BEST PRACTICES :: IMPROVING THE PATIENT EXPERIENCE
Phlebotomists taking the lead as change agents I
By Dennis J. Ernst, MT(ASCP), NCPT(NCCT)
n the late 1990s, an industry-wide trend to decentral- ize phlebotomists was well underway, and the future of the profession was in doubt. Today, phlebotomists are not only reclaiming their status as laboratory profes- sionals, but their roles are expanding to include functions previously delegated exclusively to nurses. Instead of diminishing phlebotomy as a procedure any healthcare professional can perform with minimal or no training, administrators are learning it’s not as easy as a good phlebotomist makes it look. With plunging patient satisfaction scores and sample quality hitting rock bottom, many decentralized systems have walked it back, return- ing blood collection procedures to laboratory personnel who are sample-centric by nature and perfectly suited to maintain the quality of the samples they test.1 With renewed recognition for their skill, the once- marginalized phlebotomist is today’s venous-access spe- cialist who not only performs venipunctures and skin punctures but draws blood from vascular access devices (VADs) unassisted. In some states and hospitals, phleboto- mists have even been trained to start and discontinue IVs. Such a significant practice change for both nursing and phlebotomy professions requires solid training and strong coordination with nursing. Facilitating the transition, new technologies are emerging that utilize a phlebotomist’s skill set while significantly reducing pre-analytic errors when drawing from a VAD.2
Advanced phlebotomy teams
The Mayo Clinic has been an early leader in applying phlebotomy’s strengths to other practices. Sharon Johnson manages Mayo’s Vascular Access Technician (VAT) team where select phlebotomists are taught IV access procedures for the facility’s intensive care units. Johnson found that the skill set required for venipuncture was highly trans- ferable to IV access and could even increase first-attempt success rates.
“Our cardiac team wanted faster labora- tory turnaround times (TATs), better patient care, improved customer ser- vice, and fewer rejected samples,” says Johnson, the Operations Manager in the Division of Clinical Core Laboratory Services at Mayo Medical Laborato- ries. “One of our top priori- ties in this practice change is to choose individuals who want to expand their skills and have proven themselves to be dedicated and experienced phlebotomists.”
Johnson plays a criti- cal role in staffing the IV access team with qualified
36 MAY 2019
MLO-ONLINE.COM Phlebotomist using new technology to draw blood from a VAD. Image courtesy of Velano Vascular.
phlebotomists. She admits the success of the program would have been uncertain without an aggressive approach to the practice change at Mayo. While improv- ing sample quality from line draws remains at the heart of the cross-training initiative, she gives a high priority to making sure they receive intensive training which includes 30 additional hours of training, and shadowing with nursing to ensure proper IV placement and dressing. “You can’t abbreviate the training for such a major practice change,” says Johnson. You have to teach more than how to draw off of IVs independently, but teach them the ‘why’ of each step and the con- sequences of not performing it properly. Only when you train meticulously can you realize the full benefit of faster lab TATs and fewer rejected samples. Our vas- cular access techs have to familiarize themselves with the materials and perform 20 successful IV starts under supervision before being cleared.” At Mayo, the commitment of laboratory management to taking the lead in the cross-training initiative has paid off in a multitude of benefits for all involved. “This practice change continues to deliver better patient care and customer service, faster TATs, higher quality samples, and staff satisfaction,” she says.
Obstacles removed Historically, one of the biggest arguments against involv- ing phlebotomists in drawing from IV lines has always been the nature of VADs to hemolyze and dilute samples. Studies show samples drawn during an IV start or from an existing line have the potential to be hemolyzed up to 78 percent of the time depending on the size and composition of the cannula, the force of the withdrawal, and other factors.3-5
Very few VADs are engineered to be
red-cell friendly. Another study showed draws from tem- porarily discontinued IVs to be contaminated with fluids, even after two minutes.6
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