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  • 1.  Specimen Collection and Patient Safety

    Posted 05-01-2024 23:56
    Edited by Katarina Messenger 05-02-2024 08:37
    Hello everyone.  I wanted to get some input on a a situation I am dealing with at my current employment.  I am a phlebotomist at a major outpatient oncology center here in the Dallas, TX area. 

    My supervisor asked me to draw the patients blood, first, and then have the patient give their urine sample.  I explained to them that I personally do not do this because of patient safety.  I was taught you always ask a patient to give urine samples first and then draw blood, in order to prevent any foreseen safety mishaps that may or may not occur. That I remember hearing about a known legal case in which the phlebotomist was found liable for patient's injuries because they did not follow this stander of care.  My supervisor told me we draw their blood first to save time, so we don't have patient complaints about patient wait times.  I again stated I was not okay with this.  

    My supervisor then suggested that I bunny hop from phlebotomy station to phlebotomy station, draw patients while I was waiting for a patient in the bathroom.  (After 2pm I am the only phlebotomist in the lab.). I state I was again uncomfortable with that because of the foreseen possibility of misidentifying a patient. My manger didn't like that answer.  Stating patients were upset with long wait times. I told her I understood but I didn't feel comfortable putting patients or myself at risk for possible safety concerns.  

    Is their anything else you can possible suggest I can use to back up my argument on patient care and safety.  And why it could be potently dangerous to our phlebotomist and patients in this positions? 

    I look forward to hearing from you. 



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    Katarina Messenger PBT (ASCP), CMLA (NHA), CMA (AAMA, NCCT)
    Dallas TX
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  • 2.  RE: Specimen Collection and Patient Safety

    Posted 05-02-2024 13:19
    I believe you are right, I was taught the same. Send patient for urine sample before drawing blood to avoid any unforeseen accidents and injuries due to phlebotomy complications on the patient. 





  • 3.  RE: Specimen Collection and Patient Safety

    Posted 05-03-2024 00:33
    I am a retired CLS, MLS(ASCP), PBT(ASCP) and Phlebotomy Instructor.
    I taught my students to ask for the urine sample first, then draw the blood, for the very reason I did not want patients passing out in the bathroom with the door locked.
    End of lesson.
    Sent from my iPhone


    Original Message


  • 4.  RE: Specimen Collection and Patient Safety

    Posted 05-04-2024 00:36
    What about patients experiencing pain on urination or having lower abdominal pains but out of abundance of caution the doctor request blood test too?Does the order change ?



    Original Message


  • 5.  RE: Specimen Collection and Patient Safety

    Posted 05-03-2024 09:13
    Good morning all

    It's interesting discussion and many input on the subjects. I realized I also have long time experience in phlebotomy and Clinical lab scientist since January 1984 until now in outside of US and US. I remember in some patient they have difficulty on bladder control when they have pain or sharp prick. When we use needle to draw blood once a while some one would not able to control their bladder and flood unknowingly. From that incidence I remember everybody systems is uniquely deal with different situation. It does not happens most of the people but may happens some time. So I felt not only think about time management, we need to think about patient management. It is not a regular occurring episode but be careful how much fluid they drink before you draw blood or have anxiety on needle prick? Thank you for sharing your thought everyone.



    Original Message


  • 6.  RE: Specimen Collection and Patient Safety

    Posted 05-03-2024 06:59

    Katarina,

    From a legal standpoint here is what you need to do, if your supervisor will not listen to you, you need to document all conversations.  Use your work email stating the date and time you have spoken to them in the email and send that specific email to yourself and work and outside of work such as your personal email.    Any further conversations regarding this will need to be documented as such just incase you are called in for questioning. 

    My questions are does you lab have a policy on what is needed to be done first?  Normally it is the urine and then the blood is drawn, they might not have a procedure written like this.  If not you just document your concerns, let HR know that you not only spoke to the supervisor but also the lab director and the pathologist.  You could be the voice that addresses this policy and has a policy in place due to patient safety concerns.  You can also address this to the compliance person if they have one, normally you can call a 1-800 number and voice your concerns, there is no retaliation and it can be unanimous.  I have done this before.  

    In your situation documentation will be your friend.  Unfortunately people's egos get in the way of making quality decisions when it comes to patient care it sounds to me like this situation is one of them.  When I started out as a phlebotomist back in the day, 20 years ago I carried a little notebook with me that I jotted down notes in for myself.  I still do this today, but I do it in email form since its easier and documents the date and time for me.  

    If you do get called in for questioning you have your documentation on hand, you can pull your email up on your phone and read the summary of the conversation you had.  Remember to keep emotions out of your statements.  

    At the end of the day your reputation and license is on the line, you need to protect it however you can and it sounds to me like your supervisor is just wanting those surveys so they can keep their Medicare reimbursements up.  If a lawsuit happens the hospital might or might not stand behind you.  That is what I think about when I have supervisors tell me its ok, we don't need to worry about it the hospital will fight for you.  The supervisor is not an attorney.  

    Feel free to reach out to me if you need anymore guidance.  



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    Rebecca Ross
    Augusta GA
    (719)671-4479
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  • 7.  RE: Specimen Collection and Patient Safety

    Posted 05-05-2024 09:56
    Edited by Frank Resch 05-05-2024 09:56

    I will echo Rebecca's excellent documentation advice but add to keep patient information out of your emails or it could be a case with HIPAA.  The problem these days is electronic communication and documentation is still in its infancy when dealing with how little patient information are we allowed to document outside of the patients file.  Great suggestion, I just wanted to add the extra protection of patient privacy.



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    Frank Resch Supervisor/Lead Med Lab Scientist/MedTechnologist
    Whitehorse YT
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    Original Message