Invisibility in the Outpatient Laboratory

Authors

  • Megan Shetterly, MS, RN Patient Safety Authority

DOI:

https://doi.org/10.33940/culture/2021.9.6

Abstract

If you are a Harry Potter fan, you are familiar with the term “cloak of invisibility”: a magical cloth that renders the object it covers or the person who dons it invisible. What does this fictional artefact have to do with patient safety? Well, in this case it serves as a metaphor for patients (including me) who have felt their identities were overlooked (cloaked) during the blood draw process.

Maybe you have had this experience: You walk into the outpatient laboratory setting, register, then sit in the waiting room until they call your name and direct you to the room where you will have your bloodwork drawn. It’s fairly routine. Once you enter the blood draw room, the phlebotomist makes one last check, usually by asking your name and date of birth and cross-referencing it with the identification information on their laboratory orders. When this information is confirmed, the phlebotomist gathers their supplies, applies the tourniquet to your arm, accesses your vein with a “little prick," and starts filling up tubes of blood. Usually, this process only takes a few minutes and voilà, you are done!

Author Biography

Megan Shetterly, MS, RN, Patient Safety Authority

Megan Shetterly (mshetterly@pa.gov) is a senior patient safety liaison at the Patient Safety Authority, working with various Pennsylvania healthcare facilities to reduce medical errors. In her role, she has facilitated collaborative patient safety projects focused on blood specimen labeling and preoperative screening. She is a certified professional in patient safety (CPPS), is certified in Just Culture Training, and is a TeamSTEPPS master trainer.

References

Liberatore, K. Speaking Up for Safety—It’s Not Simple. Pa Patient Saf Advis 2018 Sept: 15(3): 37-47.

Patient Safety Authority. Speak Up. Reprint, with permission, from the Joint Commission on Accreditation of Healthcare Organizations. [cited 2021 May 3] Available from: http://patientsafety.pa.gov/NewsAndInformation/Brochures/Documents/brochure_speakup_2006_4.pdf

Patient Safety Authority. Blood Specimen Labeling Collaborative: Path to Results. Pa Patient Saf Advis 2011 Jun;8(2):53-4.

Patient Safety Authority. Reducing Errors in Blood Specimen Labeling: A Multihospital Initiative. Pa Patient Saf Advis 2011 Jun;8(2):47-52.

Agency for Healthcare Research and Quality (AHRQ). TeamSTEPPS 2.0. [cited 2021 April 23] Available from: https://www.ahrq.gov/teamstepps/instructor/index.html

Centers for Disease Control and Prevention. Division of Laboratory Systems. Strengthening Clinical Laboratories. November 15, 2018 [cited 2021 April 8] Available from: https://www.cdc.gov/csels/dls/strengthening-clinical-labs.html

Three patients sitting in an outpatient lab, but their bodies are invisible, not their clothes.

Published

2021-09-17

How to Cite

Shetterly, M. (2021). Invisibility in the Outpatient Laboratory. Patient Safety, 3(3), 56–59. https://doi.org/10.33940/culture/2021.9.6
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