

Lawsuit imageDrive drunk in Nampa, Idaho and the cops will stick it to you. Literally. That's because 11 officers on the Nampa police force trained in phlebotomy are qualified to draw your blood samples.

Nampa, a city of 80,000 just west of Boise, has been using "phleboto-cops" as an alternative to driving DUI suspects to the nearest clinic in the interest of time. The fear was that long transport times driving suspects to the nearest contracted phlebotomist or healthcare facility were letting drunks off the hook. The agency felt the body's metabolism was lowering their suspected drunk drivers' blood alcohol levels significantly in transit. Once the blood is drawn on site, the concentration in the tube remains stable until tested as long as the sample is properly handled.

In some states, DUI suspects have to give verbal and/or written consent to have their blood drawn for alcohol. Not in Idaho, which has an implied consent law on the books. By using Idaho roads, a driver has technically consented to a blood draw if a police officer deems it necessary.

Nampa officers get their training at the College of Western Idaho's phlebotomy program. Idaho isn't the only state where officers draw blood from suspected DUI cases. Police in Tucson, Arizona also have been trained.


From the Editor's Desk

Oct2011aBWsmallestSay good-bye to our web site.

The URL www.phlebotomy.com will remain the same, but in a few months our site will have an entirely new look. Long overdue, phlebotomy.com will be easier to navigate, more adaptive to mobile devices, and far more visually appealing. We're also adding an entire new section devoted to educating patients on their blood draws and the important role phlebotomists play in their care.

Testimonials 216wAnother new feature will be testimonials from those we've served over the years. If you are inclined to tell us how you feel about what we've done to help you and your facility, how we might have enhanced your training program, or impacted the profession and industry, we'd love to share your kudos on our web site and attribute them to you. 

Please submit your comments to support@phlebotomy.com and include your name and facility/organization/institution. NOTE: By submitting your comments, you agree to let us use them on our web site and other marketing materials, and to identify you and your place of employment.

Thank you in advance for taking the time out of your busy day to share your impressions about how we might have helped you. I say this frequently, but never tire of telling you what an honor it is to be a resource to you. If you have anything less than flattering to say, feel free to let us know that, too. Good or bad, we always want to know how we're doing. 



Dennis J. Ernst MT(ASCP)
Center for Phlebotomy Education


The Empowered Healthcare Manager:  You just might be a zookeeper 

Every month, Phlebotomy Today-STAT! reprints one of the prior month's posts to The Empowered Healthcare Manager blog, written by Dennis Ernst.  

WeaselYou might be a zookeeper if you have the following cast of characters on staff:

Monkey---the monkey is always on your back, finding problems for you to solve without ever suggesting solutions. Monkeys consider it their job to find things you need to fix. They are very intelligent, but are often manipulative creatures.

Rat Pack---these rodents form cliques that spend more time in everyone else's business than taking care of the work load. They ostracize your top performers, stir up trouble with those who don't join the pack, and wreak havoc with morale. They are the reason you can't keep good people.

Weasel---sneaky and manipulative. Weasels won't do their fair share, and always seem to be absent or busy when STATS or babies need to be drawn. 

Snake---worse than any weasel ever aspired to be. Snakes set you and their coworkers up for failure then rubs it in. Can never be trusted.

Turkey---These ground-dwellers were poorly trained and don't really know why processes are done a certain way. They make bad decisions, take short-cuts, and compromise test results and patient care. Though they're good at fanning their tail feathers and looking attractive when they know they're being watched, they're most content when nothing is expected of them.

BeeQueen Bee---considers herself above routine work and better than everyone else, even her supervisors. Her self-appointed authority is likely a smoke screen to cover a lack of skill.  She will attack anyone with her stinging tongue if they insist on getting close enough to see what she is actually doing. 

Bull---bulls bully your staff into submission, if not tears. They are overbearing and abusive to others, but are too smart to ever let managers catch them. They often cozy up to management so that if anyone ever reports them, you're convinced it can't be true.

Sloth---lazy, inept, and has contempt for standards. Sloths will do only what is required of them and will descend to the lowest level of activity that doesn't get them into trouble. Loves to hang around turkeys.

Skunk---considers personal hygiene to be optional.  Has chronic bad odors.

Donkey---these are your slow, methodical, stubborn, unmotivated employees who resist change. They are frequently heard saying "I've always done it that way and I'm not going to change," "it's worked all this time," and "my specimens never get rejected, so why should I do things any differently."

