Allow me to gape in horror.
So that’s why labs take so long to come back. Yeesh.
Keep laying down the law, and I would document everything to whoever is in charge of the nurses. Maybe if you can show that the hospital is losing money due to unnecessary delays something might change.
Great rant. Too true.
Dudes- don’t worry too much- those are rare occurances. However, not rare enough.
That would be me. Every. Freaking. Time. No matter how many times or how firmly I suggest that they forget even bothering with trying to find an adequate vein in my arms and to go for the back of my hand, they inevitably insist that they’ll have no problems.
So they strap and I squeeze and they tap, tap, tap, then poke, poke, poke and either don’t find a vein they can even get into, or find one but it just won’t squirt out any blood.
Lather, rinse and repeat on the other arm. Then back to the first arm. Then they give up and do what I told them to do in the first place, or have someone else come in and try. I end up looking like an IV drug user who’s been in a bar fight, with hole pokes and bruises up and down my arms and across my hands! It’s ridiculous.
I don’t have to have blood drawn quite as frequently anymore (I’m down to once every six months now), but for a period of about 3 years I was having blood drawn every 6 to 8 weeks to monitor my Hashimoto’s disease. If anyone had ever made me come back for more of that torture because they were too lazy or stupid to properly label my samples, heads would fucking roll and complaint reports would be filed, that’s for damn sure.
Thanks for caring so much about the integrity of your job, Leah!
Yay, new techie-types! I love having other lab techs on this board!
I work in a blood bank, where specimen labeling is incredibly important. I can’t accept a tube if it hasn’t been signed by the phlebotomist, and all of the nurses and techs know this. Inevitably, sometimes, a tube will show up unsigned. People forget, I understand. It gets busy on the floors and I can see how someone can forget to initial a tube. But when it’s a STAT specimen, and I call the floor to have the nurse come label it, and then she takes a half hour to get her butt downstairs, I can’t help but be really mad at the people calling me asking where the results are.
The other part is when I get three specimens in one day for a baby in the preemie nursery. Once the blood bank tests are done, there’s no need to repeat them right away - the blood type won’t change. For biochemistries and blood gases, sure, but why are they sending so many specimens to me? I call to tell them it’s a repeat, and sometimes you can almost hear them shrug with indifference. I just feel so bad for the little preemies. And then they wonder why the poor kid’s hemoglobin isn’t going up. Stop draining him!
But it isn’t the norm, really. Most of the time, everyone on the health care team is working together to make sure patients are getting cared for. I guess that it’s just that the bad moments really stick in our minds.
Speaking of stick, Leah, my good friend is on a prophylactic drug regimen after getting scratched by a needle left on a blood bank syringe. Uncapped, sitting open in a biohazard bag full of ice. When that sort of thing happens I am seriously tempted to take the needle back up to whoever did the draw, and poke them with it so they can join in the fun.
Now I feel completely vindicated for insisting that the labels go on my specimens before the tech leaves the room with them. (I hate having blood drawn.)
Although, honestly, most of the phlebotomists I’ve dealt with have done that without prompting. I’ve only had a couple of techs look at me funny for insisting.
Oh, yes. There’s also the ever popular “No one will know”.
CSF is one of the specimens we are allowed to accept unlabelled but only if the physician accepts full responsiblity for identity of the specimen. One day there were two different patients who both had a lumbar puncture performed-four tubes of CSF drawn on each one- and all their specimens, with no label whatsoever, were dumped into the same bag for transport to the lab. It was awful but there was no way to know which tube was from which patient so we had to dump them all. As far as I know though that’s the only time that’s happened since I’ve been here.
Now I can’t claim perfection. I’ve made my share of mistakes, but I also adhere to lab protocol for rechecks and thus catch them before they ever get to the patient’s chart. I’ve accidentally broken specimens as well though only a handful of times in the past sixteen years thankfully. When it happens I admit it up front and tell the concerned parties the recollect is my fault. Being a very hard stick myself I know what a redraw can mean to someone. But accepting responsiblity is an important part of a job like this dammit! So I just want to scream when I find that more often than not a patient is told the lab goofed and that’s why they have to be redrawn when the truth is that someone else screwed up, not us. But no one ever sees the lab what with electronic charts and pneumatic tube systems so big deal, right? I didn’t used to have high blood pressure you know…blech.
I’ve been a QC lab tech for something like 6 years, including a 2-year period where my average job lasted 3 weeks but I was never unemployed for longer than 2. The most common problem in all those labs was mislabeled or unlabeled samples. Even the worst lab manager I ever had (the one who started every day by yelling at the warehouse manager “I’m going to rip your head off!!!”) had the policy that “incomplete labels are not accepted, labels must be filled by the person who took the sample and not by the lab worker”.
In some cases, putting the wrong thing in the wrong container could have led to the kind of explosions you see in the movies. Some of those cases correspond to factories that are in the middle of a village. One of them was one block away from a street. Yeah, jolly good fun… “sorry, I do NOT accept unlabeled containers, period.”
