CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Rickard
All Sarasota Memorial staff members who perform blood collection have access to phlebotomy education, including the multiskilled technicians who report to nursing units. “Most nursing units request the lab’s phlebotomists,” Rickard says. Units that do not use phlebotomists from the lab can send their own multiskilled technicians to the laboratory, where educators assess their preanalytical skills and help ensure they are forming good habits when performing blood draws so specimens will not be rejected.
A hemolysis prevention tip sheet displayed on all nursing units has also been key. The tip sheet (developed in collaboration with Becton Dickinson) warns against, for example, pulling back on the syringe too far during the blood draw or with too much force while transferring the blood to a collection tube. It warns, too, against underfilling the tubes. “We remind nursing staff that all tubes, not just the coagulation tubes, must be full,” Rickard says.
Explaining the significance of the order of the draw has also been of help, Damato says. While nurses receive training on phlebotomy procedures, “we continue to reinforce exactly why the draw should be carried out in a particular order, and they are very receptive.”
Damato
Sarasota Memorial acquired and went live on Jan. 2 with the Siemens 5100 coagulation analyzer, which has automated checks for hemolysis, icterus, and lipemia, as well as for volume, Rickard says. For a time, she expects the hemolysis rates to rise because the laboratory no longer relies on technicians to determine visually whether specimens are hemolyzed or improperly filled. “You can miss some when you’re looking at it,” Rickard says. “Now we have an actual measurement so we’ll catch more.”
“Rates will increase a bit and then we will educate and reduce them again. It’s continuous improvement.”
Best practices, new instruments—one thing trumps all in blood collection: proper patient identification. “That’s God-given, of course,” says Stony Brook’s Finnegan. “It’s the most important step in phlebotomy.”
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Amy Carpenter Aquino is CAP TODAY senior editor. To order the CAP’s So You’re Going to Collect a Blood Specimen (PUB225), call the CAP at 800-323-4040 option 1.