Zookeepers find it impossible to be team leaders. There's just too many animals in the house that prevent excellence, loyalty, professionalism, and respect from ever taking root.  Without a thorough house-cleaning, the staff will always be dysfunctional and your department will never be more than mediocre. 

RacehorseCleaning house requires the drawing of a line in the sand, and the proclamation of what behaviors will no longer be tolerated. You will be tested, so be prepared to fire one or more of these characters. The only way your staff will ever reach its potential is if you're able to convert or import two more species that no facility can have enough of: eagles and thoroughbreds.

But you have to clean house first. Eagles won't soar with turkeys and thoroughbreds won't run with donkeys.

Subscribe to The Empowered Healthcare Manager.


Product Spotlight: "Blood Collection Errors" SmartChart™

SmartChart_PatientRisks Preview72Blood Collection Errors and their Impact on Patients is the newest member of the Center for Phlebotomy Education's family of SmartCharts™.

The 2-page chart consists of a table listing over 40 errors that can be committed during the collection, transport, and handling of blood samples. A corresponding column lists the impact each error has on the test result and patient. Errors listed in the chart include improper mixing, patient misidentification, probing for veins, filling tubes in the wrong order, pouring blood from one tube into another, underfilling tubes and many more.

Blood Collection Errors joins four others in the SmartChart™ series, which includes:

  • Blood Specimen Handling and Processing;

  • Investigating Elevated Potassium Results;

  • Analyte Stability;

  • Blood Sample Collections During IV Starts.

The SmartCharts are attractively designed pdf documents for printing and posting in blood collection areas, and are available for immediate download. All information on each chart is highly researched and reflect the most current CLSI standards and guidelines. For more information and to purchase, click here.


CE Day: One Day, Six Credits 

CEday_DEwelcome_400wJoin industry expert Dennis J. Ernst MT(ASCP) as he presents the Center for Phlebotomy Education's second annual Phlebotomy CE Day on December 5, 2015 in San Diego.

With the interactive dynamics only a live event can provide, Mr. Ernst will deliver four lively  presentations worth six P.A.C.E.® continuing education credits total.* Lectures include:

  • Safety and Infection Control (1.5 credits)
  • The Standard of Care for Phlebotomy: What you MUST Know (1.5 credits)
  • What Would You Do? (case studies) (1.5 credits)
  • Your Best Foot Forward: Mastering Professionalism and Customer Service (1.5 credits)

Half-day registrations worth 3 CE credits are also available. More information and to register, 

* This event meets California's Department of Health Services' requirements for maintaining phlebotomy licensure and for maintaining certification by most certifying agencies. The Center for Phlebotomy Education is approved as a provider of continuing education programs in the clinical laboratory sciences through the ASCLS P.A.C.E. program. Accepted by all nationally recognized phlebotomy certification agencies. All other healthcare professions, check with your credentialing agency. Provider #491. California Provider #0001.


Are We Losing the War Against Hemolysis?

HemolysisIf the results of a recent College of American Pathologists (CAP) Q-Probe are any indication, the war on hemolysis is over. Hemolysis won.

Researchers surveyed nearly 850 laboratories about how they measured, quantified, and reduced hemolyzed samples in their facilities over the last year. Seventy percent said their efforts to reduce hemolysis show little or no progress. Only 49 percent actually took steps to reduce their hemolysis rates. Less than half of those surveyed even monitored their rates at all. 

Only 55 percent of those responding reject hemolyzed samples for glucose. Sixty-nine percent reject samples when LDH is ordered, while 85 percent won't test potassiums. That means 15 percent will.

Of those who took corrective action to reduce hemolysis, on average 2.4 different strategies were used. Only 53 percent retrained their phlebotomists to prevent hemolysis, while 37 percent established quality improvement teams. Fifty-seven percent shared their data with administrative leadership.

Only 5-6 facilities implemented a restriction against drawing during IV starts and from VADs, transitioned from decentralized to centralized phlebotomy or changed blood collection tubes. Two percent of those surveyed gave up on improvement.

The cost of giving up is staggering. One facility saved $556 per day when they reduced their emergency department hemolysis rate. Sarasota Memorial Hospital saved $3.7 million by reducing their hemolysis rate to less than 1%.

Clearly, hemolysis can be beaten. Most facilities, however, seem to consider the fight more than they are up for.  

Read the full study.

