At Hays Medical Center (HaysMed), a 222-bed hospital in Hays, Kan., a 20-member phlebotomy team serves every area of the facility. The team's diverse duties include working with patients in emergency, medical, surgical, pediatric, obstetric, oncology, hospice, ophthalmology, occupational medicine and inpatient rehabilitation. In addition, we support HaysMed DeBakey Heart Institute, which provides heart surgery and cardiac care for people throughout western Kansas. With such a wide spectrum of specialties and patients, HaysMed phlebotomists must be prepared to collect blood using a variety of methods, from fingersticks to more complex arterial collection, requiring different supplies.
Before April 2011, organizing and carrying necessary supplies and equipment from patient to patient was a challenge. The standard medical "tackle boxes" used had limited storage and no support for computerized applications. Phlebotomists who anticipated needing extra supplies that didn't fit in the tackle box compartments simply stuffed them into their pockets. Perhaps most problematic was that the tackle boxes had no ability to support bedside barcode technology, an important safeguard against medical error.
In 2010, while pursuing a master's degree in Healthcare Administration from Bellevue University, it occurred to me that a portable phlebotomy workstation-similar to those already used in HaysMed nursing units-could help make phlebotomy workflow more efficient while also improving patient and provider safety. This idea became the focus of my practicum, which was based on research and best practices in healthcare. My goal was to design and build a phlebotomy-specific mobile cart to enhance workflow, point-of-care service, patient and employee safety, and bedside barcode technology.
The Design Process
In terms of functionality, phlebotomists need sufficient space to organize cotton balls, syringes, phlebotomy tubes, bandages and other necessary supplies and equipment. The mobile carts used in the nursing units sparked the idea for a similar cart dedicated to phlebotomists.
After researching several mobile workstations and reviewing the options offered with each, I concluded that the cart we selected had to be relatively compact in weight and size above all else. It also needed to be ergonomic and easily maneuverable so that it could be customized for lab work. Other elements that played into the selection decision included:
- locking drawers for organized and secure storage of various supplies;
- lighted keyboard and drawers for less obtrusive bedside draws during the night;
- easy to use from a sitting or standing position; and
- document protector for caregiver notes, procedures lists, codes, contact numbers, etc.
When HaysMed decided to purchase carts, I developed further specifications. For starters, phlebotomists need additional space for lab supplies and secure sharps disposal. Although most hospital rooms have used sharps receptacles, having one available immediately at the bedside greatly reduces the risk of needle sticks to patients, employees and visitors-especially children who might be present. Other considerations included:
- a 5-minute setting on automatic drawer locks to provide enough time to retrieve necessary supplies within workflow without having to re-key security codes;
- two baskets to be placed on both sides of the supply drawer box for wipes and a barcode printer;
- three lined baskets for smaller items, such as tourniquets, syringes, skin wipes, alcohol wipes, blood culture bottles, culture swabs, antiseptic swabs, blood bank bracelets, and specimen bags;
- a dedicated bracket on the rear of the cart for gloves;
- a bracket to hold the barcode scanner in place during cart operations; and
- two additional bins utilized for a small sharps container and to transport sealed test tubes.
Working with supply vendors and various hospital staff, we were able to make all the information technology (IT) and clinical modifications without ever needing to contact the cart vendor for supplies or support. HaysMed IT staff built an onboard barcode charger and integrated it with our hospital information system. By the spring of 2011, HaysMed had three portable phlebotomy workstations ready to go.
Resistance Quickly Overcome
April 2011 was the go-live date for the first mobile phlebotomy workstations. I trained each phlebotomist individually and carefully watched for adjustments based on real-life challenges in day-to-day use.
In the beginning, we met some staff resistance to the idea of pushing a cart, but it did not take long before they realized how much easier and safer their jobs became because of them. Gradually, the initial opposition was replaced by enthusiasm. In a matter of weeks, the carts were so successful that a fourth cart was implemented. They're now used in every unit, navigating throughout the hospital, moving smoothly in and out of elevators, and crossing a variety of thresholds, including carpeted halls and tiled patient rooms.
With standard locations for all supplies and necessary equipment, each phlebotomist knows exactly where to reach for the items they need to perform any number of services. In fact, the only supply that differs from one cart to the next is the size of gloves on board. With a glove bracket on every cart, however, each phlebotomist has ready access to gloves that fit.
As team members become familiar with the standardized locations for equipment and supplies, workflow has become smoother and more efficient. We no longer have to search multiple drawers-or pockets-for the right syringe or tube.
The most satisfying aspect of the project is the fact that the portable sharps container and barcoding capability have significantly enhanced patient and employee safety. Since 2011 when our carts went live, HaysMed phlebotomy staff has only had two needlestick exposures compared to four in 2010, three in 2009 and seven in 2008. With a barcode scanner and printer at the bedside, we now have two additional ways to identify our patients and make sure they're getting the correct service.
Jessica Fisher is the Health Unit Coordinator and Phlebotomy Supervisor at HaysMed in Hays, Kan.