Describe the proper action to take when a patient initially refuses to have his/her blood drawn

UC Irvine Pathology Services has established a uniform policy for specimen acceptance/rejection that:

• Has a positive impact on patient care
• Protects specimen quality
• Eliminates risk of exposure to the healthcare worker
• Complies with all accreditation standards

• Patient name
• Patient medical record number, with check digit
• Patient location
• Collection date and time
• Specimen type and/or source
• Test required (note any special handling required)
• Ordering physician

For patient safety, it is essential that the following be adhered to when submitting blood specimens for CROSSMATCHING purposes. Use special pink-top (EDTA) tubes.

1. Take a Crossmatch/Transfusion form, patient printed labels with the patient's first and last name, patient file number (PF#) or medical record number (MR#), and 1 pink-top (EDTA) tube to the patient's bedside.
2. Verify the patient's identity by asking the patient to state and spell his/her name, if able, while comparing the patient's identification band with the addressographed Crossmatch/Transfusion form and the patient's printed label.
3. The patient's name and PF# or MR# must be obtained from the patient's identification wristband. If the patient does not have a wristband, a wristband must be obtained prior to drawing the patient's blood.
4. Write the following data on the patient's printed or computer-generated gummed label at the bedside:
   • Date of phlebotomy
   • Time of phlebotomy
   • Legibly printed last name of phlebotomist
5. Affix the patient's printed gummed label to the specimen tube at the patient's bedside.
6. Send the labeled specimen tube with the Crossmatch/Transfusion form to the Blood Bank.

If the Blood Bank does not have a previous ABO/Rh on file for the patient, and the patient's initial blood type is other than type O, the Blood Bank will request a second sample to be collected for an ABO/Rh confirmation.

Failure to properly label the tubes will require that the specimens be redrawn. If the patient requires blood as an emergency and another sample cannot be drawn, an Emergency Release Form must be signed for uncrossmatched group O blood.

Specimens must be accompanied with a specimen transmittal or clinic encounter form that must match the specimen label. All handwritten requisitions accompanying specimens must have the following legible information:

• Last, first, and middle name of patient
• Medical record number (8 digits)
• Patient’s date of birth
• Last and first name of ordering physician
• Nursing station or clinic originating requestTest(s) or procedure(s) requestedSpecimen source and body site
• Date and time of specimen collection

All patient specimens MUST be placed in biohazard bags for transport to the Laboratory.

Laboratory procedures will not be performed on unacceptable specimens. Specimens collected using the incorrect tube type and transport material will not be tested. Specimens received showing evidence of leakage will not be tested. The nursing station from which the specimen originated will be notified. 

Mislabeled Specimens

Specimens received unlabeled, double labeled, or with a requisition bearing a name and/or medical record number different than what is affixed to the specimen will not be tested. The patient’s nurse and/or physician will be notified to recollect the specimen.

• Any specimen is unlabeled if the container holding the specimen (test tube, urine container, surgical specimen container, etc.) does not have the patient’s first and last name, medical record number, collection date and time, specimen type, and test required on it.
• A specimen is mislabeled if it arrives in the laboratory with a requisition bearing different names on the requisition and the label OR if the name in the computer does not match the label. The laboratory will consider a mislabeled specimen an unlabeled specimen.
• Blood Bank sample labels (crossmatch or type & hold) must be handwritten. Addressograph labels must not be placed on crossmatch specimens.

A specimen is incompletely labeled if some of the required information is missing:

• If the name and the medical record number are missing, the specimen will be considered unlabeled and handled as such.
• If there is any other information missing, the location where the specimen originated will be called to supply the information.

Specimens identified as precious specimens such as ascites fluid, amniotic fluid, cerebrospinal fluid, joint fluid, pleural fluid, surgical tissue/aspirate and certain timed specimens where the specimen cannot be recollected without undue harm to the patient will be tested only if the following conditions have been satisfied:

• The patient’s physician must be notified. He/she must agree to accept responsibility for the specimen and give written authorization for testing.
• In addition, the pathologist on call must be notified. He or she must review the circumstances and give written authorization for testing.A licensed caregiver designated by the patient’s physician must identify and correctly label the specimen.
• It will be documented in the laboratory computer system that the test was performed on an unlabeled specimen so that this information appears on the preliminary and final reports.

The Blood Bank requires a new specimen for each unlabeled or mislabeled specimen, no exceptions.

For many patients, blood draws are a routine part of medical care, so it's important to ensure the process is as comfortable as possible. Although improving the experience is beneficial to everyone, for people who have a needle phobia, these efforts can be life-saving.

It's estimated that 10 percent of the population struggles with a fear of needles, and this can lead to skipping important blood tests and treatment injections, putting their health at risk. To ensure that all your patients are protected from unnecessary discomfort, check out these seven tips to improve their experience during blood draws.

Visit Club Staffing to find open travel phlebotomist positions and see the country while you work.

7 WAYS TO REDUCE DISCOMFORT DURING BLOOD DRAWS

1. Pay attention to patient body language
The moment you and the patient make contact, pay close attention to their reaction to determine the level of their anticipatory discomfort. Body language, eye shifting and tone of voice can give you clues about how patients will respond to blood draws. Approaching anxious patients with confidence can help alleviate their fears.

"I go in with confidence," says Rebecca Park, RN and founder of RemediesForMe.com. "If the person who is drawing your blood seems nervous and doesn't seem like they've been doing this for long, it gets the patients more nervous."

2. Communicate with your patient
Every patient is different, so what comforts one patient during blood draws may induce anxiety in another. Instead of trying to guess the best way to approach the procedure, ask the patient what would make the process easier for them.

Ross Coyle, Public Relations Officer at Stanford Blood Center says his staff communicates by "explaining the blood draw process to new and anxious donors before and during the procedure." Open communication can make your charges feel more comfortable and establish greater trust in you.

3. Take your time
Establishing trust is essential to preventing a patient's discomfort, so try not to rush through blood draws. Give the person time to inform you of any fears they might have and reassure them that you won't insert the needle until they've given consent.

This may take longer for patients with severe phobias, but it's better than the alternatives of traumatizing the patient with restraints or risking the cancellation of necessary blood tests.

4. Have distractions available
For some patients, having something to distract them from the procedure can help make blood draws tolerable. "I talk with my patients during the blood draw to relax them," says Park. "If they're not 100 percent focused on the needle, their anxiety goes down and so does the pain."

5. Encourage patients to breathe through the procedure
Deep breathing can help ease some of the pain caused by blood draws. "To decrease the pain, I have the patients take a deep breath in," offers Park. "As I insert the needle, I have them slowly breathe out." She explains the pain subsides more quickly if the body is relaxed.

6. Encourage hydration
Dehydration can make it more difficult to find a suitable vein for blood draws. "Ensuring the donors are well-hydrated prior to a donation [helps] minimize the risk of a reaction like lightheadedness or fainting," says Coyle. "We offer them a snack if they haven't eaten as well as encourage them to drink more water."

7. Let your patient warm up
If your patient has just come in from outside in the winter or if the office you work in stays cool, give your patient an opportunity to warm up before attempting a blood draw. This can be done by allowing the patient to sit in the waiting room a moment or encouraging quick physical activity.

You can even use a warm water bottle or heat pack on the area first. Heat makes veins dilate and expand, increasing the odds that you'll find success on the first needle insertion.

Blood draws are not a procedure that most patients look forward to, but there are ways to reduce discomfort and improve the overall experience.

By using these seven tips, you can ensure you're giving your patients every reason to trust you to do your job and minimizing the pain and trauma that can come with unsuccessful blood draws.