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Phlebotomy Today

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November, 2014

Last Chance for California Phlebotomists
NAACLS Stands Firm
The Empowered Healthcare Manager
Product Spotlight
Summary of Surveys on Phlebotomy.com
This month in Phlebotomy Today
Survey Says
What Should We Do?
Tip of the Month


Last Chance for California Phlebotomists

  PhlebotomyCEday Phlebotomists in California who still need to complete their state's required six CE credits by the end of the year have only a few days left to register for Phlebotomy CE Day taking place Saturday, November 15. More information and to register. 


NAACLS Stands Firm: Those Who Test Blood Samples Don't Need to Know How to Draw Them

In November of 2013, the National Accrediting Agency for Clinical Laboratory Sciences, NAACLS, released its revised program requirements for Medical Laboratory Scientist programs. Missing was the requirement that students learn to draw blood samples. According to NAACLS Chief Executive Officer Dianne Cearlock, Ph.D., the revised requirement generated little comment from program directors affected by the change.

Yet educators attending the 2013 Clinical Laboratory Educator's meeting in San Jose were stunned when it was revealed at the NACCLS workshop taking place at the same event.

"Program Directors were coming to our booth shocked that NAACLS dropped the requirement," said Catherine Ernst RN, PBT(ASCP) Executive Vice President of the Center for Phlebotomy Education. "People kept saying 'did you hear?… did you hear?… did you hear?' and until then we hadn't. Apparently, they hadn't either until that morning."

The Center for Phlebotomy Education's Director Dennis J. Ernst MT(ASCP) contacted NAACLS president  Dianne Cearlock and confirmed the change. According to Cearlock, the justification centered around three key factors: 1) the Standards Revision Task Force was seeking to identify core curriculum for MLS practice; 2) the impression that phlebotomy is not under the supervision or responsibility of the laboratory in many clinical sites, making practical experiences difficult to coordinate; 3) the presumption that today's job market often does not require the MLS employee to perform phlebotomy procedures.

"I question the premise that decentralizing phlebotomy services is sweeping the nation. We interact closely with laboratory professionals, and we just don't see it." Ernst states phlebotomy is often underestimated by non-laboratory professions, but admits to being caught by surprise at the NAACLS change. "I can understand how other professions underestimate the importance of proper phlebotomy technique, but I never would have thought a laboratory agency would diminish it."

Ernst is concerned about how the change will impact patient care. "I am of the opinion when those who test samples no longer have to know how to draw them, there's a disconnect from the patient that is critical to their work. We're putting MLS professionals in a silo where patient contact is not possible."

Marketability in the workforce is also a concern for laboratory professionals who lack the skill to draw blood samples. "Not only is confinement to that silo unfortunate and potentially dangerous to the patient, but it's a disservice to the student who exits those programs far less marketable in the workforce. Their applications will go straight to the bottom of the stack when they apply to facilities that require their testing personnel to also draw samples."

Cearlock suggested Ernst send a letter to the NAACLS Board of Directors expressing his concern. According to Ernst, the board has not responded. "It's my understanding the letter was received by the board, but generated very little discussion at their last meeting.

The change does not prevent program administrators from teaching the procedure to MLS students, according to Cearlock, and teaching the skill is still required for accredited Medical Laboratory Technician programs. Ernst encourages laboratory educators and professionals who share his concern to contact officials at NAACLS and encourage them to reverse their decision.



The Empowered Healthcare Manager: Better than you found them

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

Every empowered manager's goal should be to leave their employees better than they found them. Not just a little better, but so valuable that they can no longer pay them what they're worth.

If you constantly nurture entry-level employees to become so marketable in the workforce that they take the talents you nurtured to another employer, perhaps even your competitor, you've done something profound. You've made someone more valuable.

The real beauty of creating employees you can no longer afford is they are not likely to leave you to work for someone who might parasitize them, dispirit them, and empty them in exchange for a better wage. (If they do, something else about working for you needs fixing.)

Make your employees marketable and they will either remain with you forever at less than market value for the sheer joy of working for someone who invests in them, or leave to seek a better lot in life. Either way, you win.

The alternative is to make them mediocre and unmarketable. How rewarding is that?

