Phlebotomy Today

Phlebotomist Receives $1.6 Million in Discrimination Case

A jury in California has ordered the University of California to pay $1.58 million to a phlebotomist who alleged she was harassed and subjected to racist comments by coworkers. Nicole Birden, a phlebotomist at UCLA Medical Center in Santa Monica, sued her employer in 2016, claiming her colleagues used racial slurs, made disparaging remarks about her skin color and tampered with blood samples she had drawn. In her suit, she claimed the activity created a hostile work environment.

Shortly after Ms. Birden began working for UCLA in 2015, her complaint claims she experienced racially motivated discrimination, harassment, and bullying from co-workers and supervisors including harassing phone calls on hospital-issued phones during work hours. She claimed her coworkers also mislabeled tubes of blood she had drawn or threw them away altogether. In June of 2016, her employment was abruptly terminated despite the fact that she was never reprimanded, written up or received any kind of disciplinary action against her, according to an article posted on her attorney's website about the award.

Read the full story in the Santa Monica Daily Press.

 

Product Spotlight: Streaming Videos Around the Clock

Hardly a day goes by when someone isn't watching a video on the Phlebotomy Channel. In the last two years alone, over 40,000 views were logged by healthcare professionals, trainers, and educators around the world. Are you among them? If not, you should be.

The Phlebotomy Channel is where you can access 17 full-length videos that go way beyond what you'll ever find on YouTube, and far more accurate (unless, of course, you're viewing our YouTube Channel!). The difference can be compared to that between a snack and a meal. Our YouTube channel offers quick bites; the Phlebotomy Channel is a banquet.

Designed for facilities, academic programs and healthcare systems, the Phlebotomy Channel streams the most current phlebotomy training videos to your staff and students flawlessly wherever there's a high-speed Internet connection. If you're currently assembling trainees in one room to watch a DVD, assign them to watch the streaming version at their convenience, freeing yourself to accomplish your more pressing tasks. That's good time management.

Once you subscribe to the Phlebotomy Channel, you'll not only get more productive, you'll get:

• Seventeen of the most popular phlebotomy training videos on the planet;

• Instant access anytime anywhere;

• The most current versions, even when the industry standards change;

• An insanely affordable cost-per-view.

See why schools and hospitals around the world trust the Phlebotomy Channel to flawlessly deliver high-caliber training videos on demand. Plus, with real-time tracking, you'll get a full report on who watched the videos you assigned and when. You'll also be able to assess their comprehension with the CE quiz accompanying every title.  Start streaming. You'll be amazed how convenient it is.

 

New Study Rings Alarm on Cost of Contaminated Blood Cultures

Researchers in Houston have shed new light on the true cost of contaminated blood cultures, sounding the alarm that it's worse than we had thought.

Authors of the study, a systematic review of the published literature on the economic costs of blood culture contamination, concluded the cost to the patient was up to $12,611 for unnecessary pharmacy charges and up to $11,152 in unnecessary laboratory work. Patients treated according to false positive blood cultures kept them in the hospital up to 22 extra days.

As many as 49 articles published between 1978 and 2018 were reviewed and included in the literature review. The contamination rate reported in the studies ranged from 0.9% to 41%.  Fifty-nine percent of those treated unnecessarily received vancomycin, which not only added to the cost of their care, but increased their risk of being infected by vancomycin-resistant organisms.

The authors concluded the cost of blood culture contamination was spread across multiple departments within a facility and recommended interventions to reduce the risk of blood culture contamination so that direct and indirect costs could be reduced.

Read the study.

 

Stage Set For World-Class Preanalytic Summit

From the Editor's Desk

Everything takes longer than you think it should. Everything. 

