“Exposure to Blood Beyond the Hands
and Reporting Practices among those who Draw Blood”
Survey Conducted by
DenLine Uniforms, Inc.
The questions posed on a variety of phlebotomy topics probe into the practices, policies, and opinions of healthcare professionals who draw blood samples. The following month, the Center discusses the results in its e-newsletter, Phlebotomy Today-STAT! Recent survey topics can be broadly categorized as 1) patient and collector safety, 2) collection technique, 3) personnel, and 4) working conditions. A sampling of the surveys conducted over the past two years is summarized here:
Patient and collector safety
Q Does your facility provide outpatients with an identification band prior to a blood draw?
Forty-one percent of respondents indicated their facility tags outpatients with identification bracelets, while 59% worked in facilities that did not provide outpatients with an ID band. Identifying outpatients with ID bracelets is up to the facility. Even when ID bracelets are used for outpatients, steps must be implemented that ensure the band is correct and was applied to the right patient.
Q Do you routinely ask inpatients to state their name as verification of their identification bracelet?
Ninety-two percent of survey participants indicated that they routinely ask their patients to state their names as part of their patient-identification protocol. CLSI requires this step in its venipuncture standard (H3).
Q Have you ever found an identification bracelet attached to the wrong patient?
Yes: 74%; No: 16%.
Q Do you have ammonia inhalants on your collection trays or in your outpatient drawing areas?
Eighty-one percent of survey respondents stated they do not stock them, while 19% responded that they do. Because ammonia is a respiratory irritant and because asthmatics do not identify themselves as such when presenting for lab work, the potential exists that a fainting patient who is given whiffs of ammonia could go into respiratory distress. CLSI has cautioned against the use of ammonia inhalants since 2003.
Q Do you ever use non-safety needles for phlebotomy procedures?
The findings of this survey taken in January of this year revealed that non-safety needles and skin-puncture devices are still being used in some healthcare facilities for venous draws (11.4%) and capillary collections (25.7%). Tube holder reuse was also reported by 17.1% of those surveyed.
Q Does your facility stock glass blood-collection tubes?
Another survey showed that 56.9% of facilities continue to stock glass blood-collection tubes (blood-culture bottles excluded). For U.S. facilities, the use of glass tubes and non-safety sharps could be considered a violation of OSHA regulations unless there is compelling documentation to justify their use.
Q Do you allow patients to pick the vein from which you draw?
Sixty-two percent of survey respondents indicated the patient’s choice takes priority as long as the collector feels confident with the vein selected. Thirty-five percent said that they have final say but would consider the patient’s choice, while 3% stated the patient’s preference is not a factor. Allowing patients to choose the site where venous access is attempted could be considered performing beneath the standard of care, particularly if the basilic vein is selected. According to the CLSI standards, draws to the basilic vein should only be considered when the safer medial and cephalic veins have been ruled out.
Q Does your facility limit the number of winged collection (butterfly) sets specimen-collection personnel can use per month?
Nearly 33% of survey participants stated that limits to butterfly use are in place in their facilities, with another 11% indicating that usage is actively monitored and/or a “gatekeeper” system is in place where staff must obtain butterfly needles through another individual such as the lead phlebotomist, lab manager, or lab director.
Q How does your laboratory transport blue-top citrate tubes for coagulation testing?
If you answered “at room temperature,” you are in agreement with 82.8% of survey participants and the CLSI standards. Transportation of whole blood samples on ice is not recommended for the majority of plasma-based coagulation assays because of the potential cold activation of Factor VII, loss of von Willebrand factor, and platelet disruption.
Q Is phlebotomy centralized or decentralized at your facility?
Centralized: 60%; Decentralized: 40%.
Q Does your facility formally evaluate the competence of all staff who perform phlebotomy procedures?
Collector competence is formally assessed by more than three-fourths (79%) of the facilities represented, with 60% of respondents indicating that competency evaluations are conducted within six months of hiring and/or task assignment, and annually thereafter. Direct observation was the most common method used, followed by the administration of a written test. Twenty-one percent of respondents reported their facilities do not formally evaluate the competency of all staff assigned to perform phlebotomy procedures.
Q If given a choice, would you seek inpatient services at your employing institution for you or a loved one as opposed to elsewhere?
More than 81% would have themselves or their loved ones treated at their facility. Eighteen percent would not. Recurring themes echoed among respondents who would seek medical care in-house were the level of caring shown by the facility, the faith and trust they place in the employer and staff, and the high standards and level of care maintained. For the majority, the “insider knowledge” that comes with being an employee was a plus for the employer.
Q If your blood collection staff covers multiple shifts, how would you describe the shift change?
Fifty-nine percent of respondents described the hand-off between shifts as smooth/seamless, 30% considered it as quarrelsome/contentious, and 11% deemed it confused/chaotic. Contributing factors to a less-than-smooth transition included attitudes of “it is not my job” and “leave it for the next guy,” combined with ineffective leadership. On a positive note, more than half of survey participants reported an efficient transition between shifts. One recurrent theme expressed by this group was the staggering of schedules of blood-collection personnel to provide a sufficient overlap between shifts. Add clear employee expectations, plus a defined shift hand-off protocol for specimen-collection continuity.
Q Does your facility have a formal career ladder for phlebotomists who want to progress into positions with increasing responsibilities, authority, and/or pay?
Twenty-eight percent of respondents confirmed that there was. Seventy-two percent indicated that no career ladder exists in their facility for phlebotomists.
Q If you could change one thing to make your job easier, what would it be?
Among all respondents, the single most desired change — including increased pay — was respect from other departments and patients. Teamwork was a close second with more than 30 other suggestions given.
Of those who identified themselves as phlebotomists (68%), the No. 1 answer was also respect from patients and other healthcare professionals, followed by teamwork among co-workers. Phlebotomists also wished for better chairs to reduce back strain while drawing blood. Higher salaries and additional training rounded out their list.
The top three desired improvements cited by phlebotomy supervisors and lab managers that would make their job easier: 1) physicians who coordinate their orders, 2) a motivated staff, and 3) more space in outpatient drawing areas.
Q Do you feel respected by other healthcare professions?
Sixty-three percent of those surveyed indicated that respect from other healthcare professionals is generally lacking. Reasons given include the perception that phlebotomists and/or laboratory personnel are less educated and are thereby undervalued by other healthcare disciplines.
In terms of job title, 71% of survey participants who identified themselves as phlebotomists or medical-lab assistants reported a lack of respect, versus 29% who feel respected.
For those self-identifying in supervisory roles (i.e., phlebotomy or laboratory supervisors/managers), the numbers were a little more evenly split; 57% versus 43%, respectively.
According to Woodrow Wilson “The ear of the leader must ring with the voices of the people.” The Center expresses sincere thanks to all of our survey participants who have taken the time to chime in and provide such valuable feedback over the years on all things phlebotomy. Never fear that your responses are falling on deaf ears, because the Center is listening.
Lisa O. Ballance is the director of Online Education with the Center for Phlebotomy Education located in Corydon, IN.