Subscribe to The Empowered Healthcare Manager blog


Product Spotlight: Phlebotomy Channel

Phlebotomy Channel Logo Final_MediumTMThe Phlebotomy Channel is the only web platform that streams training videos on phlebotomy to healthcare professionals and facilities around the world. Providing smooth, on-demand viewing, the Phlebotomy Channel hosts 19 dynamic, high-powered training videos, studio-recorded lectures, and archived webinars viewable on any computer with a high-speed Internet connection. Titles currently available for streaming include:

Applied Phlebotomy training videos

  • Basic Venipuncture
  • Preventing Preanalytical Errors
  • Avoiding Phlebotomy-Related Lawsuits
  • Skin Punctures & Newborn Screens
  • Arterial Blood Gas Collection

Applied Phlebotomy: Lecture Collection

  • Safety Survey: How Vulnerable Are You to a Needlestick?
  • Delivering World-Class Customer Service
  • Seizing Control of Blood Culture Contamination Rates
  • Ending Hemolysis in the ED... and Everywhere Else
  • Managing the Risks of Patient Injury
  • Mastering Pediatric Phlebotomy
  • Four Pillars of World-Class Phlebotomy
  • Potassium Results Your Physicians Can Trust
  • Successful Strategies for Difficult Draws
  • The Ten Commandments of Phlebotomy

Archived Webinars

  • Preanalytical Benchmarks: How Does Your Lab Compare?
  • Assessing Phlebotomy Competency
  • Industry Update

"The Phlebotomy Channel is light-years ahead of any other online training for laboratory and nursing personnel," says Dennis J. Ernst MT(ASCP), Director of the Center for Phlebotomy Education. "It's arguably the most dynamic, convenient, and cost-effective way to educate phlebotomy students, the laboratory staff and other healthcare professionals on how to draw blood properly and according to the standards."

The Phlebotomy Channel provides managers and educators with a full administrative panel to assign titles to their staff or students for viewing and gives a full history of who has watched which videos.

Full-length previews for every title are available as well as a promotional video that highlights feature built into the platform at www.phlebotomy.com/PCTV.cpe.


Summary of Surveys on Phlebotomy.com

Each month, the Center for Phlebotomy Education posts a survey question inviting readers and visitors to its website and Facebook page to participate, and then publishes the results in the following issue of Phlebotomy Today-STAT! This month, we summarize responses from some of the more intriguing surveys conducted over the past 12 months. Topics include bullying, conflicts between phlebotomists and techs, gossips, laboratory/nursing relations, and more. Links are provided to the archived issue of Phlebotomy Today-STAT! that discusses the survey results at length. 

My Gift
Suppose today is the birthday of every one of your co-workers. What is the one gift you would like for them all to receive today?

Pay raise---30%
Day off with pay---20%
Good veins---4%
Gift cards---4%
Appreciation and recognition---10%

Full survey results and commentary

Fainting5smFainting and ammonia use
How do you react to patients who become dizzy or actually faint?

Cold compress on the patient's head or neck---88
Recline patients---44
Ammonia inhalants---12

What is your facility's written policy for reacting to patients who become dizzy or actually faint? (Multiple responses permitted.)

No policy---36%
We are to recline them, with or without assistance---36%
We are to recline them, but only with assistance---24%
We are to use ammonia inhalants---12%
We are to use a cold compress on their head or neck---68%
We are to lower their head---32%

Are ammonia inhalants accessible for use on fainting patients?


Have you ever used an ammonia inhalant on a fainting patient?


If you have used ammonia inhalants on fainting patients, has any patient ever reacted adversely to the ammonia?


Full survey results and commentary 

  ScrubsOnTheGround_WalMartScrubs on the Ground
Does your facility's dress code policy for scrubs prohibit pant legs from touching the floor?


If your facility has a policy, how strictly is it enforced?

Never enforced---50%
Strictly enforced without exception---19%
Randomly enforced---31%

How often do you see staff in any department with pant legs sweeping the floor as they walk?

I never see scrubs on the ground---6%
At least five occurrences each day---13%
More than ten occurrences every day---10%

Full survey results and commentary

Policies on drawing on combative patients
Have you ever been physically assaulted by a combative patient while attempting to draw a blood sample?


Does your facility have a policy on combative patients specific for drawing blood samples?


