Managing the Risk of Patient Injury: Introduction (01:34)

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Dennis J. Ernst recalls reviewing cases where a patient sustained an injury during a venipuncture; the same mistakes appeared in several cases. This video will highlight the eight most common mistakes healthcare workers make during a blood collection procedure that lead to injuries and litigation.

Risks of Phlebotomy (04:38)

Risks include: nerve damage as a result of direct needle contact or arterial nick; subcutaneous hemorrhage, lymphedema; syncope; and death. Attorneys hold personnel to the standard of care. See an illustration of the anatomy of the anecubital area.

Case Study: One (01:17)

A man discovered his wife convulsing in bed the day after surgery and she subsequently died. A physician accused the phlebotomist of drawing the blood sample above the IV, resulting in inaccurate results; the phlebotomist was exonerated.

Errors that Injure Patients (02:42)

Errors that result in patient injury are classified as technical, judgmental, or administrative. One technical error is an excessive angle of insertion; the CLSI recommends 30 degrees or less. Hear two case studies.

Technical Error: Excessive Repositioning (02:55)

A common error encountered in phlebotomy-related litigation is excessive repositioning. Hear three case studies and learn CLSI standards involving needle relocation.

Technical Error: Inadequate Pressure (03:48)

Failing to apply adequate pressure after a venipuncture can result in patient injury, leading to litigation. Hear three case studies. Observe for hematoma and do not allow a bent arm as a substitute for direct pressure.

Judgmental Errors (01:24)

Unacceptable site selection is the most common judgmental error Ernst encounters. Learn acceptable and unacceptable sites according to CLSI standards. Hear a case study.

Judgmental Errors: Unacceptable Vein Selection (03:12)

Learn CLSI standards for vein selection. Hear a case study.

Judgmental Error: Patient Misidentification (03:27)

Errors of mislabeled blood samples and misidentified patients still occur. Learn CLSI standards for inpatient and outpatient identification. Hear a case study.

Judgmental Error: Unacceptable Site Selection (01:25)

Avoid drawing blood on the same side as a prior mastectomy; always seek physician permission and get it in writing.

Judgmental Error: Inattentiveness (02:51)

Over 2% of patients faint during or immediately after a blood draw. Expect all patients to lose consciousness and be attentive. Hear two case studies.

Judgmental Error: Failure to Terminate (00:41)

Immediately remove the needle if the there is a withdrawal of consent or if the patient experiences extreme pain, shooting pain, electric-like pain, tingling, or numbness during the procedure.

Judgmental Error: Labeling Errors (02:27)

Labeling all collection tubes while at the patient's side is a CLSI and Joint Commissions requirement. Label tubes after the procedure is complete and confirm they are labeled correctly. Hear a case study.

Administrative Error: Insufficient Training (01:13)

If an injury occurs, attorneys will look for system-wide weaknesses. In CA, phlebotomists must undergo 80 hours of training. Ensure your facility has a comprehensive training protocol; hear a case study.

Administrative Error: Inadequate/Irregular Competency Evaluations and Patient Misidentification (00:55)

Perform regular and comprehensive evaluations of personnel who perform blood draws. Tips include: direct observation, cognitive assessment, and documentation. Administrators, managers, and supervisors must discipline infractions.

Managing Risk Summary (01:05)

Review the concepts discussed in this video by asking yourself the eight questions presented in this segment.

Additional Resources (00:56)

See additional resources for phlebotomy information.

Credits: Managing the Risk of Patient Injury (00:24)

Credits: Managing the Risk of Patient Injury