The Most Underestimated Procedure in Healthcare

Not a month goes by when I’m not stunned into disbelief by the perceptions that still persist about drawing blood samples. One month a few years back I hit the trifecta.

1) I was exhibiting my former company’s educational materials at a regional trade show in Maine. One of the items we gave away was a bookmark with the “order of draw” on them. (Filling blood collection tubes in the wrong order can significantly alter the test results reported to the physician.) As one person stopped to view our offerings, I handed her a few and said “Here’s something everyone needs to know where you work.” She studied it for a few seconds, then looked at me suspiciously and said “this doesn’t really matter, does it?”

2) One of the organizations I approached to consider my latest book, The Lab Draw Answer Book, in their online store was membership organization for critical care nurses. I thought it was a perfect fit for four reasons: 1) ICU/CCU nurses frequently draw blood samples from their patients, 2) there’s an entire chapter on line draws and IV infusions, 3) the standards of the Infusion Nurses Society are heavily referenced throughout, and 4) the book is co-authored by a nurse. Their Purchasing Manager requested a copy to review for inclusion, and emailed me a few weeks later with their decision. “Our nurses thought our membership was not the audience for this title.” I about fell off my chair.

3) I was recently approached by a dentist wanting me to endorse his 1-day venipuncture workshop for dentists. (Our phlebotomy school required 96 hours plus clinicals.) During the discussion it was revealed that all attendees would perform live draws on each other before the end of the day. I asked if there’s a mechanism in place to assess an accidental needlestick should one occur. The individual espoused with confidence that every attendee could assess their own exposure.

Is there any wonder why I have a sign on my wall telling me where to bang my head?

Let’s take these one-by-one.

1) The order of draw has been around since 1997. With ample scientific evidence, the need for a specific order has continuous support in peer-reviewed publications. I’m not so naïve to think there isn’t a segment of the healthcare workforce that pooh-poohs concepts they don’t agree with. By and large, people don’t want venipunctures to be complicated or require an understanding of preanalytical physiology. They want it to be as simple as “needle goes in, blood comes out.” But it just ain’t so. It never will be. People who convince themselves it’s that simple don’t usually frequent trade shows or educational events. Your typical conference attendee is usually up on things and understands the nature and complexities of preanalytical errors. That’s why I probably had a dumbfounded look on my face when one attendee suggested the order of draw “doesn’t really matter.” It makes me wonder what other things might not matter to the same person, like checking ID bands, wearing gloves, and pouring the contents of one tube into another just to make them full.

2) I love nurses. (I even married one, which proves it!) They are the backbone of healthcare. But when a critical-care nursing organization feels its members don’t need a reference book on blood sample collection, I have to wonder why. Seventy percent of the objective information a physician receives about a patient’s health comes from laboratory test results. Yet, scanning through their current online offerings, their library is devoid of any title on the topic.

Ask any nurse, especially a critical-care nurse, if he/she wishes they knew more about drawing blood samples and the response will likely be a resounding “yes.” So, naturally I’m puzzled why The Lab Draw Answer Book was passed up as a resource. It’s not just sour grapes, it’s a general disillusionment about the subject not being represented by any title in a library for critical-care nurses. I realize drawing blood is only one small aspect of the entire repertoire of tasks a critical-care nurse has to perform, but the results that come from the samples they draw dictate the majority of their other activities. My co-author agrees.

3) The argument that all dentists are qualified to assess blood exposures was stunning. According to the workshop leader, participating in some form of bloodborne pathogens exercise once every two years qualifies a dentist to evaluate a needlestick. That tells you just how dismissive some professionals are of some really important aspects of their profession. Throughout my entire professional life I have been subjected to annual bloodborne pathogen training. Never once did that training include how to evaluate a bloodborne  exposure. That’s what infection control professionals are for. It’s not that simple. It doesn’t surprise me, really, that people who consider themselves to be authorities on post-exposure management because they read an article on handwashing every two years also think they can teach venipunctures in one day.

That’s where we are in this world.

But for every one of these jaw-droppers that come my way, I have dozens of other interactions that give me hope. Encounters that more than counterbalance the head-bangers. Take the following as examples:

  • the supervisor I met who is took on her entire healthcare system’s lax approach to patient identification and ID bands. Not just her department, not just her hospital, but the entire multi-hospital system into which she was just hired.
  • the growing number of healthcare systems I’m hearing about that are expanding the responsibilities of the preanalytic personnel to include starting IVs, draw from existing lines, and performing arterial collections.
  • the increased chatter in the industry to welcome more phlebotomists into professional membership organizations and give them the representation they so richly deserve;
  • the development of PIVO, a product to prevent hemolysis during line draws, something that’s plagued the industry for decades;
  • Magnolia Medical’s SteriPath device, which reduces false-positive blood cultures, and the cascade of unnecessary procedures and antibiotics that result, by 90% or better;
  • the phlebotomists at Getlabs, who are saving lives by delivering outstanding healthcare to everyone.

Despite the ever-expanding dent in my wall, from where I sit the glass of progress in educating healthcare professionals about drawing blood samples correctly is half-full. I will continue to pour myself efforts into it until it overflows. Putting my former company in the hands of Shanice Keith a while back was a cloning of sorts, allowing the company to continue while I embraced new horizons. With her at the helm, the fight against complacency toward phlebotomy got a new warrior… and I got a new assignment.

I accepted the position of Director of Quality at Getlabs shortly after selling my company, and now serve as Senior Quality Advisor and Clinical Educator. I didn’t seek these positions; they sought me. Now that we’re united and well down the road, it occurs to me that everything I’ve done in my entire healthcare career has prepared me for this role, Working in hospital laboratories large and small, teaching phlebotomy at the university level, drafting industry standards, writing books, lecturing, creating educational materials, opening a phlebotomy school, reviewing legal cases involving phlebotomy-related injuries, starting my own company, recruiting and managing high-powered talent… all of these provided the experiences I need to help Getlabs attain and deliver unrivaled quality. That includes fending off the slings and arrows of those who underestimate the procedure. Oh, don’t get me wrong, when it comes to defending standards and resisting attempts to compromise quality, I’m up for the fight. Been doing it for for decades. Some months I even hit the trifecta.

My point is this: we’re all put in this world for a purpose. That goes for you, too. Now that our paths have crossed via this blog, the fact that you’re still reading this far tells me quality is one of our shared values. Because of that, we need to lift each other up and push each other beyond our comfort zones toward the pursuit of ever-increasing, always-unrivaled quality. Patients we haven’t even interacted with yet are expecting it upon our arrival. When that intersection comes, we have to be prepared.

I don’t know about you, but when I draw my last breath, I want it to be that someone was spared suffering because I drew my first. That’s my own personal mission statement. The thing about pursuing quality in phlebotomy, though, is that we will never know how many people we saved from suffering by doing the right thing, by following the standards, by refusing to compromise. We can only hope we spared a multitude of patients from injury and suffering; but, for people like you and me, that hope is all we need to keep defending the high ground.

Take care, my friend.

Dennis J. Ernst
[email protected]