Phlebotomy Today

Fear of Needles Leads to Pancreas Transplant

Because of her paralyzing fear of needles, a British patient let her health decline to the point where a pancreas transplant was necessary to save her life.

According to the Medical Daily, a health and science news outlet, Sue York was diagnosed with Type 1 diabetes when she was seven. Now 51, York's ability to manager her condition was seriously compromised due to her aversion to needles. Her condition required two injections per day. Some days, she just had to walk away from the needle. But when the UK enacted legislation in 2012 requiring diabetics like York to test her blood glucose level before driving, and every two hours thereafter, she asked to be put on the transplant list.

York's transplant, conducted in January, makes her the world's first pancreas transplant required because of needle phobia.

Read the full story.

[Editor's note: Phlebotomy Today-STAT! subscribers are urged to exercise an abundance of compassion and understanding towards all patients with an aversion to needles. Because all it takes is one negative needle experience to turn patients like Sue York into transplant patients, phobic-friendly phlebotomists play a pivotal role in preventing aversions from becoming full-blown phobias. Listen to my podcast with needle-phobia expert, Dr. Amy Baxter.]

What Should We Do?: Patients who can't speak

Question: Every now and then we may have a cognitively functional patient who just can't speak. Is it acceptable to identify them using leading questions? For example, let's say the patient’s DOB is April 10, 1999. You could ask him if the month of his birth was January. Then ask if it's in March. Then ask if it's in October and so on, eventually offering April. If he answered no to all except April, would that be considered positive confirmation? Then you could follow the same track for date and for the year. I am only referencing a patient with the wherewithal to follow this line of questioning, i.e., trach patient, laryngeal dystonia, etc. What about reading their lips? I want to be able to properly identify all patients, and it seems like this could be an acceptable form. What should we do?

Our response: This is a fantastic question, and a very interesting approach. We're assuming a caregiver or family member is not able to provide the patient's ID on their behalf, which would be preferable. We've mulled this over a good deal, but can't get comfortable with the kind of multiple choice dialog you're asking about.  It's still having the patient affirm something the collector speaks. We don't think the standards will ever split the hair that way. However, we are in favor of creating three charts: one lists the 12 months of the year, the second displays the days of the month from 1-31, and the third lists years, perhaps in columns that go from 1900 to 2010 or similar. Then have the patient point to the day, month and year of his/her birth. That's not affirmation. 

However, you still have the problem of getting them to provide their name. For that, you could simply provide a fourth chart with the alphabet and have the person spell their full name by pointing at each letter sequentially. 

Books for Pediatric Patients About Their Blood Draw

When you're a young patient, healthcare can be a scary place. Within hours of birth, most newborns are welcomed into their new worldly home with a sharp poke to the foot. It's not very welcoming, and a good thing they don't remember. As they grow, they learn needles usually inflict pain. According to pediatric pain specialist Dr. Amy Baxter, MD, 63 percent of all children are afraid of needles. Small wonder since children in the U.S. are mandated to have 36 vaccines by the time they reach the age of six.

While a multitude of distraction techniques and cards, numbing products, and other approaches address pediatric pain during blood collection, several children's books are also available to teach children what to expect and why blood testing is necessary and important. Phlebotomy Today-STAT! provides this review.

 

So You Have to Have a Blood Test?
Publisher: Minister for Employment, Training and Further Education, South Australia (TAFE SA)
Year of Publication: 2011

Colorful characters named Sally Syringe and Neville Needle walk children through the process of getting their blood drawn. The booklet has its origins in a research activity conducted by Australia's Minister for Employment, Training and Further Education, South Australia (TAFE SA). Since the study involved venipunctures on children, it occurred to the researchers neither parents nor children had anything to prepare themselves for a blood test. To meet the need, the agency produced the booklet, targeting infants on up to teenagers.

"Our government pathology company, SA Pathology, purchased enough copies for all of their collection centres," says Trudy Dalgetty, TAFE SA Pathology Coordinator. "Initial feedback was good, especially as it is written in story form and the children can color in the back pages. It has been very beneficial in the hospital environment."

Availability: TAFE SA web site.