And it’s not like the guys bringing the sample didn’t know this, once I rejected an unlabeled sample from one of them and another one who was there told him “what, you decided to drop off of being a voluntary fireman and decided to become an arsonist instead?” He looked kind of cute, beetlejuice-red over the blue overalls.
…away from a school (
me). The factory was most certainly surrounded by three streets and one road.
To quote that, and of course the rest of your whole post, too… whew. Good to know I’m not the only going nuts about this stuff. 
Of course, I’d rather no one ever make mistakes, but at least experiences can be shared if it’s going to happen.
God, yes. That’s exactly why it needs to NOT happen. :mad: The blood gas spec I mentioned in the original post was exactly this type of thing. Bad respiratory tech! Bad!
If a patient requests I use the hand, I figure they know best and I do it.
The only time I ever ignored a patient request was in the psychiatric ward, or with very unstable patients who I knew were deliberatly messing with me. Sometimes someone would insist that I draw blood from THIS SPOT ONLY on their arm, and there was either nothing but a mass of scar tissue, or no vein at all. Then I’d try to wheedle them into letting me go where I could feel something.
Otherwise, normal patients? What the patient asks goes. If they want it in the hand, with me full well knowing hands are more painful, then they must really know that that works best. Really, it’s insulting to ignore a patient’s request, when the request is not unreasonable.
Oy. I agree with most everything the OP said, and I’m a nurse.
There is another side, though. Our lab consistently cancels labs they think are repetitive (this is our theory, anyway–after repeated calls to find out why that PTT was cancelled etc). The mislabelled or not labelled thing–that is bad. I don’t get the nurse laughing–sounds like a jerk to me.
At my hospital, you learn very quickly to label everything, because no-one likes doing anything twice. I have had the blood I’ve drawn thrown out and it only had to happen once. (urine on the other hand, seems to almost never get labelled!). Nurses here draw off central lines, but do not do peripheral sticks.
And I have seen phlebotomists not label stuff, so it’s not just nurses.
To my mind, it comes down to 2 things: 1. poor communication between depts(if one phleb lets one nurse come and label an already sent specimen, then the rigor of the standard is undermined), and 3. short staffing. Crucial details are much less likely to be missed, if adequate staffing exists. Lab techs and nurses are spread way too thin, IMO.
Good rant, OP.
Hijack: OK, let me preface this by saying that I am an accounting type and have no lab training at all. However, when I worked at a lab animal program all the managers, including the tech mgrs, etc., would meet and discuss things like not recapping sharps, PPE, etc., so I picked up some basics. How wonderful to hear later that our Director , in front of a number of lab techs, would go ahead and recap sharps?!? I’m like, even I know that and I would never have occasion to touch a sharp, and our big boss fucks up?? :rolleyes: Not to mention that big fuss of setting up a true barrier area and having him of all people not follow the SOPs.
Oh, definitely. But I can tell you in my particular situation that I have had a phleb not label a spec maybe twice in six months, whereas I get them from the nursing floors unlabeled or mislabeled several times a week. I am generally harder on the phlebs if they mess up, though, because their only task is blood, and the nurses have a lot more going on.
Outpatient doctors’ offices, not just inpatient at the hospital, and also outside hospitals are also notorious for mistakes.
Those three things that you mention are definitely the source of almost all the problems.
And thanks
By the way, the cancelling tests issue. Sometimes I notice that a test is being repeated on a patient, but I never cancel anything without authorization of some sort. Sometimes tests are being repeated due to hemolyzed or otherwise unsuitable specimens, so I never just assume it’s a dup. I always speak to someone and get it clarified first, because I don’t want to be responsible for cancelling a test a patient direly needed. If someone is cancelling things as duplicates just because they think it’s unnecessary, that person should get a kick in the pants.
Damn bureaucrats!
Leah --our day shift is very good. I cannot say enough good about the morning phlebs. They will call and ask and even call and ask for clarification–and also to save the pt sticks (example: if pt needs a coag profile at 0700, can we wait to draw their lytes and CBC then as well?). Absolutely–no-one likes getting stuck at all, much less twice. Sometimes it can’t work that way–and pts need to understand why. it can be as simple as “these are timed tests and unfortunately, the timing of them differs. Thanks for being patient.” kind of thing. IMO, both phlebs and nurses can explain this to pts.
But to just cancel a lab and not call or not call and tell the RN that the spec is hemolyzed–that happens, too often on the off shifts, and especially on the noc shift.
I have no doubt that nurses are more likely to not label than phlebs. Nurses are continually distracted at the bedside, whereas the lab tech’s only purpose at the bedside is to draw blood. Kind of the nature of the beast sort of thing. But, regardless, proper procedure has to be followed.
I wouldn’t judge all nurses by the idiot who laughed. She sounds like a problem, but most of the time (in my experience) lab and nurses work well together.
Ugh, hearing that makes me want to grab a ruler and start smacking knuckles.
And that’s mostly why I felt like pitting that particular nurse. It just reflects badly on the good ones when one behaves like that.