Wrong Blood in Tubes

Mr. Smith has been working at North West University Hospital for the better part of 30 years as an Advance Nurse Practitioner (APN). During that time he has been exceedingly pleased with the reputation that this facility has received throughout both the metropolis and the state at large. When he was simply a Registered Nurse, he took a hands-on interest in critical human resources processes such as interviewing and screening potential candidates to ensure that they had the proper qualifications to make their work at the hospital as best aligned with the current staff and its company as possible. He took pride in recommending certain individuals to HR, and was rarely wrong about the sort of individuals he helped to hire.

Within the coming 12 months, however, Smith — who has long been contemplating retirement — will stop working and dedicate the rest of his life to his family and to working in his garden. As such, he has spent the past couple of years allowing others to fulfill some of the critical responsibilities that he once did, and has been working in more of a supervisory capacity. Gradually Smith has found himself deferring from decisions and allowing others to make choices that affect the outcome of the hospital, its patients, and its staff to get acclimated to doing so when Smith is no longer present.

Recently, however, he has incurred a great deal of alarm that has him now contemplating postponing retirement. For the past several weeks, there has been a drastic increase in the difficulties that patients are having after receiving routine blood transfusions. Prior to becoming a full-fledged APN Smith worked as a phlebotomist while studying in medical — the phlebotomy department had been a particular source of pride for him at North West and one of the final areas of his previous hospital-wide overseeing that he had been least inclined to give up. He knows how critical it is to preanalytical lab testing (Lima-Oliviera et al., 2010).Yet this morning when he came in, he was greeted with the news that once again, a patient experienced severe complications after receiving a blood transfusion the preceding night. As the APN who has the most tenure at this institution, Smith makes it a point to punctually arrive and leave everyday at 9 a.m. And 5 p.m., respectively. Only once in the past couple of weeks has a patient experienced discomfort after a blood transfusion during the day shift — and even then it was due to an excess of antigens that related to a previously denoted auto-immune deficiency disease.

Smith’s cause for concern, then, is considerable. He would particularly uncomfortable about retiring from the hospital with a rash of issues related to blood being taken on patients. Additionally, there have been a couple of news stories about some of the complications patients experienced after having their blood taken. Smith worries that the reputation he has helped establish at the hospital is systematically declining. However, while critically reviewing records of all of the recent problems patients have endured over the past several weeks, he reflects on the useful aspects of the situation. The problem appears largely confined to the phlebotomy department, and relates to those individuals who are working in it during the evening and swing shifts.

Smith decides to call in the head of human resources, Sheila Santiago. He expresses his concern to Santiago about the rash of issues related to lobotomy, and shares his reports of the incidents with her. Santiago points out that there are a wide range of individuals — in varying positions — that have taken blood from patients who have underwent serious complications afterwards. These include some of the most prominent and lesser known workers in the department, including formal Medical Doctors, nurses, phlebotomists, and aides.

Interestingly enough, the principle point of commonality between all of these workers is that they were all hired after Smith stopped overseeing the phlebotomy department. The person who had been overseeing the department since Smith stepped down from supervising its daily operations is David Daniels, and APN who, due to a restructuring of positions in the wake of Smith’s impending retirement, has been charged with heading up several departments at once while the organization looks to hire new people and restructure itself. Smith and Santiago manage to catch up to Daniels later on in the day. Daniels admits that he was uncertain about what had been happening to cause the onslaught of blood drawing problems. When he is confronted with the knowledge that Smith and Santiago presenting him about all of the employees who treated patients prior to problems with their procedures were trained by him, he realizes that the problem likely involves the way he was training these people.

After going over Daniels’ training methodology, it becomes apparent that the hospital workers aren’t properly identifying patients prior to drawing blood most likely do to a “lack of appropriate training” (Waheed et al., 2013). Santiago believes that the problem has a fairly straightforward solution — all of the individuals trained by Daniels should be retrained by Smith prior to the latter’s retirement. However, Smith believes that the problem is more substantial than that. Although he agrees that retraining I blood drawing would be beneficial for all laborers who perform this task, he prioritizes the problem according to a pair of codifications: the wellness of the patients and the reputation of the hospital. Both of these matters are dire, yet he views the former as a matter of life and death. Training is one thing, he argues, but proper patient identification is another. Part of the solution might be to utilize virtual reality simulators as part of training (Wandell, 2010), Smith reasoned.

References

Lima-Oliviera, G., Guidi, G., Salvagno, G., Montagnana, M., Rego, F., Lippi, G., Picheth, G. (2012). Is phlebotomy part of the dark side in the clinical laboratory struggle for quality? Lab Medicine. Retrieved from http://labmed.ascpjournals.org/content/43/5/172.full?sid=08febff4-f115-48c1-9d3d-37ea7c8ffa1a

Waheed, U., Ansari, M., Zaheer, H. (2013). Phlebotomy as the backbone of the laboratory. Lab Medicine. Retrieved from http://labmed.ascpjournals.org/content/44/1/e69.full#aff-1

Wandell, H.F. (2010). Using a virtual reality simulator in phlebotomy training. Lab Medicine. Retrieved from http://labmed.ascpjournals.org/content/41/8/463.full?sid=08febff4-f115-48c1-9d3d-37ea7c8ffa1a