 

Sarah Ann Needs a CBC
Author: Jim Carroll
publisher: Xlibris
Year of publication: 2003

According to the author, this book was written for 9- 12-year olds and is intended not only to help them overcome their fears of having a blood sample withdrawn, but "hopefully they will learn some basic hematology." Sara Ann is very active and athletic, but one day she does not feel well. The doctor orders a CBC, but she's afraid of the needle. The doctor´s office suggests she watch a video that explains what a CBC is to eliminate her fears. Characters in the video Sarah watches include Charlie Circulatory System, Rudi Red Cell, Herman Hemoglobin, Lulu Leukocyte and Patti Platelet. Ned Needle and Betsy Butterfly relate how easy it is to take blood from people´s veins. With her fears put to rest, Sara Ann successfully has her blood sample taken.

Availability: Purchase online from Xlibris.

 

Parents Handbook: Your Child's First Blood Test and What You Need to Know
Josephine Franco
Publisher: Dorrance Publishing
Year of Publication: 2011

According to the book's introduction, it is written to help parents get over fears and anxieties they have had in the past involving blood sampling in order to help their own children cope with what should be a simple, stress-free procedure. The bulk of the 96-page book dispels eleven myths of blood collection and the nature of testing. Other sections include answers to commonly asked questions, letters from patients, an extensive glossary of terms, and an illustrated children's story at the end of the book called "The Blood Cell Gang."

Availability: Amazon.com

 

Adventures of the Lab Explorers: Sometimes When You Feel Bad
Author: Deborah Brock
Publisher: BookSurge
Year of Publication: 2005

The author, a laboratory educator in Pendleton, South Carolina, began sketching laboratory characters that would become the essence of the Lab Explores series in 2000. By 2005, the characters Unit, Eri, Petri and Hema had coalesced and Sometimes When You Feel Bad was launched to teach children what getting their blood drawn was like and why it is necessary. According to a recent article in Advance for Medical Laboratory Professionals, Brock's work imparts an understanding of health on many levels.

"Each story I write not only has information about lab testing, but also encourages good health behavior," says Brock. "For example, in Petri's adventure, children are encouraged to wash their hands, especially after a break in their skin so they don't get germs in the cut."

Brock also stressed the importance of public awareness of the importance of the laboratory's role in healthcare. "The Lab Explorers may only play a small part in promoting our profession, but if we all did a little something to share about our profession, maybe more people would know and appreciate about our valuable contribution to healthcare."

Availability: American Society for Clinical Laboratory Science online bookstore

 

Oodie Goes to the Hospital
Publisher: Greiner Bio-One
Publication Year: 2015

Greiner Bio-One created and published Oodie Goes to the Hospital, a colorfully illustrated children's book the company makes available to those who purchase their capillary collection products as part of their "Perfect Patient Promise" program. The book is intended to be placed in outpatient areas and given to younger patients. "Oodie the Greinersaurus," the company's dinosaur-like mascot, is the main character of the story that chronicles his trip to the hospital where he learns about the importance of blood testing.

"When dealing with young patients, the experience can be scary for the patient and time consuming for the phlebotomist," says Senior Marketing Manager Mackenzie Farone-Waite. "It has been shown that distracting patients can assist with patient comfort during these procedures and make it easier for the phlebotomist to get the sample. That's why we created this book."

Availability: Contact marketing@us.gbo.com

 

Ernst Interviewed by IGGBO

Dennis J. Ernst MT(ASCP) NCPT(NCCT), director of the Center for Phlebotomy Education and editor of the Phlebotomy Today family of enewsletters was recently interviewed by IGGBO, the Uber-like service putting phlebotomists and practitioners together. In the interview, conducted last month, Ernst talks about what made him leave the laboratory to start what has become a global resource to healthcare educators and professionals, what brings him the greatest satisfaction in his work, and what a typical day is like for him as the Director of the Center for Phlebotomy Education.

Read the interview.

From The Empowered Healthcare Manager Blog

Every month we run an excerpt from our editor's popular blog, The Empowered Healthcare Manager.

 

The Top 15 Things You Won't Hear an Empowered Manager Say:

15. I sure wish I would have reviewed her background check.

14. [Starting any sentence with] To be perfectly honest with you...

13. [Ending any sentence with] ...just don't get caught.

