Phlebotomy skills expected of career entry CLS/CLT graduates: A Missouri Hospital perspective

Clinical Laboratory Science, Winter 2000 by Millstead, Claudette

OBJECTIVE: To determine how much, what type, and what proficiency of phlebotomy experience CLS/CLT students should have during the training program to be prepared to meet the needs of the majority of Missouri hospital employers.

DESIGN: Survey to determine the role healthcare professionals, inside and outside the laboratory, play in today's blood collection patterns and phlebotomy management.

SETTING/PARTICIPANTS: The Missouri Organization of Clinical Laboratory Science mailed 204 surveys to the Missouri Hospital Association member laboratories.

MAIN OUTCOMES/CONCLUSIONS: This research examined the need for modifying phlebotomy skills of clinical laboratory science students. Data gathered from employers support the premise that entry-level competencies of CLS/CLT graduates will vary according to clinical facility size. CLS/CLT programs may use data from this study to plan phlebotomy practicums. It can be extrapolated that Missouri employers who are most likely to employ career entry graduates expect them to draw blood from 9.3 patients within one hour. Fifty-three percent of 40 to 400 bed hospitals expect graduates to perform difficult draws in at least eight types of hospital units. Laboratories are the major managers of hospital wide phlebotomy services; thus, CLS/CLT curricula should include phlebotomy management methods.

ABBREVIATIONS: CLS = clinical laboratory scientist; CLT = clinical laboratory technician; MIT = medical laboratory technician; MT = medical technologist; RT = respiratory therapist. INDEX TERMS: Employer expectations; proficiency training; student training.

GLOSSARY:

Teaching hospital refers to a hospital with accredited physician, nursing, clinical laboratory science, and or radiologic training programs.

Final patient redraws refers to hospital department responsible for collecting blood after patient has been punctured two times by two different hospital personnel.

"Hard-to-get" refers to a patient who has endured two unsuccessful attempts to draw blood.

Difficult draws refers to more than two attempts to obtain an adequate blood sample.

Clin Lab Sci 2000;13(l):7

Claudette Millstead EdD CLS(NCA) CLP(NCA) is the Scientific Assembly Phlebotomy Chairperson, Missouri Organization of Clinical Laboratory Science.

Address for correspondence: Claudette Millstead EdD, Bates County Memoral Hospital 615 West Nunery Butler MO 64730 (660) 679-4135

As hospitals develop strategies to use personnel more efficiently, administrators have reassigned some blood collection duties to personnel other than CLSs/CLTs and phlebotomists. For this reason, when CLS/CLT programs revise their phlebotomy curricula, the type and extent of clinical experiences required for career entry are questioned. If CLS/CLT graduates have responsibility for performing phlebotomy on the job, their clinical training should be adequate since hospitals vary in their expectations regarding phlebotomy needs from the laboratory. A current assessment of hospital blood collection patterns should assist CLS/CLT educators in making phlebotomy practicum decisions. Additionally, educators must also know what proficiency level is expected of career entry graduates.

PROBLEM

The purpose of this study was to determine how much, what type, and what proficiency of phlebotomy experience CLS/CLT students should have during the training program to be prepared to meet the needs of the majority of Missouri hospital employers.

METHOD

Six laboratory managers representing different sized hospitals in Missouri completed a draft survey instrument. After making revisions, 204 surveys and cover letters were mailed to member laboratories of the Missouri Hospital Association. The survey instrument is available from the author.

There were 113 responders for a 55% return rate. Eighty were from urban and 33 from rural communities. Twenty-six responders were from teaching facilities. Two mailings were required to gather the desired number of returns. The first mailing was sent October 1997 and the second mailing was January 1998. Returns were divided according to hospital bed size. The relationship of hospital size and type of personnel performing blood collection in various units was explored. Selected elements of the phlebotomy program were identified. Managers were asked to estimate the institutions current performance associated with each element and assess the degree of venipuncture proficiency career entry graduates require.

DATA/RESULTS

The greatest number of responders was in the category of 40 to 400 bed facilities with a total of 98 hospitals supplying data. The majority of CLS/CLT graduates will find jobs in facilities of this size. There were only six hospitals responding in the 600 bed facilities. Therefore, analysis and conclusions are based on the 40 to 400 bed responses.

Table I provides demographic information concerning the survey. Excluding 400 facilities, approximately 27% of responders were from rural hospitals and 79% from non- teaching facilities. When the average percentage of time certified CLTs are expected to draw patients is calculated, using percentage averages from bed size between 40 to 400 in Table 1, the result is 45%.