Segments in this Video

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


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

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Managing the Risk of Patient Injury

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In this video lecture, an expert witness in phlebotomy-related litigation identifies common errors in the performance of venipunctures that cause minor and catastrophic injuries to patients and bring legal action against phlebotomists, laboratories and hospitals. He outlines policies, procedures and practices that phlebotomists and their managers can implement to minimize their risk of litigation. Case studies from his files as an expert witness in phlebotomy-related litigation illustrate key concepts.

Length: 38 minutes

Item#: BVL128001

Copyright date: ©2014

Closed Captioned

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