What Should We Do?: a standard deviation

Dear Center for Phlebotomy Education:

I have a labeling issue here. I know my staff is supposed to show the patient the labeled tubes after the draw to confirm they are labeled correctly. However, some of them are just showing them the labels before they're even attached to the tube. They are arguing with me that it's the same thing. I tried telling them the CLSI standard states we are to show the patient the labeled tubes for verification, not the labels alone and unattached, but they still push back. It's an ongoing problem and I've promised them I'd ask the guru himself if it makes any difference. What should we do?

My response:

You certainly have a cantankerous staff! It's troubling that they don't respect your authority and do as you instruct, which is precisely what the standards require. That, I believe, is a bigger problem. But let's look at the labeling issue first. 

Yes, it matters that patients verify the labeled tubes, not the unattached labels, for many reasons. Here's why:

1. The lab isn't testing the label, they're testing the blood;
2. Showing the patient the label only confirms the label is printed correctly;
3. Their way provides zero assurance they're putting the right label on the sample;
4. Their way is not the same and goes against the CLSI sample labeling standard, GP33;
5. They don't get to interpret the standards to suit themselves;
6. If a sample gets misidentified and a patient suffers complications, it's their fault,

The only alternative the standard permits to having the patient confirm the labeled tube is for the phlebotomist to compare the labeled tube to the patient's ID band. But the label must still be on the tube. You should ensure your procedure manual states precisely what the standard says. Assuming they've agreed to follow it as a condition of their employment, they can't argue with you. 

Not that they even should. After all, your order as their superior should be enough. Make sure your manual backs you up. That should be the end of the discussion. Instead of them making you jump through flaming hoops to prove you're right, flip it around and make them prove you're wrong. The tail seems to be wagging the dog with your staff, not the other way around.

Rest assured you will be tested to see if you mean it. You probably have been already. If defiance is in their genetics, then disciplinary action should be in yours.