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Visit the Phlebotomy Links resource page on LabExplorer
As phlebotomy continues its transition from a laboratory-based function to a nursing-based function, issues continue to emerge that question the value of assigning phlebotomy responsibilities to non-laboratory professionals. Without properly training those new to blood collection, patients may suffer increased discomfort, disabling injuries and the negative impact that compromised specimens can have on their care. Also at risk are the multi-skilled healthcare workers themselves who don’t perform venipunctures frequently enough to feel comfortable with the equipment. They are seen as more vulnerable to sustain an accidental needlestick.
It is too early to tell if this trend to cross-train is a permanent shift in the assignment of phlebotomy responsibilities or a mere swing of the pendulum that will someday return phlebotomy to a function performed only by laboratory-based employees. But as the nation continues to debate this trend in practice and in conference, pivotal questions remain unanswered: Is it in the best interest of the patient? Is it in the best interest of the healthcare worker? Is it in the best interest of the facility?
While hospital administrators and laboratory managers’ struggle with these questions, two issues are inviting state and federal governments into the decision-making process. The first is the issue of mandating phlebotomy certification. As a result of the highly publicized incident in California in which a phlebotomist admitted to washing and reusing venipuncture needles on several patients, state legislators across the country are considering sweeping legislation that mandates phlebotomy certification for those who collect blood specimens. Since this unconscionable practice was exposed in April, California passed legislation setting minimum training requirements for phlebotomists. Many other states are expected to follow suit. If this prediction is correct, pressures will increase to restore phlebotomy to a laboratory function.
The second issue is the risk of accidental needlesticks to healthcare workers. With over a million accidental needlesticks every year, those who collect blood specimens are exposed to risks that many feel can be drastically reduced through safer needle designs. One study showed that the number of accidental needlesticks could be reduced by as much as 76 percent. Because of the extra expense, however, healthcare facilities are reluctant to make the switch, preferring to treat healthcare workers after they suffer an accidental needlestick instead, a policy many find disturbing and irresponsible. Many state and federal legislators are now drafting legislation mandating facilities to purchase and use only safety needles that protect their workers from needlesticks. Leading the way is California where legislation recently enacted forces healthcare facilities to purchase only safety needles. Similar legislation is being considered in other states as well as in the U.S. Congress.
Aside from these issues, phlebotomy managers continue to struggle to assure that sound phlebotomy practices are being taught and regularly applied facility-wide. Assuring that collectors apply the proper techniques in regard to the order of draw, patient identification, specimen handling, storage and transportation, site selection, labeling, and many other principles of blood collection is a challenge that takes daily attention. Without strict enforcement of these principles, results may be compromised putting patients at risk of being misdiagnosed, suffering medication errors, or of being otherwise mismanaged.
Because of an increase in litigation against phlebotomists and their employers, training programs must teach techniques that do not put the patient at risk of injury. Misguided punctures can result in permanent and disabling injuries to underlying nerves and arteries. If the collector is not aware of the location of these structures, the proper angle of insertion, or of techniques that can result in injury to the patient, the phlebotomist, phlebotomy supervisor, laboratory and its parent facility can suffer the agonizing torture of a lawsuit brought by the patient. Managers need to implement policies that protect them from potential injuries by establishing rigorous training and evaluation criteria and schedules that minimize this risk.
Never before has phlebotomy been under such intense national scrutiny. Sweeping changes are well underway that will forever change the way phlebotomy is viewed and conducted. These initiatives are a call for all phlebotomists to become actively aware of the issues facing the industry and to assess their own personal standards of performance so that they may further protect themselves and their patients from injury while obtaining high quality specimens for laboratory testing.
Dennis
J. Ernst, MT(ASCP) has been involved in phlebotomy for over 20 years as a
medical technologist, educator and legal consultant. He is one of the most
prolific authors on phlebotomy issues and techniques and is widely recruited
by organizations and associations to speak at their state and nationals
conferences. Laboratory supervisors, journalists, and attorneys look to Ernst
as an industry expert for information, quotes, and opinions. Here are some of
his credentials:
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Author of Phlebotomy for Nurses (scheduled release 1/15/01) |
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Founding Director of the Center for Phlebotomy Education |
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Phlebotomy instructor at the University of Louisville School of Allied Health Sciences. |
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Observing Member of the NCCLS Subcommittee on Blood Collection Procedures |
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Active in legislative initiatives to improve the competency of those performing phlebotomy. |
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Retained by attorneys across the U.S. as an expert witness in phlebotomy liability cases. |
A partial list of Ernst’s writing credits:
Collecting Blood Culture Specimens, Nursing99, July 99.