Full survey results and commentary

Morning Draws
What time does the specimen collection staff at your facility start morning draws?

3 a.m.---11%
4 a.m.---28%
5 a.m.---20%

By what time is your laboratory expected to have lab results from morning draws available to physicians? 

7 a.m.---40%
8 a.m.---26%
9 a.m.---9%

Which best describes phlebotomy services in your facility? 


Full survey results and commentary

Butterfly Wings
Do you let go of the wings of a butterfly set after inserting?


Does your facility have a policy on whether or not butterfly sets can be released after insertion?


Full survey results and commentary 

You're Fired!
If you had the authority, how many of your coworkers would you like to fire today?

Fewer than five---35%
Five or more---10%

If you had the authority, would you give your immediate supervisor a promotion, raise, demotion, or termination?

Promotion and raise---31%

Full survey results and commentary

Repositioning, reinserting needles when you miss.
What do you do when you miss the vein?

I only relocate the needle under certain circumstances---86%
I always relocate the needle---9.5%
I never relocate the needle---5%

To what extent do you re-position the needle?

Only if I think I know where the vein is and if it isn't near anatomical structures that could be damaged ---71%
Only if I think I know where the vein is---18%
I will relocate if the patient gives me permission---12%

Do you ever take the needle out and reinsert it nearby?


Does your facility have a policy on either of these situations?


Full survey results and commentary

Rainbow1Drawing rainbows
How often do you draw extra tubes of blood on patients just in case additional tests are ordered?


 In what wards/departments do you draw extra tubes most often?

Obstetrics: 12.7%
Surgery/recovery: 18.6%
Emergency Dept.: 65.7%
Acute care wards: 14.7%
ICU/CCU: 25.45%
NICU: 1.0%
Psych wards: 3.9%
Isolation patients: 14.7%
Lockup rooms: 6.9%

 Does your facility have a policy permitting extra tubes to be drawn just in case?


Full survey results and commentary

Are your suggestions welcome?
How comfortable do you feel suggesting changes in the workplace?

Suggestions are welcome---74%
Suggestions are not welcome---26%.

 How are your suggestions for change actively solicited?

We are asked directly in person or during meetings---89%
There are suggestions boxes we can drop our suggestions into, even anonymously---22%
We have a bulletin board for people to post ideas---22%
We receive emails requesting our ideas/suggestions---44%

 Full survey results and commentary


This Month in Phlebotomy Today   

PT_logo-2012_400Here's what subscribers to Phlebotomy Today, the Center for Phlebotomy Education's paid-subscription newsletter currently in its 15th year of publication, are reading about this month:

Feature Article

What Every Phlebotomist Must Know About Ebola

On the Front Lines
Tourniquets and Transdermal Patches

Sticks, Staph, and Stuff
Coming to Work Sick

The Empowered Manager
Capable of Doing Good Work but Choosing Not to.

Double Tourniquet Technique

Videos Focus on Reducing Laboratory Costs, Increasing Productivity

What's Wrong Here?

For subscription rates and to subscribe to Phlebotomy Today, click here.


 Survey Says: phlebotomy tray practices Red Target_SS 

Last month, Phlebotomy Today-STAT! readers and visitors to our web site were asked about their practices regarding phlebotomy trays and their disinfection. Fifty-six percent reported they use phlebotomy carts to carry supplies to and from inpatient and ED rooms with 42 percent carrying handheld trays. Four percent carried their supplies in their pockets.

 We also wanted to know where respondents who used trays set them when preparing patients and performing the procedure. Eighty-six percent said they placed the phlebotomy tray on their patients' beds, 43 percent on the patients' bedside trays, 14 percent on the night stands, and 4 percent on the floor. Forty-three percent also place their trays on a chair. (Multiple responses were permitted.) One respondent indicated his/her facility has "nooks" where trays are set outside of the patient room.

 Also for those who carry handheld trays, we asked if they place a protective barrier between the tray and the surface upon which they set it. Seventy-five percent don't, 25 percent do. PhlebTrayMessyHigRes

 Since so many phlebotomy trays come in direct contact with patient surfaces, routine disinfection is the only way to prevent them from spreading pathogens. So we asked if our respondent's facility has a policy on how frequently phlebotomy trays and carts should be disinfected. Fifty-five percent indicated they had a policy. Of those, half were to disinfect after every shift, 36 percent were supposed to disinfect daily, 8 percent weekly, six percent monthly and 3 percent annually. Thirty-one percent were to also disinfect when their tray was visibly soiled. Unfortunately, only 67 percent of those said their facility had a policy indicated it was enforced. Here are some comments:

 The trays on top of carts are personal and are the responsibility of the individual to keep clean. They are inspected weekly.

