Lapses in Critical Thinking That Can Negatively Affect Patient Care

David Liss, RVT, VTS, CVPM, program director at Platt College, discusses how lapses in critical thinking can negatively affect patient care.

Interview Transcript (slightly modified for readability)

“First of all, the general lapse is going to be a lapse in knowledge. A veterinarian technician not having the knowledge to interpret what they are being involved in. They put the blood into the machine and it spits out results. If they do not know what those results mean, then there is a lapse there. The bigger lapse is saying, the bloodwork is done I put it into the chart.

I think one of the biggest areas, since I am in emergency critical care is blood tests that are either too high or two low that are life threatening and a veterinary technician or a veterinary assistant not knowing the alert values. Such as a packed cell volume (PCV) value higher than this or lower than that and that’s when you need to tell the veterinarian immediately. When I worked full time in emergency and had emergency staff before education, I used to train my veterinary assistants, who used to do a lot of the running of the bloodwork because the veterinary technicians would be with the patients, to yell across the room from the lab what certain things were, [such as] the potassium [level] because if it was 7 or 8 or 9, I want to know the potassium is really high to go find the veterinarian and get them to prescribe the treatment for that. As opposed to, we did the bloodwork and it’s filed, put on the doctor’s desk and the doctor is in a room. Twenty minutes later the doctor will come out and say, “Why didn’t anyone tell me that the potassium was 9?”

And so, I think one of those huge lapses is not understanding what those blood tests mean and how rapid interpretation and knowing what comes next is really vital to patient care.

A second lapse, I think would be, not paying attention to proper sample handling and proper technique for even filling blood tubes and sending blood tubes out to the lab. When you have a patient and you are taking the blood and looking at these samples, it is not as simple as poking them with a syringe and popping it into any tube. The labs really want good venipuncture technique, avoid bruising, filling the tubes in the right order because their tests can be completely screwed up if they do not do those things correctly.

You have this patient who is really low on blood and you are already drawing blood from them, and then you send the tubes to the lab in the wrong order or with the wrong technique or the smears are bad or whatever it may be, and the lab [comes back and says] we cannot use this. And, the lab is not directly in the clinic and so they do not know your patient is critically ill. And so, it is really critical that the veterinary technicians are good with phlebotomy technique, venipuncture technique and then even beyond that with sample handling, sample preparation—all that stuff is really vital. A lot of times I talk to veterinary technicians who brush those thing off and say, “Oh it doesn’t matter whether I keep the needle on or don’t,” and it really needs to be standardized because having spoken with the other side—clinical pathologists and people who work in labs—they say, “This sample is useless: there are cells that have been lysed or the anticoagulant to blood ratio was off and I cannot run the right testing.

It is so important that veterinary technicians take [those techniques] as being [important] as well. The lapse would be assuming that the needle to the vein is the only thing that we need to worry about, not everything that happens after that.”