The Ten Commandments of Phlebotomy, Advance for Medical Laboratory Professionals June, 1999.
Phlebotomy on Trial, Medical Laboratory Observer (MLO), May, 1999.
Four Indefensible Phlebotomy Errors, Journal of Healthcare Risk Management, Spring 1998.
Is the Phlebotomist Obsolete? Medical Laboratory Observer (MLO),October 97.
Phlebotomy in 2010: A Procedure, Not a Profession, Laboratory Medicine, October 1996.
Integrating Phlebotomy Services Advance for Laboratory Administrators, March, 1996.
Flawless Phlebotomy Nursing95, October, 1995.
Easing Your Child’s Fear of Needles Parents magazine, May, 1995.
Job Markets For Today's Phlebotomists. Advance For Medical Laboratory Professionals, July 25, 1994.
Phlebotomists Seeking to Master The Art Should Leave Room For Humility. Advance for Medical Laboratory Professionals, August 9, 1993.
The Center for Phlebotomy Education
Dennis
J. Ernst MT (ASCP) founded the Center for Phlebotomy Education to be a
resource center for all allied healthcare professionals who perform, teach or
supervise phlebotomy in response to the increasing diversity of healthcare
professionals who are assuming phlebotomy responsibilities.
It is the belief of the Center that those properly trained in venipuncture procedures are less likely to suffer accidental needlesticks from contaminated needles, less likely to injure patients, and more capable of providing testing labs with specimens free of variables introduced during collection and processing that alter results.
| Phlebotomy.com | www.phlebotomy.com |
| American Nurses Association | www.nursingworld.org |
| International Healthcare Worker Safety Center | www.med.Virginia.edu/medcntr/centers/epinet/statelist.html |
| Phlebotomy Tutorial | http://medstat.med.utah.edu/WebPath/TUTORIAL/PHLEB/PHLEB.html |
| Southern California Phlebotomy Training | www.scpt.com |
| More on the fun side | www.svs.net/Later/home.htm |
| NCCLS | www.nccls.org |
| SUNY Upstate - Phlebotomy links | www.upstate.edu/phlebotomy/pages/library/organizations.htm |
| Virtual Hospital - Phlebotomy | www.vh.org/Providers/CME/CLIA/Phlebotomy/Phlebotomy.html |
| UCLA Library Resource - History | www.library.ucla.edu/libraries/biomed/his/blood/blood1.htm |
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One of the goals of Labexplorer.com is to share the careers of our explorers with other laboratorians. To learn more about the contributing explorers' business role in the laboratory community please review the information on the Center for Phlebotomy Education.
Workshops
"Phlebotomy for Nurses and Allied Healthcare Professionals" is a six-hour workshop conducted twice monthly at the Center’s Louisville, Kentucky classroom facility. The Center also conducts workshops at conference centers in selected cities throughout the year and at healthcare facilities across the country by request for those who prefer on-site training. Continuing Education credits (CEUs) are available for nurses.
Customized In-services
A sixty- to ninety-minute in-service is available on any aspect of phlebotomy to facilities as part of their continuing education or monthly staff meeting.
Conferences
The Center is conducting a three-hour conference entitled "Current Issues in Phlebotomy" in selected cities across the United States. Designed specifically for laboratory directors, nurse educators and phlebotomy supervisors and instructors, these conferences provide current information on timely phlebotomy topics such as licensure and needle safety legislation, phlebotomy liability and late-breaking news impacting those who manage, perform and teach phlebotomy.
The Center’s Director, Dennis J. Ernst MT(ASCP) is also available to speak at the state and national conferences of healthcare organizations.
"Ten Commandments of Phlebotomy" Poster
This 16x20
four-color poster serves as an eye-catching reminder to those collecting blood
specimens to practice blood collection and handling techniques that protect
patients from injury, safeguard themselves from accidental needlesticks,
produce specimens of uncompromising quality and demonstrate compassion for the
patient. Displayed in outpatient drawing areas, this poster also serves as
visible evidence of the facility’s ongoing commitment to quality patient
care.
The poster is available from the Center for $16.95 plus $3.50 s/h at P.O. Box 161, Ramsey, IN 47166. Discounts for quantities of ten or more. Call (812-633-4636)or e-mail the Center for an order form Illustrating the poster in miniature. E-mail phlebotomy@phlebotomy.com
Books & Videos
The Center offers a wide variety of videos and textbooks for phlebotomy educators and managers through special arrangements with such phlebotomy authorities as NCCLS, BD Media Center, and ASCP Press. Call to request a current catalog.
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Many
thanks to Dennis Ernst our first Lab Explorer.
Visit Phlebotomy.com a
wonderful site developed
by Dennis Ernst.