Editor's Note: The Center for Phlebotomy Education details a proven strategy for reducing hemolysis rates in its video "Ending Hemolysis in the ED... and Everywhere Else." View the preview.


This Month in Phlebotomy Today:  

Here's what subscribers to Phlebotomy Today, the Center for Phlebotomy Education's flagship newsletter currently in its 15th year of publication, are reading about this month:

Feature Article
How Professional Are You? A Self-assessment

On the Front Lines
Gloves and pneumatic transport 

Sticks, Staph, and Stuff
Party time!

The Empowered Manager
The burden of constant affirmation

Preassembling needles saves time... or does it?

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

Subscribe to Phlebotomy Today and get this issue immediately.


Survey Says:  The order of draw 

Lady listeningIn last month's issue, we asked our readers to tell us what they knew about the order in which blood tubes must be filled. Not surprisingly, 98 percent were aware there was an order. Unfortunately, only 62 percent were able to list the order correctly. Of those, twenty-two percent thought there was one order when using a tube holder and a different order when filling tubes with a syringe. Eleven percent weren't sure. Let's talk about that.

The Clinical and Laboratory Standards Institute has never advocated a separate order of draw for syringes. A separate order first appeared in textbooks in the early 1990s without evidence of its necessity. The myth that inspired a separate order was likely that blood inside the barrel of the syringe could clot before the tubes were filled, so it might be best to fill tubes containing anticoagulants first, and the serum tube last.

Figure 1.

However, NCCLS (now CLSI) consensus concluded the potential for carryover from the needle of the syringe was greater than that for clotting that might take place within the syringe during a properly performed venipuncture. Therefore, NCCLS recommended the same order of draw be followed when transferring blood specimens from a syringe to multiple blood collection tubes in 1998. Still, they myth perpetuates.

In our survey, 88 percent of those who knew there was an order of draw were confident they knew what the correct order was. Of those, 11 percent got it wrong. (See Figure 1 for the CLSI recommended order.)

We probed those who knew there was an order of draw about how often they follow what they perceive to be the proper order. Eighty percent said they follow it "without fail." Eleven percent indicated they usually follow it while two percent said they rarely follow the order of draw.

This month, we're asking our readers and visitors to our web site how many butterfly sets they use in a normal day and how they handle patients who request them.

Take the survey

Editor's note: The Order of Draw poster depicted in Figure 1 is available from the Center for Phlebotomy Education. Click here for more information.


What Should We Do?:  Limits on multiple heelsticks

Right way wrong way sign What Should We Do? gives you the opportunity to ask our team of technical experts for advice on your most pressing phlebotomy challenges. Whether technical or management in nature, we'll carefully consider solutions and suggestions based on the industry's best practices so that you and those in other facilities with the same problem can benefit, all the while maintaining your facility's anonymity. What Should We Do? is your opportunity to ask us for suggestions on the best way to handle your real-life dilemmas.

This month's case study: We're having issues where nursing insists their neonates have heelsticks performed multiple times, even when a good blood flow cannot be established.  I'd like to be able to tell them there's is an established maximum number of times my staff should stick a neonate's heel, but can't find anything in the literature on this topic. What should we do?

Our response: First of all, you need to make sure your staff is prewarming every neonate's heel properly. When the tissue is properly warmed, your staff shouldn't have too much trouble obtaining enough volume. Prewarming should take 3-5 minutes at a temperature not to exceed 42-degrees Celsius. Massage also helps. If they're already investing that much time, make sure there isn't a lengthy delay after removing warmth prior to the puncture.

Also, make sure the infant's foot is not elevated, but on a plane lower than the heart. Forcing blood in the limb to go uphill to the foot will minimize the volume available in the capillaries. A good inservice on prewarming may solve the problem. Investing in commercial heel warmers might be necessary if you find compliance with the temperature limits using wet washcloths to be a problem.

That said, there are no guidelines on limits to the number of repeated attempts for heelsticks. You'll need to establish a policy based on a consensus within your facility. It would also help if the physicians and nursing staff could understand the importance of consolidating orders so multiple sticks in a short period are not necessary.

Answers just ahead signGot a challenging phlebotomy situation or work-related question? Email us your submission at WSWDpanel@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.) 
     Each month, our "What Should We Do?" panel of experts collaborates on a response to one of the many compelling problems submitted by our readers.


Tip of the Month

This month's featured Tip of the Month: Spotting a Winner.