 [Carts are cleaned] at the beginning of every shift. I work at a Level 1 Trauma Center, and no employee truly trusts the person before them to clean the cart to their standards.

 Supervisor checks every month after we have signed off our end-of-month date check and clean sheet.

 We have QC weekly sheets to check off on tray cleanliness. Our infection control officer along with state and Joint Commission do random checks.

 Our trays are cleaned after every patient and carts cleaned after every shift

 Everyone puts on gloves at the beginning of the shift and uses PDT Super Sani-Cloth Disinfectant Wipes. We also wipe down our Collection Manager Hand Held Devices at the beginning of every shift.

 Supervisor is on hand at the time but no one ever gets reprimanded if it is not done properly.

 Let's face it, phlebotomy trays are bug bombs. The bottoms of your shoes are probably cleaner than the bottom of your phlebotomy trays. It's disturbing that only 25 percent of those who set their phlebotomy trays on patient surfaces put a protective barrier between. Patients use trays to rest their hands on and set items on like hearing aids, dentures, and silverware that easily transmit what was on a phlebotomy tray into their susceptible bodies. We need to do better.

 According to OSHA consultant Dan Scungio, MT(ASCP), SLS, CQA (ASQ) (AKA "Dan the Lab Safety Man"), "With normal use, phlebotomy trays should be cleaned and disinfected on a regular basis. Daily these trays should be spot-cleaned as needed and supplies should be refilled. Each week the tray should be completely emptied and disinfected with an approved disinfectant. Restock the tray once all pieces have been cleaned and reassembled. If a spill of blood or other types of specimens occurs, immediately stop and thoroughly disinfect the affected area of the phlebotomy tray."

This month's survey asks if phlebotomy services at your facility are centralized (samples drawn primarily by laboratory personnel) or decentralized (samples primarily drawn by non-laboratory personnel), and for your facility's hemolysis rate as an indicator of sample quality. We also ask decentralized facilities how their staffing model  is working.

Take the survey


What Should We Do?: Wrist risk

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: I've been practicing phlebotomy for over nine years, the first eight were in a hospital setting. I was taught that you NEVER should draw from the underside (palm side) of a patient's wrist due to the nerve bands that run there. I am now working for another hospital in an outpatient lab setting. I have witnessed several employees drawing from this former no-no area. When I brought this to my supervisor's attention, I was told she has done it herself and as long as you are careful and use a 25g needle it is ok. What should I do?

WristAnatomyOur Response:
You are correct that there are too many nerves and tendons in this area to make is a safe option for obtaining a blood sample. Your supervisor may not know the standards forbid draws to the front (palm-side) of the wrist. That means you are in the awkward position of having to bring the standards to the attention of your superior.

  We suggest making sure your lab has a copy of the Clinical and Laboratory Standards Institute's venipuncture standard (GP41). Every lab should have a copy since it's what they will be held to if a patient is ever injured and takes legal action. The standard is quite clear that the front of the wrist is off limits.

 If your lab doesn't have a copy, it's not your place to purchase one (besides, they cost $200 for non-CLSI members). Instead, find reputable resources that support and reflect the standard. One source is our web site. Simply visit www.phlebotomy.com and enter "wrist" into the search window. Several authoritative documents will come up, including back issues of this newsletter.

 We would add that it's not only the front of the wrist that's vulnerable to nerve damage during venipuncture, but the lateral (thumb-side) of the wrist as well. Even though the standards still permit draws here, a preponderance of evidence is likely to render this site off limits as well in the next revision. It's best, therefore, not to allow draws anywhere in the wrist area. 

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. Panelists include:


Got a challenging phlebotomy situation or work-related question? Answers just ahead sign

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.)


Tip of the Month

Each month on our home page, we post a "Tip of the Month" from our rich library of archived Tips.

This month's Tip: "Fear Factor". 


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