It doesn't seem to matter how much I think things out in advance and prepare, there are always obstacles that double or triple the time of any given project. Take, for example, the home my wife and I started renovating in 2008. What began as simply replacing nine windows that should have taken a few months turned into a total gutting of the three-story structure that took eight years. Then there's the deck-staining job I thought I could knock out in one afternoon. It took three days. Oh, and let's not forget the three-hour train ride from Chicago that turned into 14.
     I could go on and on, but suffice it to say my life is littered with projects and activities that go way over the anticipated time frame. There's always something that seems to get in the way, complicate the project, or expand its scope. You would think by now I'd factor those things in when setting my expectations for completion, but I don't. I'm either an eternal optimist or one who refuses to accept reality. Probably both. 
     My latest never-ending project is one I embarked upon last October, which should have taken three months tops: rebuilding the phlebotomy.com web site.

Every few years, it's important for any company to give their site a makeover, a new look and feel. And so it was for us last year when we started the facelift, which still isn't complete. The programmer I've been using for the last ten years or so is a very likeable chap and a whiz with web design. But highly talented web developers are also highly coveted. Being a longtime client, though, I figured we were a preferred customer. He confirmed that when he said,  "I think we could have this done by the end of the month." Looking back, I should have asked what month and what year.

Knowing you can't rush perfection, I gave him a long leash. I felt lucky to be his client because he's so proficient and efficient. He can make changes to our site in half the time others can, and is always responsive. With the Phlebotomy Channel and Phlebotomy Central, it's a complicated site, for sure. This time, though, he went weeks without parsing even a snippet of code. Five months later and with precious little progress, I told him that it's time we part ways.
     Sometimes consultants and clients outgrow the need for each other. Recognizing when it's time to move on is important in business, lest the attachment hampers your ability to grow and expand. Hence was the case with this developer, who really did outstanding work for us for many years, and gave us the infrastructure that allowed us to grow. But all things change, and redesigning our site had become something to do when all other clients have been satisfied. His priorities weren't working for us this time, and I needed to find a developer who didn't put everyone else's projects ahead of ours. I carefully composed the email pulling him off the project.

"You've done excellent work for us, and I greatly appreciate all you've done. But sometimes business relationships morph to a point where they don't work anymore. I think that's where we are and I need to move on to another developer."

He understood and made some recommendations. That's the kind of guy he is. He may be slow this time around the track, but he's a fair and decent man. I'm glad I chose my words carefully and politely so that they'd land softly. I learned a long time ago a flaming sendoff is never appropriate. No matter how scorned I may be, people are people and deserve honesty and civility. Besides, even when you close a door, someday you might be thankful it has hinges.

I became thankful just one week later.

     As I looked for other companies that knew our shopping cart and the nuances it imparts to a site rebuild, it became obvious the search would last longer than I had anticipated. (I should have known.) I quickly realized the qualifications we needed in a developer were not easy to find. There are precious few freelancers who know the complexities of our site's shopping cart enough to be efficient, and the last thing I wanted was to pay a developer to learn programming on my dime. Plenty of companies have the expertise in-house, but when you hire a web design company instead of an individual, you can expect to pay five to ten times more than a decent freelancer... like the guy I had just turfed out.

A sneak peek at our next web site

As it turned out, I needed my developer more than he needed me. When both parties know who needs who the most, let's just say it's not the best situation. But the reality is I needed the rebuild completed at a reasonable cost, and had only one option. I was thankful the hinges on the door still worked. 

He was very understanding and vowed to be more responsive. But if there's one thing I've learned in business is that when you let someone go, then invite them back, you've lost some dignity. With my developer, expecting to be treated any differently than before would have been pretty irrational on my part. As expected, he went back to work at his usual snail's pace, and I stopped complaining... except to you in the form of this column. This is where I vent sometimes, and I know you don't mind.

So, here we are six months later and almost a year since we first embarked upon the redesign. But I'm happy to report the site is really, truly just about ready. I expect it will go live in 2-3 weeks. I think you'll like it. It will be simpler, cleaner, and with better navigation. It will make it easier for us to place carefully selected ads on the site (something we've always shunned, but will experiment with) and make our free offerings easier for you to find and download. Once launched, the work won't be over, though. Web site work is never really over, but requires constant tweaking and perfecting.

