Problem
Case Study
Michelle has two patients with very similar names on her phlebotomy requisition list: Mrs. Elizabeth B. Brown and Mrs. Elizabeth M. Brown. When Michelle entered the room designated for Mrs. Elizabeth B. Brown, she found patient Elizabeth M., at least as indicated by the patient's identification band. Michelle immediately reported the mix-up in patient location to the nurse's station. Mrs. Manley was at the desk and was the nurse in charge of these patients. Mrs. Manley was a good friend of Michelle's. When Michelle told Mrs. Manley of the mix-up in ID or location, Ms. Manley told her not to worry, she would fix the problem, and because no harm has occurred, she did not think that there was any need to report this problem to any other nurse or her supervisor.
i. What should Michelle do?
ii. What problems may have occurred if Michelle had not noticed this error?
iii. What ethical issues are present?
Mrs. L.M. is a 58-year old woman who is very overweight (5'6", 250 lbs). Her doctor has ordered thyroid tests, T3, T4, a liver panel, cholesterol, and triglycerides. She walked from the multilevel parking structure to the blood drawing center and is now experiencing rapid heartbeat and "lightheadedness". Mrs. L.M. informed Alejandro, the phlebotomist, that about an hour earlier the nurse in the doctor's office told her that her blood pressure was 160/95. Alejandro's initial venipuncture attempt was unsuccessful. On the second try, the patient complained of a sharp tingling pain at the site of the venipuncture.
i. What should have been Alejandro's initial assessment of the patient?
ii. How is a blood pressure of 160/95 interpreted? What do these numbers mean?
iii. What procedures might have helped in obtaining the blood sample?
iv. What tubes are necessary for the tests ordered? What anticoagulants are needed? Are there special transport conditions to be followed?
v. What complication occurred with the second attempt? What does Alejandro need to do now?
Baby boy Jones born two weeks prior was brought in to the Outpatient laboratory with orders from his physician for CBC, Bilirubin, Blood Culture, 2nd Newborn screening. The phlebotomist "Christine" on duty drew the blood and the parents left with the baby. Upon receipt in the laboratory the processor noticed that the CBC had clots in the specimen microtainer tube. The Bilirubin test was highly elevated outside of normal established range, the physician was surprised at the results and asked for a recollect. After three days the Microbiology supervisor generated a report that showed the blood culture drawn on baby boy Jones was contaminated. A week later the Phlebotomy supervisor told Christine she had to call the parent of baby boy Jones back because the Newborn screen was QNS.
i. What does it mean by "clotted" CBC specimen?
ii. What could have caused the clotting or clumping of sample?
iii. What might have affected the Bilirubin result?
iv. What does a contaminated blood culture mean?