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Phlebotomy Today

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December, 2014

Phlebotomy School Under Scrutiny
The Empowered Healthcare Manager
Product Spotlight
This month in Phlebotomy Today
Survey Says: Decentralized Phlebotomy
Decentralized Phlebotomy Article Featured in Advance
What Should We Do?: Bullied
Tip of the Month
: Catch Me if You Can


Phlebotomy School Under Scrutiny

Looking thru magnifierNational Phlebotomy, a school in Phoenix, Arizona, recently came under fire for not providing certificates of completion to graduating students. According to a report aired on KTVA-TV, an independent television station in Phoenix, three students completed the 2-day weekend program after paying the $200 tuition, but have yet to receive the promised certificates. The television station's consumer advocate "3 on Your Side" investigated National Phlebotomy and found little evidence of a legitimate business. The story aired on December 5.

"This is beyond sad," said Dennis Ernst, Director of the Center for Phlebotomy Education. "What's worse than not getting their certificate was their understanding that completing a 2-day course makes a person suddenly marketable as a phlebotomist. Certificate or no certificate, they're no more marketable than they were the day before they plunked down their hard-earned money."

According to Ernst, unsuspecting consumers across the U.S. are throwing their money away on abbreviated phlebotomy courses thinking they'll have a marketable skill. "Weekend courses can be good refreshers, but to be fully trained and marketable in healthcare a phlebotomy program has to take weeks or months, not days." The Center for Phlebotomy Education's own School of Phlebotomy included 96 classroom hours and 100 clinical hours, including at least 100 patient draws. 

"I'm not a fan of over-regulation, but I wish more states and legislative bodies would mandate minimum standards for phlebotomy schools like California has," says Ernst.

View the news story.


The Empowered Healthcare Manager: the value of humility 

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

Two months ago my mom and I engaged in a friendly game of Scrabble. She's 89-years old. I use words to make my living. She beat me soundly.

Last week your best phlebotomist couldn't get blood from a patient that your newest phlebotomist got on the first stick.

Even though you've hired dozens (if not hundreds) of employees and have perfected the art of hiring the cream of the crop, next month you'll hire the worst employee you've ever had.

There are people placed in our lives for the sole purpose of keeping us humble. Their timing is always perfect. As soon as we boast, bam!  Toot your own horn and a sour note is bound to come out before your most critical audience. It's embarrassing, but it's appropriate.

The alternative, humility, is powerful and protective. If you let your work speak for itself, allowing others to notice on their own instead of bringing your abilities to their attention, you'll never be humbled. When the humblers make their rounds sniffing out the prideful, you'll get a pass.

The best reputations---the ones that stand on their own, the ones that endure and really matter---are organic and don't require the dung of pride to bear fruit. They are also immune from humiliation.

The humble can't be humbled.

 Subscribe to The Empowered Healthcare Manager.



Product Spotlight:  DVD Teaches How to Prevent Hemolysis


HemolysisDVD_200wIsn't it time to stop tolerating hemolysis?

Sure, you monitor it as a laboratory quality indicator (don't you?), or as your own personal quality indicator, but have you accepted hemolysis as a problem you have to live with? Say it isn't so.

A new DVD from the Center for Phlebotomy Education not only discusses the most common causes of hemolysis (hint, most of them don't occur in the laboratory), but provides strategies every healthcare professional and manager can implement to get their hemolysis rates down to nearly negligible levels. 

Highly researched, impeccably accurate, and dynamically presented, Ending Hemolysis in the ED... and Everywhere Else is the second in the Center's new Applied Phlebotomy Lecture Collection series, released this fall. Narrated by Dennis J. Ernst MT(ASCP)NCPT(NCCT), this video is a studio-recorded version of one of his most popular topics.

One facility found recollecting a rejected sample cost them $12.06 in supplies and personnel time. If that's near what you're lab is shelling out, this video pays for itself after only preventing 20 samples from being hemolyzed just by implementing the 7-steps outlined in this DVD.

It's not just about saving money. Consider the frustration the patient endures, the aggravation the physician goes through in delayed results, and the interdepartmental friction caused when labs and nursing departments play the blame game. 

Hemolysis: Just say "NO!"

 More information and a 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
Vein-Finders: Rescuing the Difficult Draw

On the Front Lines
Coban on infant heels

Sticks, Staph, and Stuff
Retouching a cleansed site

The Empowered Manager
What winning looks like

How Fist-Pumping Raises Blood Potassiums

Myth Busted!
Tourniquets for fingersticks? Really?

What's Wrong Here?