A year is a long time to rebuild a web site. Not as long as gutting a 3-story house, mind you, but still a lot longer than it should be. It won't be much longer, though, and phlebotomy.com will  have that new look we've all been waiting for (some longer than others), then I'll be on to the next big project. That project will be filming the third edition of our Preventing Preanalytical Errors video. Yeah, I know, it should be done by now. But you can't rush perfection, which is what we strive for with everything from videos to rebuilding our web site. By the end of the year, I think you'll be pleased with both. 

I'm just not saying what year. :)

 

Take care, my friend,

Dennis J. Ernst, editor
phlebotomy@phlebotomy.com 

 

Blood Test Detects 5 Pathogens Faster Than Cultures

A blood test that can detect bloodstream infections in as little as three hours has recently received FDA approval.  

The T2Bacteria panel (T2 Biosystems, Lexington, MA) identifies five organisms known to cause sepsis directly from whole blood but without the incubation times required by traditional blood cultures. In three-to-five hours, the panel can detect five organisms commonly associated with antibiotic-resistance and often referred to by the acronym ESKAPE: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.

According to the study, the panel had an overall sensitivity of 89.7% per patient and per assay and a sensitivity of 89.5% per patient and 97.8% per assay. The study involved more than 1400 adult patients at 11 academic medical centers across the United States, and was funded by T2 Biosystems, manufacturer of the panel.

An editorial published in a later issue of the Annals of Internal Medicine questioned the limitations of the panel and its clinical utility, however. The authors cited the low prevalence of positive blood cultures, collection of a single set of culture specimens for comparison, and the inability of the panel to detect other pathogens. The editorial questioned whether the panel adds value to the management of suspected septic patients and suggested further research is necessary to see if its use expedites antibiotic therapy and its effect on the duration of therapy, the patient's length of stay, and how its use impacts patient outcomes, laboratory workflows, and cost.

Read the study in the Annals of Internal Medicine.

 

Advice From the OSHA Expert: Fire Drill

Dan the Lab Safety Man

Whether you collect blood in one location or in several, fire safety is a topic you should always have in the forefront of your mind while at work. I often find that employers overlook this important aspect of employee safety. When I perform safety audits, I notice that many who perform phlebotomy just do not have sufficient fire safety training and education. Unfortunately, when a fire occurs, this lack of training can be deadly.

The College of American Pathologists (CAP) requires that every laboratory employee be trained in the use of a fire extinguisher. There is no requirement for this to be done annually, but I would recommend it in order to always be comfortable with extinguisher operation. While not all clinical laboratories are CAP-accredited, this is still good safety sense. The most common acronym used to remember the steps of fire extinguisher operation is P.A.S.S.

P = pull the pin
A = aim the nozzle at the base of the fire
S = squeeze the handle
S = sweep from side to side

Knowing your fire evacuation routes and walking to your evacuation meeting location are not CAP requirements, but they are best safety practices. It is important to remember that if you have a designated evacuation meeting place that you gather there during an evacuation, no matter where in the facility you may be when an emergency occurs. For example, if you are in the cafeteria when a lab evacuation is announced and you do not go to your meeting location, it could mean trouble. If you are not accounted for by your coworkers, fire rescue personnel may be sent in after you unnecessarily. Their lives could be placed in danger when yours is not.

So how do you remember how to respond to a fire? A commonly-used acronym is R.A.C.E., which stands for:

• Rescue
• Alarm or Alert
• Confine
• Extinguish

You can contact Dan Scungio, “Dan the Lab Safety Man” at samaritan@cox.net.

 

Test Talk: LDH

A regular feature that spotlights a different laboratory test each month, what it measures, why physicians order it, and any collection handling restrictions and requirements that must be met.