12. That skull­-and­-crossbones tattoo on your hand... was that there when I hired you?

11. We only had five complaints on you last month. Good job.

10. I'll wait to see if the problem goes away by itself.

9. Nobody up the ladder is pushing me, so they must be satisfied with the quality of my work.

8. Only fifteen more years until I can retire.

7. It's already four o'clock. There's no sense in working on [your most dreaded task] today.

6. I wonder if I've gotten any emails in the last ten minutes.

5. I could easily delegate this to someone, but I think I'll do it myself.

4. I wonder if [name any employee] is a good fit here.

3. Who should I complement this month?

2. By the noise level out there, it sounds like the staff is really scrambling. I think I'll close my door.

1. I wonder why I wasn't invited to the leadership workshop.

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Podcast With Dr. Amy Baxter, Part 2

In the March issue of Phlebotomy Today-STAT! we interviewed pediatric needle pain specialist Dr. Amy Baxter as that month's Mover & Shaker. We also posted a link to the podcast of Part 1 of our interview. This month we finish the conversation with a discussion on distraction, muscle-tightening techniques, and the right questions to ask of every patient to assess their fear of needles. 

Listen to the podcast.

Movers & Shakers: Dan Scungio

This month's Mover & Shaker is Dan Scungio, MT (ASCP) SLS, CQA (ASQ), aka, "Dan the Lab Safety Man." We consider him a M&S because he found a way to take his passion to a new level, impacting clinical laboratories far and wide. Besides being the Laboratory Safety Officer at the Sentara Health Care system based in Virginia, Mr. Scungio is a highly recruited speaker at state and national laboratory conferences as well as a volunteer member for CLSI helping to create safety guidelines. As Dan the Lab Safety Man, he consults with laboratories to improve their safety practices, conducts an annual Academy for Lab Safety Excellence, and makes books and DVDs available on his web site.

Dan is the go-to guy for the Center for Phlebotomy Education whenever we're stumped by a safety question on blood collection, handling, processing and transportation. Dan has authored several safety articles for prominent laboratory publications such as Medical Laboratory Observer (MLO), Advance for Administrators of the Laboratory, Clinical Lab Products, Medical Lab Management, and Clinical Laboratory Management Review (CLMR). Dan has also written the fourth edition of the Complete Guide to Laboratory Safety with Terry Jo Gile.

We asked if he would answer a few questions for us on how his career morphed into becoming a leading OSHA and lab safety consultant.

Phlebotomy Today-STAT!: What made you want to venture out as an OSHA consultant? Was there a pivotal moment?

Scungio: I had been a lab manager for over 10 years when I was considering changing careers. I met Terry Jo Gile (known as "The Safety Lady") who spoke at a local conference, and we talked about the role of a lab safety officer. With her inspiration, I applied and accepted the position of Laboratory Safety Officer for a system of laboratories. It was a big job, and on my first day I learned that I did not have the eyes to see the safety issues that were occurring. Over time I learned that was the source of so many lab safety issues- it wasn't that people didn't care, it was that they hadn't been trained to develop their "Safety Eyes." They couldn't see what was wrong, and they didn't have the training to deal with the issues once they could see them. When Terry Jo approached me about working with her and becoming a lab safety consultant, I felt ready. We worked together until her retirement, and I have been working to open peoples' Safety Eyes ever since.

PT-STAT!: What brings you the greatest reward in being an entrepreneur?

Scungio: The greatest reward I experience in my business is when a client tells me my presentation or material was useful or valuable to them. My goal truly is to make people who work in labs everywhere safer, and if a small part of that message works, I am humbly gratified.

PT-STAT!: What do you see as the greatest challenge in your industry?

Scungio: I see two great challenges in laboratory safety today. The first is what I see as an overall lack of focus on lab safety. Behaviors such as not wearing gloves or lab coats should never occur in today's world, but it is surprisingly prevalent. I hear from several clients that PPE compliance in labs is their biggest challenge. Why is that? What don't laboratorians understand about the dangers of chemicals and bloodborne pathogens? The problem is individual lack of safety ownership, and one of my goals is to promote that. The second major challenge in lab safety that I see has to do with training the next generations about safety. New graduates seem to have a better grasp of some safety issues. For instance, they might never consider handling samples without gloves, they have respect for the danger. On the other hand, they might think nothing of taking out their cell phone in the lab (with gloves on) to snap a picture and post it on the internet. Lab guidance tells us not to use personal electronic devices in the lab, but we know that in this technology age, these devices are not going away. How do we reconcile these things and keep safety at the forefront in a way staff will comply? It's a tricky problem that has to be discussed from different viewpoints.

