Core Lab Phlebotomy

• Timed orders must be placed 1 hour in advance in order to be drawn as requested.
• Specimen collection will be performed within 1 hour plus or minus of the requested time.

1. Stat and Timed for Phlebotomy Collection:
   1. 24 hours a day, 7 days a week
2. Scheduled Routine Rounds for Phlebotomy Collection:
   1. 06:00 Round (05:00 for Therapeutic Units collection)
   2. 18:00 Round
3. Phlebotomy Collection draws are ordered by placing orders in POE.
   
   
4. Request for Phlebotomy draw should be specified in POE as Lab Collect.
   
   
5. Phlebotomist are assigned to a specific zone and will collect the specimens as close to the target time as possible based on patient load.

KEY POINTS: Stat draw requests are available 24/7 on eligible units. Phlebotomy is expected to draw stats within one hour of notification.

• Orders for phlebotomy are electronically communicated from the POE system.
  
  
• Orders must be placed for lab collection in any of the available scheduled collection rounds prior to the cutoff time for the specific round.
  
  
• All patients collected on the round must have preregistered orders in the Lab Information System (LIS).
  
  
• Patients without electronic orders cannot be documented in the automated tracking system.
  
  
• In order to prevent delays and tests cancellations unit can help by preparing patients before the start of phlebotomy rounds.
  
  1. Inform patients to expect phlebotomy.
  2. Review orders to ensure all orders are in, and are under lab collect status.
  3. Check to ensure wristbands are attached to patient and are scannable
  4. Ensure proper signage and supplies are available
  5. Change status to unit collect if patient has central line for specimen collection or to be collected in dialysis
  6. Coordinate other procedures such as PT and dialysis (Change to unit collect is necessary)

1. The Phlebotomy Team prints barcoded specimen collection labels at the patient's bedside using Specimen Collection Verification (SCV). Each label displays the patients name, JHH medical record number (Patient ID) and CSN.
   
   
2. The phlebotomist reports to the unit and attempts to collect all lab orders listed on the phlebotomy handheld device. The phlebotomist scans each specimen, then scans the patient wrist band which enters the collection date and time into the automated system.
   
   
3. If there are no lab collect orders communicated to the LIS for a given round location, there is no reason for the phlebotomist to present on the unit for the specified round.
   
   
4. Phlebotomist will review all of the incomplete phlebotomy orders and arrange for redraws if needed.
   
   
5. Unless otherwise communicated by the unit, missed patients will be attempted by another phlebotomist.
   
   
6. Unavailable patients will be attempted when the patient returns.
   
   
7. The nurse will be notified of the Incomplete Collection and documented in the LIS.
   
   
8. Phlebotomist will return to the unit for redraws (as necessary). Exception is a patient refusal.
   
   
9. All other missed requests are attempted a second time.
   
   
10. Successful collection of any outstanding phlebotomy orders will be documented in POE.
    
    
11. Any patient that is missed on the redraw round will have a capillary collection for eligible tests.
    
    
12. The other tests will be cancelled by the charge phlebotomist with nurse notified.
    
    
13. Once cancelled in the LIS, the order status for these requests will update within POE.

1. Patient Refusal
   1. When patient refuses to have labs drawn the phlebotomist will report this to the nurse taking care of the patient and the name of the nurse the phlebotomist spoke with will be documented.
   2. If the nurse is not successful convincing the patient to have his/her blood drawn the phlebotomist will confirm with the nurse or provider and the order will be cancelled.
   
   
2. Unable to Obtain
   1. If phlebotomist is unable to obtain the specimen after two attempts due to a difficult venipuncture, the patient's nurse will be informed and phlebotomist will document in the Lab Information System (LIS)
   2. Phlebotomist will inform the nurse that another phlebotomist will attempt to obtain specimen.
   3. If after two attempts the second phlebotomist is unable to obtain the labs, the nurse will be informed and the phlebotomist will document the name of the nurse and the time the phlebotomist spoke with the nurse.
   4. The phlebotomists will then offer to perform a capillary stick for tests ordered that can be obtained via capillary puncture, mainly CBC and CMP.
   5. If the patient agrees to the capillary stick, the collection will be attempted and any tests not collected will be cancelled.