Hemolysis: The Elephant in the Room That s Eating Your Lunch. Presenter Dennis J. Ernst MT(ASCP), NCPT(NCCCT)

Transcription

1 That s Eating Your Lunch Page 1 : The Elephant in the Room That s Eating Your Lunch Presenter Dennis J. Ernst MT(ASCP), NCPT(NCCCT) 2017 Center for Phlebotomy Education, Inc. All rights reserved. Part of the 2017 Accurate Results Begin With Me! lecture series Center for Phlebotomy Education

2 About today s speaker: Ernst---: The Elephant in the Room That s Eating Your Lunch Page 2 Dennis J. Ernst MT(ASCP) is the executive director of the Center for Phlebotomy Education, Inc. in Corydon, Indiana. After spending 20+ years as a medical technologist in large and small hospitals in Michigan, Indiana, and Kentucky, he started the Center for Phlebotomy Education, Inc. as an international educational resource for the growing number of healthcare personnel and professions being assigned blood collection responsibilities. In addition to conducting phlebotomy presentations around the world, he regularly chairs revisions of the CLSI specimen collection standards. Among his other credits: Dennis J. Ernst MT(ASCP) Center for Phlebotomy Education, Inc Edsel Lane Corydon, IN phlebotomy@phlebotomy.com Toll Free: Author of dozens of articles on phlebotomy in consumer and trade publications; Author of Applied Phlebotomy (Lippincott Williams & Wilkins, 2005) Author of Blood Specimen Collection FAQs (Center for Phlebotomy Education, Inc., 2008). Author of The Lab Draw Answer Book (Center for Phlebotomy Education, 2017) Co-author of Quick Guide to Blood Collection (AACC Press, 2016) Regular panelist for CDC Evidence Reviews to determine Best Practices for the preanalytical phase of laboratory testing. Editor of the Phlebotomy Today * family of e- newsletters published since Over 14,000 readers worldwide. Mr. Ernst edits Phlebotomy Today--STAT!, a free technical newsletter delivered monthly by . To subscribe, visit Material in this presentation and handout is copyrighted. Unauthorized recording or duplication in any form is prohibited. *Phlebotomy Today and Accurate Results Begin With Me! are registered trademarks of the Center for Phlebotomy Education, Inc. Some images in this presentation sourced from Shutterstock.com 2017 Center for Phlebotomy Education, Inc. All rights reserved.

3 : The Elephant in the Room That s Eating Your Lunch The magnitude % of samples hemolyzed: ED vs non-ed Non-ED (3 studies) ED (7 studies) Magnitude Costs Impact Causes/cures The Seven-Step The magnitude % of rejected specimens due to: Clotted QNS Inadequately labeled The magnitude The costs % of samples hemolyzed: facilitywide % 0.2% 5.6% $ /day* *ED hemolysis only Education. All Rights Reserved. 1

4 The costs Sarasota Mem. Hospital: $3.7 million saved by reducing their ED hemolysis rate. of specimens drawn by: Laboratory phlebotomists ED personnel 1.6% 12.4% Laboratory Medicine The costs The costs Sarasota Mem. Hospital: Improved interdepartmental relations Physician satisfaction Patient care Staff camaraderie *St. Elizabeth Medical Center: $16,184 saved/year by reducing their ED hemolysis rate. *$_/sample The costs The impact #2: Recollection Sarasota Mem. Hospital: Tip sheet for posting/distribution Staffed phlebotomists in 1/3 of ED Banned draws from existing lines Standardized draws during IV starts Physician/patient frustration Decreased productivity Inaccurate results Increased turnaround Interdepartmental friction Education. All Rights Reserved. 2

5 Inaccurate results Prothrombin time Troponin Potassium T4 LDH RBC AST aptt ALT Fibrinogen Phosphorous Hematocrit Iron Magnesium Ammonia All analytes diluted during Increased turnaround Time it takes to redraw a hemolyzed sample: minutes. % of samples hemolyzed when drawn by: venipuncture (6 studies) IV starts (8 studies) < Line Technique Difficult draws rate during IV starts from existing VADs Education. All Rights Reserved. 3

6 Do not draw during an IV start. (CDC Best Practice) Limit line draws to larger canulas rates and IV catheter sizes IV catheter size rate 14 gauge 0 16 gauge 0 18 gauge 10% 20 gauge 15% 22 gauge 25-60% 24 gauge 100% Journal of Emergency Nursing When unavoidable, draw only when IV is inserted into antecubital. (CDC Best Practice) If you must draw during an IV start: Avoid draws from IVs in the hand; Use a syringe; Draw only from large-gauge IVs. Use a syringe when drawing during an IV start % of samples hemolyzed during an IV start: with a syringe with a tube holder 9% 22% during IV starts from existing VADs Excessive plunger pressure Journal of Emergency Nursing Education. All Rights Reserved. 4

7 Forceful transfer Forceful transfer Frothing Allow tubes to fill on their own from forced filling: % Assure tight fittings Discard and replace syringe Angle the tube Forceful Transfer Frothing Vigorous mixing Education. All Rights Reserved. 5

8 Invert tubes gently Sluggish Prolonged constriction Release tourniquets within 1 minute Sluggish Relocate or Terminate Sluggish Prolonged constriction Milking capillaries Education. All Rights Reserved. 6

9 Prewarm capillary sites Pneumatic transport Temp. extremes Monitor transit and storage temps. Pneumatic transport Evaluate and modify during IV starts from existing VADs Excessive plunger pressure Forceful transfer Frothing Vigorous mixing Sluggish Prolonged constriction Milking capillaries Pneumatic transport Temp. extremes Education. All Rights Reserved. 7

10 Percent Jan. ED 4.3 OB 2.4 ICU/CCU 2.1 Outpatient 3.2 Eliminate/minimize line draws Educate all personnel on the causes during IV starts Forceful transfer from existing VADs Frothing Excessive plunger pressure Vigorous mixing Sluggish Prolonged constriction Milking capillaries Pneumatic transport Temp. extremes The magnitude The cost Track departmental & individual rates The impact The strategy Education. All Rights Reserved. 8

11 Provide Feedback Percent Jan. Feb. Mar. Apr. ED OB ICU/CCU Outpatient Your take-away 1. is a huge and preventable waste of money and productivity; 2. Fixing it requires a wellcrafted plan and ruthless determination. Provide Feedback Your take-away 3. the 7-step plan 4. Educate, reinforce, remediate, reward. Provide Feedback Celebrate! Education. All Rights Reserved. 9