PT-STAT!: At the end of your career, what would you like to be able to say was your single greatest accomplishment?

Scungio: I hope I can look back and see that overall, laboratories are safer places- fewer injuries and lab-acquired infections would be the result. Laboratorians would have a clearer safety perspective and ownership of their safety culture. That may sound Utopian, but I do not wish to accomplish this for my sake. I want those who work in the labs to have happy healthy lives to share with friends and family.

Visit Dan the Lab Safety Man's web site.

Listen to a podcast interview with Dan Scungio.

This Month in Phlebotomy Today (May, 2016)

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s flagship newsletter currently in its 17th year of publication, are reading about this month:

Feature Article
Journal Roundup, Part 1

On the Front Lines
Blood pressure cuffs as vein finders?

From the Editor's Desk
"As you wish, Buttercup"

Sticks, Staph, and Stuff
Risks of capillary collections

High-powered Talent
Compare yourself to your past, not your peers

What's Wrong Here?
A monthly image to test your powers of observations

Subscribe to Phlebotomy Today and get this issue immediately.

Survey Says: If I could pass a law...

Last month we asked visitors to our web site and Phlebotomy Today-STAT! readers what laws they would like to enact for those who draw laboratory samples. Then we turned the tables and asked what laws they would have patients abide by. Our wannabe legislators chimed in with 43 laws pertaining to those who collect blood samples. a full 21 percent of those laws would mandate certification for those who draw blood. Nine percent mandated a formal training program, and another nine percent would require continuing education. Just as many laws were proposed that mandated positive patient identification. Other laws include:

• Everyone must label specimens at the bedside;
• Phlebotomists must not make more than two attempts;
• Do not assume anything about a patient before you meet them. Treat them as the most important person you will be see that day.
• Everyone must wear gloves and not rip the fingertips off;
• Dress & act like a professional, and relax, so they will, too;
• Nurses are not allowed to draw blood;
• Make an effort to learn how to pronounce surnames, especially those of the dominant ethnicity;
• Never use the basilic vein;
• Follow CLSI policies;
• Remember the patient's rights;
• If the phlebotomist is uncomfortable with patient or situation, another co-worker can be requested to collect, without penalty/discrimination to phlebotomist who refuses.
• Everyone must follow the order of draw;
• Listen to the patient when you ask which arm is best. Not necessarily how/where to stick;
• Only Coban is allowed to be applied after the draw;
• The person drawing blood has to listen and respect what the patient is telling them;
• Only use a hard surface to engage safety on needle;
• Do no harm;
• Do enjoy what you do, it shows;
• Always wear gloves when in contact with a patient.

Turning the tables, those who participated in the survey proposed 31 laws that apply to patients.  Sixteen percent of those suggested were equivalent to "Do not move when the needle is in your arm." Other proposed laws include:

• Do not cough in my face;
• Ask questions to understand the process;
• Patients must report their contagious diseases;
• The phlebotomist chooses what equipment to use;
• Only patients with lab orders could have blood drawn;
• Patients must not be abusive or threatening;
• Take a shower and wear clean clothing;
• Be cooperative and helpful;
• ID must be provided prior to collection;
• Listen to my questions & directions;
• No fist pumping;
• Realize that what occurs with non-experienced people taking blood is not necessarily going to occur with trained and experienced phlebotomists;
• Respect your patients; treat them as you would expect to be treated;
• Always ask to see your labeled specimens before the phlebotomist leaves;
• Show appreciation;
• Patients have the right to choose who they want to draw their blood;
• Do not yell;
• Take notice of what site works well when having blood drawn;
• Don't ask the phlebotomist what the test is for;
• Remember it's the doctor who orders your labs;
• Respect your phlebotomist, treat them as you would expect to be treated.

This month we're asking visitors to our web site and Phlebotomy Today-STAT! readers what process is in place where they work to summon outpatients from the waiting room and how the confirm patient identification once they're in the drawing chair.

Take the survey.