To Manage Blood Collection Tube Shortage, Conservation Is Key
It’s become an all-too-common refrain — COVID-19, unprecedented demand and supply chain constraints are limiting providers’ ability to acquire the essential products they need for diagnosis and treatment.
Now, along with critical supplies such as certain PPE and IV fluids, blood specimen collection tubes have joined the FDA’s list of medical device shortages. The first signs of trouble occurred in June 2021, when sodium citrate (light blue top) tubes were first identified as a shortage area. The problem has since snowballed, and the FDA’s list was amended in January of this year to include all blood collection tubes.
While suppliers are working to mitigate the shortages through protective allocation strategies and focusing production on tubes with the highest demand, those actions alone won’t immediately solve the problem. Providers must also consider ways to conserve allocated supplies by approaching blood collection in a more strategic — and flexible — way.
Conservation recommendations
In response to provider outreach based on supply needs, we have pinpointed some of the most effective ways to mitigate blood collection tube shortages:
- Instruct clinical staff to consult before blood testing. When a patient is admitted to the ER, many times medical staff “draw a rainbow” (one of every tube) and send all to the lab for testing. This is typically completed ahead of a doctor’s request to cover all bases. Instead, collaborate with the doctor to determine what needs to be drawn and only draw and test for that.
- Reduce the frequency of complete blood count (CBC) draws. A CBC draw traditionally happens every day for hospital patients, but it may not always be necessary. Determine when a CBC draw is truly needed.
- Consider interval restrictions. Lipid panels, for example, could be limited to every six months, and A1C tests could be conducted every three months.
- Use more readily available alternative tubes when possible. For example, use a 3 ml red top instead of a 6 ml. If a vacuum tube is not available, switch to a non-vacuum tube. Don’t discount alternate options just because you’ve always used a particular size or type of tube.
- Share tubes between departments that use the same type of tube. For instance, use a single purple top tube for CBC and A1C instead of drawing two purple top tubes.
- Partner with local/state/reference labs in your area to see if they have any additional supply they can share.
- Increase collaboration across departments to reduce duplicate orders. This will prevent unnecessary draws.
- Prioritize the communication of your conservation strategies. Transparent, targeted emails and meetings across your various teams can help to solidify and maintain an effective collection tube management strategy.
The importance of communication
Clearly communicating mitigation strategies is always of critical importance — something one large health system based in the southeastern U.S. discovered while navigating this very shortage during spring 2021. They found that tailoring communications to their many different teams enabled them to successfully build and maintain their tube-management strategy. Their communications included:
- Rapid updates of the situation’s seriousness through two systemwide email distributions that occurred two weeks apart and were sent by the chief medical officer and senior executive team to increase readership. These emails detailed the expected duration and projected impact to crucial testing if the suggested interventions were not taken, as well as plans to restrict testing and manage inventory.
- The participation of pathology leaders in biweekly chair and staff meetings, which allowed primary care, hospital medicine and surgery staff to ask questions about the effects on their departments.
- A collaboration between nursing and lab operational leaders to create illustrated tip sheets for nursing and phlebotomy that highlighted the importance of proper blood draw techniques and tube filling.
Not only did this communication strategy allow them to shape effective messaging to targeted audiences, but their data collection strategy also helped them identify where extra tube rates were occurring and intervene to improve overall competence.
Outlook
There’s no real guarantee yet as to when blood collection tubes will rebound to their full level of availability. The ever-fluctuating supply chain means it’s critical to always keep conservation strategies top of mind to ensure supply is available for necessary testing a quality patient care.