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The Joint Commission Takes a Giant Step Backwards Regarding Hospital Blood Draws

Posted Oct 05 2009 10:02pm

Robert Michel, who blogs over at the Dark Daily, calls our attention to a retrograde step on the part of the Joint Commission, which no longer requires phlebotomists to ask a patient to state his name prior to a blood draw (see: Joint Commission Changes Requirement for Patient ID during Blood Draws ). Here is an excerpt from the article:

When The Joint Commission recently changed the patient identification requirement for drawing a blood sample, one national phlebotomy leader considered it a step backward in patient safety.“Per a revised policy issued by The Joint Commission, it is no longer required for the phlebotomist or person drawing the blood to actively involve patients by, for example, asking them to state their name,” commented Dennis Ernst, MT(ASCP), the long-serving Director of the Center for Phlebotomy Education....“Having a patient state their name before a blood collection is a very important step in patient identification,” declared Ernst. “The Joint Commission now finds it acceptable for the phlebotomist to use the identification bracelet alone, which we all know can end up on the wrong patient. That’s disturbing to me because it’s taking a chance with a patient’s life. I think any time you dilute the requirements for patient identification, you create a possible scenario that is not favorable to anyone seeking healthcare.There doesn’t seem to be any logic that supports lessening the patient identification requirement,” said Ernst, who worries that not requiring phlebotomists to verify that the person about to be drawn matches the information on their wrist band will lead to unnecessary mistakes....“Given the frequency of these errors, it seems that asking someone to confirm their identity is a simple, positive requirement,” he added. Ernst queried The Joint Commission over this issue. He says that a representative from The Joint Commission informed him that their clients feel that it is “burdensome and unnecessary” to ask a patient to confirm his or her name.

Hospital phlebotomists are the unsung heroes of the clinical labs (see: A Tribute to the Phlebotomists ). They function as the ambassadors from the labs to hospital patients. It is commonly one of the lowest paid jobs in the lab but yet one that requires great skill, personality, and tact. We send them out to inflict daily pain on patients and, appropriately, hold them to error-free work performance. Even a single error on their part without major clinical consequences puts their jobs in jeopardy. What the lab and hospital leadership owes them, in return, is a set of procedures relating to blood draws that helps to guarantee this perfect performance. I can say with some certainty, although it will be difficult to uncover the truth, that the lobbying for this change did not come from the clinical labs. My guess rather is that the pressure came from hospital nursing services.

When I was the director of the phlebotomy team in a major hospital, I was confronted with periodic struggles with nursing personnel regarding what lab personnel considered to be proper patient identification procedures. Back in those days, patients frequently had no wrist bands in place during phlebotomy rounds, having been cut off to start IV's and for other reasons. Our phlebotomists, based on our lab procedures, requiring two identity checks when possible (ask the patient to state his or her name, check the wrist band), would refuse to draw the blood absent the wrist band. This resulted in constant howls of indignation from the nurses. "Everyone in the patient unit knows that this is Mrs. Smith." 

At a time when lab professionals are seeking the goal of "six sigma" in terms of lab errors (i.e., 3.4 defects per million opportunities ), hospital nursing services leave much to be desired, for example, when passing medications to patients. One 2006 study examined the error rate in a tertiary care hospital for this task (see: Frequency and Type of Medication Discrepancies in One Tertiary Care Hospital ). Here are the results:

One thousand, four hundred twenty-four orders representing 197 patients from 13 nursing units were sampled for this study. Thirteen percent of the orders were discrepant and 61% of patients had at least one discrepancy. The most frequent types of discrepancies were drug omissions and unordered drugs.

Hopefully, lab personnel will be able to ignore this little "gift" from the Join Commission and continue to demand fail-safe hospital patient identification procedures. Oh, and be sure to check all of those pills in the paper cups before they are swallowed by your relative in the hospital.

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