What Should We Do?: Drawing blood without orders

Dear Center for Phlebotomy Education:

I am struggling with an office that collects a rainbow of colored tubes and then holds them until they contact the provider for specific orders. The specimens sit for a longer period of time before processing and if the orders are for send-out tests that need to be processed immediately we would have to redraw anyway. I feel there are many issues with this, the first being we do not have orders to draw the patient. Second, CAP guidelines stress minimizing blood-draw volumes to prevent iatrogenic anemia. Are there regulations or guidelines out there so I can educate this office and group of providers?

My response:

Performing venipunctures in anticipation of tests that might be ordered is a bad idea.

Without the authority to order lab work, healthcare professionals who subject patients to a venipuncture that hasn't been ordered are not only operating beneath the standard of care, but likely performing outside their scope of practice. Performing a medical procedure without an order puts the facility at risk of liability should something happen during the draw like a nerve injury, arterial nick, injury due to passing out, etc. The patient's attorney would have a field day.

Being proactive is one thing, but performing a procedure that has known risks when it hasn't even been ordered is going too far. I'd discourage the idea for this reason and those you listed.

Depending on where you work, a physician's or nurse's order may not be required to draw blood. In the US, some states allow patients to order their own lab work. In these so-called "Direct Access Testing" states, anyone can request their blood be drawn without a physician's order.