They Didn’t Know That?!?

As a medical laboratory professional, I am all too familiar with the incessant phone calls from nurses and physicians asking a variety of medical questions. What tube do I draw? How much volume do need? Can I add a test on to a specimen? Often times, those scientists working “the bench” are already overburdened with the shear volume of work in front of them and prefer to not spend time answering these questions. I hear from many medical laboratory professionals that phone calls are often too repetitive, they are a “waste of time”, and the caller doesn’t listen anyway. Where many see this as a thorn in our side, I see this as an opportunity.

One of the many duties that I have as a DCLS is education; education of physicians, education of nurses, education of patients, and education of every other healthcare professional who participates in helping provide healthcare to our patients. I wish to share with you all an experience I had yesterday that will show how our presence outside of the laboratory basement truly makes a difference.

While I was rounding with the Pediatric Patient Care Rounding Team, I had a couple of questions that was posed to me by the chief resident.

The first question: “We get calls from the lab all the time about clotted specimens. Is there anything we can add to the tubes so that it doesn’t clot?”

My fellow laboratory professionals – We assume that since they went to medical school, and have attended a residency, and perhaps even a fellowship, that they understand blood collection. They do not. I explained that the purple top tubes contain EDTA … yada yada yada … tubes must be immediately mixed at draw … yada yada yada … different colored tubes indicate different additives … STOP. This is where I was interrupted and was told “I thought the different colored tubes just told y’all which department they go to.” {Sigh} [Insert more explanation of the different tubes and the order you draw them in matters … yada yada yada.

Second question: “The other problem we have is that the nurse calls the lab to find out the minimum amount of blood we need to get for a test, we collect that amount and send it, but then the lab calls and says it’s not enough. Can we please get the lab to give the right information to the nurses?”

So what do you think really happens? Do you think the laboratory purposely gives the incorrect amount of blood needed for a test on a baby just because we like to make them cry? These are our patients, too! We care about them! When a patient passes away that we have worked on, we grieve just as the rest of the healthcare team does. We do not want babies stuck anymore than what is absolutely necessary, so what’s the deal?

When I asked for an example of the most recent test, it was a send out test … on serum. When the nurse called to ask how much blood was needed, the laboratory looked up the test and replied 1 mL of serum. When I questioned a nurse: if the lab told you 1 mL of serum was needed for a test, how much blood would you collect, she replied: 1 mL. She didn’t recognize that there was a difference between amount of serum and amount of blood. Ah ha! Mystery solved.

Solution: After rounding I spoke with the nurse manager and I have schedule multiple nursing education sessions to explain the difference and answer any other questions they may have regarding laboratory testing. This is also the start of an ongoing education series with them. All of those things we think they should know? Well they don’t. No one has ever explained it to them and they have simply learned bad habits from the previous person who never had it explained to them either.

We are all a team and education is the key. The DCLS is the face of the laboratory outside of the laboratory. We may answer highly complex consultation questions, or we may answer questions that virtually every medical laboratory professional should be able to answer. The key to them listening, as I have quickly found, is the doctorate. With the doctorate, they listen.

With education being key, we too must continually learn the “latest and greatest” of our own profession. Many think obtaining CEUs (continuing education units for the muggles reading this) are just a pain, but they are essential to us staying current in our profession. While there are some good online resources for CEUs, and I have authored some of those online courses, I prefer the in-person sessions so you can ask questions of the presenter if anything needs clarification or you want further information. If you are able to attend, the ASCLS National Annual Meeting is at the end of July in Chicago this year and is being held in conjunction with the AACC meeting (this equals a massively huge exhibit hall!). I encourage any laboratory professional who can attend, to do so – I’ll be there speaking as well. http://www.ascls.org/education-meetings/annual-meeting

Education is always the key! We must educate ourselves and educate our other healthcare professionals if we are ever going to improve our profession and our patient’s care and safety.

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6 thoughts on “They Didn’t Know That?!?

  1. This was a mind blown great post. I appreciate this blog so much. I mean, how on earth would we have known that a resident didn’t know the purpose of the tube colors if you didn’t also educate us on that. Yes, education is key.

    Thank you for all you do!

    Liked by 1 person

  2. I am a MT. I have been in the field 28 yrs.. SBB, manager, lead, and now bench generalist. Never have I expected nursing to know the difference between serum, plasma or whole blood. Although I think theu should! When they ask how much blood do I need for xyz I reply with the tube and amt- 7ml red top or 5 ml lav.
    Whenever possible I try to have a teachable moment. The phonecalls never cease but the one about can add a cbc to my patient doesnot happen anynore. Instead I get, my patient has a cbc and I need an A1c now..perfect…name, etc please. It did not happen overnight but it has happened and even better new providers and staff catch on really quickly. Shocking to new lab staff as they are not used to this. We should all do this! Teach, learn grow everdyday.

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  3. I have been standing there after a fellow tech receives a phone call from a nurse and exclaims, “They didn’t know that?!?” A nurse noticed that I issued O positive blood for her B positive patient and called the lab to inquire. I told the fellow tech to appreciate her attention to detail and her level of comfort in calling the lab. We need to be available for consultation. There are many teaching opportunities to come.
    Biz

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  4. Every medical center should have a laboratory representative that meets with the heads of medical staff once a month or every 2 weeks to address simple, yet, critical issues such a those presented in this piece. But that is not going to happen any time soon so long as MLS folks are placed in a negative light. It does irk me that a recent doctorate degree supersedes a bachelors with experience when it comes to respect from our medical professional brethren. For too long lab professionals have be thought of as ‘stupid’, ‘a waste of a pay check’, ‘a monkey can do out job’, or other demeaning things that those outside of the profession may falsely propagate. Do we all need a doctorate now to be treated with respect?

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    1. The doctorate degree allows the line of communication to be opened. In my own facility I have been educating other healthcare professionals not only about laboratory testing, but also about laboratory professionals. The VAST majority of healthcare professionals have no idea the education requirements to perform laboratory testing. After looking at my own facility’s numbers, the percentage of laboratory professionals with a BS degree is far higher than the percentage of nurses with a BS degree (this may or may not be true in other facilities). For decades other healthcare professionals assumed laboratory professionals were all on-the-job trained with very minimal education, and have treated the laboratory as such. As I have been educating nurses, doctors, etc otherwise, I have had some reports of improvements in communication between bench scientists and other professionals. It will take time to rewrite a decades-old assumption but it is necessary. While it shouldn’t take a doctorate degree to open the lines of communication, in many instances it will to get physicians to listen. However, once the lines of communication are open, it should make it easier for bench-level scientists to voice opinions and be heard.

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  5. I like that you posted this. Honestly, the whole premise of my thesis circles around Primary Care Physician’s need for a DCLS to handle questions like those posed to you and result reviews. The question I get asked a lot as the lab manager for a large core lab within Primary Care is — okay, so what should I do next? It’s not that they don’t have a great head for Primary Care medicine, its just that our laboratory testing has become so precise and numerous that reflex testing, additional reviews, etc. become problematic. Drug Screen testing is a huge one right now that I get at least 2 calls on a week. You’re right in that we need a face out there to help and help mend the perceptions on both sides. I’m hopeful to start my DCLS journey in Fall 2019 after my Masters. Your post helped me figure out some of the survey questions I want to tailor for my research project!

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