AMT RPT common mistakes
AMT RPT · Understand the traps and how to avoid them.
Identifying the patient with a closed question ("Are you Mr. Smith?") or by bed number/room, then drawing without comparing the requisition to the ID band.
Closed questions invite a reflexive "yes" from sedated, hearing-impaired, or confused patients, and bed numbers are reassigned constantly; candidates do it to save time or because the patient 'looks right.'
What to do instead
Ask the patient to state and spell their full name and give date of birth, then actively compare both identifiers against the requisition and the armband (or the second identifier for outpatients) before touching supplies. Initial and date the requisition at the bedside.
Recapping a needle with two hands or carrying an uncapped needle across the room to the sharps container.
Candidates learned older habits, or the sharps container is mounted away from the draw chair and they try to 'protect' the needle until they reach it.
What to do instead
Activate the engineered safety device immediately after withdrawal, and drop the whole assembly into a sharps container at the point of use. If no container is within reach, bring a portable one to the patient; never recap, bend, or clip.
Leaving the room after a draw without performing hand hygiene, or washing gloved hands instead of removing gloves and washing hands.
Gloves feel like a substitute for hand hygiene, and the post-draw focus shifts to labeling and transport; hand hygiene is the first thing dropped under time pressure.
What to do instead
Perform hand hygiene before glove application and immediately after glove removal, using the standard sequence: remove gloves, then soap and water or alcohol-based rub. Gloves are never washed or reused; treat hand hygiene as a step on the checklist, not an optional extra.
Leaving the tourniquet tied for several minutes while searching for a vein, or removing the needle before releasing the tourniquet.
Candidates tie the tourniquet first and then hunt for equipment, and they forget the release step because all attention is on needle withdrawal and hemostasis.
What to do instead
Apply the tourniquet no more than 1 minute before the stick; if the search is prolonged, release it and reapply after 2 minutes. Release the tourniquet as soon as blood flow is established and always before needle withdrawal, then apply pressure without bending the arm.
Squeezing or 'milking' the finger hard during a capillary puncture, or collecting the drop immediately after alcohol while the site is still wet.
The drop is slow, so candidates squeeze to speed it up; residual alcohol stings and dilutes the sample, and the temptation to start collecting is strong.
What to do instead
Warm the site, wipe with alcohol, and let it air-dry completely. Lance the side of the fingertip and wipe away the first drop. Apply intermittent gentle pressure proximal to the site, never forceful squeezing, because tissue fluid and hemolysis invalidate the result.
Filling tubes in whatever order they come off the rack, e.g., drawing an EDTA (lavender) tube before a citrate (light blue) or serum tube.
Candidates memorize tube colors for tests but not the additive carryover rules, and short draws make them grab the next available tube rather than the correct one.
What to do instead
Commit the order of draw to memory (blood cultures, citrate, serum with or without clot activator, heparin, EDTA, glycolytic inhibitor) and fill citrate tubes to the full marked volume before any additive tube. When only a light blue is ordered, use a discard tube or a butterfly with discard per policy.
Pre-labeling tubes at the supply cart before the draw, or labeling them after returning to the lab instead of at the patient's side.
Pre-labeling is faster on a busy run, and candidates believe they will remember which tube belongs to whom; interruptions make that assumption false.
What to do instead
Label each tube immediately after filling and before leaving the bedside, in the patient's presence, with full name, unique identifier, date, time, and collector initials. Never label a tube that is not in front of the patient; relabel only per policy and never cover an existing label.
Centrifuging serum tubes before the clot has formed, shaking tubes to mix additives, or storing whole blood at the wrong temperature during transport.
Turnaround pressure pushes candidates to spin immediately, and vigorous shaking seems like thorough mixing; cold-chain and clot-time requirements are easy to overlook.
What to do instead
Allow serum tubes the full clot time specified by the manufacturer (commonly 30 minutes) before spinning, mix additive tubes by gentle inversion only, and follow each test's transport requirements (iced, room temperature, protected from light). Document collection and processing times for time-sensitive tests.
Discussing a patient's diagnosis or test results in a hallway or elevator, or releasing results to a family member who asks at the bedside.
Candidates want to be helpful and may not recognize casual conversation or a well-meaning relative as a confidentiality breach.
What to do instead
Discuss patient information only with those who need it for care, in a private setting, and verify authorization before releasing any result. Refer family requests to the ordering provider or the facility's release-of-information process, and confirm consent before the procedure itself.
Drawing a short or hemolyzed tube and sending it anyway, or failing to document and report a needlestick or a specimen rejection.
Candidates fear conflict, blame themselves for a difficult draw, or assume someone else will notice and correct the problem.
What to do instead
Apply acceptance criteria before the needle leaves the room: check fill volume against the marked line, inspect for hemolysis and clots, and recollect while the patient is still accessible. Report exposures and rejected specimens immediately per policy and document the corrective action so trends can be tracked.