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


 Survey Says: Are You Decentralized?

Red Target_SSIs today's climate of healthcare-reform leading more and more facilities to reconsider an alternative phlebotomy staffing model known as decentralized phlebotomy? We last polled Phlebotomy Today-STAT! readers about decentralized phlebotomy five years ago and thought it would be interesting to see which way the pendulum is swinging. The results surprised us.

Centralized phlebotomy is when the majority of blood samples drawn are collected by laboratory-based personnel, e.g., phlebotomists. However, when phlebotomy is decentralized, the task is given to non-laboratory personnel, e.g., nurses, nursing assistants, etc. leaving phlebotomists out of work or reassigned with new job titles and more bedside responsibilities as nursing support personnel.

In 2009, 60 percent of those responding to our survey indicated specimen collection was centralized in their facilities. Today, 85 percent are centralized according to last month's poll. None of those working in centralized settings were aware a transition to decentralized phlebotomy services was being considered. Of the 15 percent currently in decentralized settings, 60 percent said it's not working very well.

Of those who are now decentralized, most (60%) indicated they have been that way for at least ten years. Only 20 percent of those who are decentralized today have converted from a centralized process since 2009.

Many studies reflect a deterioration of sample quality takes place when settings decentralize. Our survey concurs. One respondent in a decentralize facility indicated 17 percent of samples drawn there are hemolyzed. The average reported in centralized settings was 2 percent. (The average in the industry is considered to be 3.3 percent.)

Some comments:  

This was discussed at our facility several years ago. I presented the pros and cons to a select group and the decision was not to move forward. We have great support from our nursing VP.

All clinical staff should have phlebotomy skills. By always being available to do the phlebotomy we de-skill docs and nurses. If they don't ever do the task they never get good at it.

We have only been centralized since Jan. 2013. The hemolyzed specimen rate and blood culture contamination rate have improved greatly since then.

The results are only as good as the specimen. Specimen collection is so often overlooked, but can have such an impact on the final results. This is an area that needs to have more emphasis placed on it and have people who understand what and why they are drawing things a certain way (ie, needle size, tube order, tourniquet time.....) But the long held belief is--anyone off the street can draw blood. That is a very scary thought!! This attitude needs to change!

 While decentralized phlebotomy can work, studies show it fails more often than it succeeds when sample quality, patient satisfaction, and interdepartmental friction are the indicators. The task of implementing and managing a decentralized blood collection model is enormous, vastly underestimated, and fraught with obstacles. Often the problems overwhelm the benefits, and many facilities ultimately revert back to centralized services.

 This month we ask what your facility's policies are on piercings, tattoos, hair styles and hair colors. 

Take the survey


Decentralized Phlebotomy Article Featured in Advance 

Advance for Administrators of the Laboratory published an article on decentralized phlebotomy in its November issue written by Center for Phlebotomy Education Director Dennis J. Ernst MT(ASCP). Ernst details the pitfalls of reassigning blood collection responsibilities to non-laboratory personnel.

Phlebotomy supervisors and laboratory managers from U.S. facilities who have experimented with the staffing strategy were interviewed, and reinforce the degree of difficulty facilities face when considering decentralizing phlebotomy procedures.

Read the full story


 What Should We Do?: Three against one

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: One of my coworkers continually snubs me. When I addressed her directly she responded, "I just don't talk to you and that's my choice." When I responded that she was being inhospitable, she said, "That's your problem!" Every subsequent act of kindness I have tried to extend to this individual always ends in disaster.  I told my boss more than once of my colleague's hostile and unprofessional behavior and  don't want to burden her again. When I took it up with the Human Resources Department they suggested I bring it up to my supervisor again. Seeing this coworker puts my stomach in knots. What should I do?

Our response: What you have is a bully, an intimidated manager and a negligent human resources department.  Rest assured, you are not the only one being victimized. Bullies are probably running rampant throughout your facility.  For their collective dysfunction to leave you tied in knots day after day is unbelievably unacceptable. 

First, make a decision on whether or not your employer deserves your skills. Depending on where you live and what your personal situation is, there are likely to be other healthcare employers who need and will respect your abilities. The alternative is to lock horns with all three adversaries where you currently work: the bully, your manager, and HR. It's already three against one, so be prepared for a tough fight.

But if you really want to remain with your current employer, you should fight for your legal right to a non-hostile work environment. It depends on your fortitude and courage. But rest assured, you have every right to demand your managers aggressively eradicate this menace. Your last resort would be to contact your state's Labor Relations Board and file a complaint against your employer.  

 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: "Catch me if You Can."