One of the most commonly performed lab tests, lactate dehydrogenase (LDH, LD) is an enzyme often included in metabolic profiles and liver panels, or ordered separately. Because it is commonly found in heart, liver, muscle, lung and kidney tissue, physicians who suspect pathologies with any of these organs will include LD levels in a laboratory workup. 

Because it can be found in almost every cell of the body, it is a non-specific marker for tissue damage. When elevated, more specific tests are usually ordered to determine which organs are involved (e.g., ALT, AST, ALP or LD isoenzymes, which are organ-specific). Since red blood cells are rich in LD, hemolyzed samples cannot be used for testing. Due to its high concentration within red blood cells, LD is often used to diagnose hemolytic anemia. Physicians also order an LD test on cerebrospinal fluid to distinguish between bacterial and viral meningitis. 

Because LD is concentrated in muscles, strenuous exercise can be a non-pathological cause for temporary elevations.

LD can be tested on serum (most commonly) or heparinized plasma. Fasting is not required. Samples to be tested for LD must be centrifuged and separated from contact with the LD-rich red blood cells, preferably within two hours. After that, serum levels will be significantly and falsely elevated due to contributions from red blood cells. 

LD used to be commonly ordered to diagnose acute myocardial infarction (MI), but has since been replaced in cardiac panels by Troponin.

 

Bibliography

1. LabTestsOnline. American Association for Clinical Chemistry. AACC. Accessed 9/9/2019.
2. CLSI. Procedures for the Handling and Processing of Blood Specimens for Common Laboratory Tests; Approved Guideline—Fourth Edition. H18-A4. Clinical and Laboratory Standards Institute. Document H18-A4 Wayne, Pennsylvania 2010.
3. Wu A. Tietz Clinical Guide to Laboratory Tests---Fourth Edition. Elsevier. St. Louis, Missouri. 2006.
   

 

Phlebotomy CE Day Fast Approaching

Registration is open for the 6th annual Phlebotomy CE Day, jointly presented by AUMT Institute and the Center for Phlebotomy Education taking place in San Diego, California on Saturday, September 21, 2019. 

All topics will be presented by the Center's Director, Dennis J. Ernst MT(ASCP), NCPT(NCCT) and will include:

• The Ten Commandments of Phlebotomy
• What's New in Phlebotomy (and What Isn't!)
• Ending Hemolysis in the ED... and Everywhere Else
• What Would You Do? (Case studies)

"Speaking to my phlebotomy friends in California at CE Day has become one of my favorite annual events," says Ernst. "I'm particularly looking forward to collaborating with AUMT again, one of the finest phlebotomy programs in the country."

Attendees present at all sessions will earn six P.A.C.E.® CE credits, which satisfy the biannual requirement for California phlebotomists. Discounted registration will be available for groups of four or more who register at the same time. All healthcare professionals throughout the U.S. and Canada are invited to attend this lively and informative event. As the event coordinator, AUMT will be managing the event, processing all registrations, communicating with all registered attendees, and providing P.A.C.E. certificates.

For more information and to register visit AUMT's CE Day web site or contact AUMT by phone at (424) 278-9442 or email at CEday@AUMT.org.

 

What's Wrong Here?

What's wrong with this picture (left)? We guarantee something isn't as it should be. (Click image to enlarge.) The answer will be in next month's issue.

Last month's image (right) depicted the filling of a tube through a multi-sample needle without the use of a tube holder. You're likely wondering why someone would ever try this, but we hear of healthcare professionals performing this dangerous maneuver frequently. Apparently, the risk of needlestick is not as obvious with this technique as you might think. 

To illustrate the potential to sustain a needlestick from the back end of a multi-sample needle, click to enlarge the second illustration at the right. The vinyl sleeve offers no protection from the needle that pierces tube stoppers when a tube holder is not used. Whenever a multi-sample needle is used, it must be connected to a tube holder. Omitting this important piece of equipment is reckless and potentially catastrophic to the user.