The Bullshit of KRONOS

The bullshit of KRONOS is extensive and all-encompassing. They micro-manage every aspect of the job to the North degree not allowing for any deviation, no matter the circumstance. When taking blood, there are different tubes for different tests. Each tube has a particular additive inside, and which tube is used depends on the tests required. The majority of tests are done on serum. Serum tests are done using a gel tube which has a yellow top and a gel serum on the bottom of the tube. The gel is silicon and it basically looks like clear glue. When you centrifuge this gel, or spin it really fast like a merry go round on acid, it separates the red cells from the serum. Imagine a clear tube like a hose, around 10cm long. On top you would have an apple juice like liquid, then you would have about half a centimetre of clear gel serum, then bright red blood cells. That’s what a gel tube looks like after centrifuging. Now the main feature of these tubes is whether they have a clotting agent or a non-clotting agent. Some testing requires your blood to clot. Blood left to its own devices, naturally clots. Medications like warfarin impair clotting, so if a person on warfarin is stabbed, they are going to bleed like a stuck pig, while a person not on anti-coagulants will bleed like a pig with a paper-cut. Citrate tubes have a chemical that halts clotting, this allows the lab to test the bodies clotting ability. It is used to test anti-coagulant levels and to look for clotting disorders such as Von Willebrand’s. Other additives, such as EDTA, which prevent clotting, are added to other tubes to allow for separate testing. Now this is where the story gets interesting, this is where the micro-management gets ridiculous.

The order of draw is exactly what it sounds like, the order in which you are supposed to collect the blood. There is a chart that we are meant to follow while taking bloods. Due to the additives in each tube, and the risk of chemical cross-contamination between the tubes, it is important to make sure the order of draw is correct and doesn't differ from the guidelines. When you stab a tube onto the vacutainer, the current under the needle can leave a certain amount of residue on the end of that needle. When you place the next tube onto the needle, trace amounts of the additive can cross contaminate the subsequent tubes. This can skewer the results and mess with the accuracy of the testing.

Citrate’s are blue and holds 2.7 mls of blood. It needs to be filled to the line to get correct testing measurements. It is used for patients mostly on blood thinners like warfarin or people who are going into surgery to see the clotting agents in their blood. If the clotting factors are too high or too low the surgery is normally cancelled or delayed. A simple nick could cause a haemorrhage, or in the opposite case, there is a high risk of a stroke. This tube has an anti-clotting agent inside to allow for the testing of clotting rate. There are a few problems with this. One, each tube has the exact amount of clotting agent inside. Subtract that from the blood and the medication they are on and you will be able to receive a result that is able to report on and adjust their medication appropriately.

We are, however, told otherwise. If you look at this logically, it doesn’t make sense. If it was so important that these measurements be exact to the .00000mm, it would be ridiculously easy to kill someone with a slight change of anti-coagulant medication. Despite preaching the destructive impact on altering the order of draw, plenty of people do not follow it.

The order of draw requires the non-clotting tubes to go first. You take the blood into that tube via the vacutainer, you then take a clotting tube, put that onto the already contaminated needle, and fill that one up as well. Then we follow with the rest of the anti-clotting tubes. All non-serum tubes contain anti-clotting agents. No matter what order of drawer you do, you will always contaminate a clotting tube with a non-clotting chemical and then contaminate non-clotting tubes with clotting chemicals. As company policy states, the order of draw is determined by the lab and is nonnegotiable.

The order of draw does logically make sense. If you reversed the order of drawer you would be contaminating non-clotting tubes with clotting agents. But this already happens when an EDTA follows a gel tube. When you need the blood to clot, it makes sense that you wouldn’t want it contaminated with clotting agents. Clotting of the specimen can interfere with the testing and produce inaccurate results. Yet citrate tubes contain anti-clotting chemicals, and Gel tubes contain clotting chemicals.

There is always some bullshit reason for everything and anything that is done at KRONOS no matter how illogical or stupid it may seem; they are so convinced of their own superior intelligence that they truly believe their way is the right way and the only way. I can see why they have the order of draw, but essentially, they are saying that a non-clotting tube is far more important than the clotting tube. Despite the fact that the vast majority of testing is done on serum, which comes from clotting tubes.

However, this cross contamination, which is already occurring from our initial non-clotting tube, means a partial element of that additive will enter the clotting tube, thus hindering the clotting agent within. As policy states we also need to let these clotting tubes sit for thirty minutes prior to spinning to allow the clotting agent to work. If these tubes were spun in the centrifuge before this time it can affect the sample. It can affect the quality of the sample, and gel smearing can occur. The majority of tests are done on clotting tubes. Why would the vast majority of tests be less important than the few that require non- clotting tubes?

Most of the time non clotting tubes are used for patients that are on warfarin which is a heavy blood thinner. We call it rat poison, because back in the day it was the main ingredient in rat poison. It was really effective at killing rats, basically they haemorrhaged to death. These days warfarin levels can be tested with a finger prick test at most medical centres. If it can be done with a finger prick, why do we need all this rigmarole with order of draw? If cross contamination is an issue, why are we cross-contaminating some tubes but not others? Collecting tubes in the wrong order at KRONOS is also a sackable offence.

KRONOS continues to take blood for these warfarin and other blood thinner tests, as they rake in the money. If they allowed their patients to use an easier form of testing their medication levels such as the finger prick tests, they would lose millions. It is a less invasive, a less painful and less time-consuming manner of getting these tests done. So, if KRONOS prides itself on innovation and quality, why do they continue to use archaic blood tests when a finger prick can do the job?

Post care blood instructions state that you should rest your arm, do not lift anything heavy, do not wear tight or restrictive clothing above or around the puncture site, avoid strenuous activities or exercise and avoid carrying heavy objects or parcels.

This is to minimise bruising and other complications, and obviously to avoid any lawsuits that people bring against the company if any serious injury does occur. However, there are certain tests which don't allow this post collection procedure to be followed. Glucose tolerance tests or GTTs are carried out on every pregnant woman receiving medical care in Australia. It is also used to test for suspected diabetes. It is a very common test and we usually have 5 booked in per day, per collection centre.

Patients need to be fasting for the GTT. They arrive for their appointment and their fasting bloods are taken by a collector. They are then given a 75-gram glucose drink. They are then required to sit in the waiting room trying to move as little as possible to prevent rapid metabolism of the glucose. Then we take their bloods on the one hour and the two-hour mark. The 1hr level should be when the blood sugars peak, and in non-diabetics the 2hr blood sugar level should have returned to baseline levels. This test both shows how rapidly the body responds to glucose, and how well the body manages glucose.

So, the GTT involves three venepuncture collects throughout the procedure. We start on one arm to do the first collect, switch to the other for the 1 hour collect, then for the third venepuncture we return to the first arm. We need to apply the tourniquet for the collection. By the time the third lot of bloods are collected, except in the cases where the patient has 3 arms (which I personally have never fucking seen) we are putting a tourniquet on an arm that has recently been stuck with a needle. The GTT violates our own instructions to avoid pressure around and above the needle site to minimise and prevent bruising. Either the instructions we give to patients are bullshit, or we are deliberately ignoring them when it suits. If we are telling patients not to wear a tight t-shirt that might apply pressure to the site, why the fuck are we applying a tourniquet to the arm that has already been stuck with a needle just 2hrs earlier? If a tight t-shirt can cause bruising, surely a tourniquet would guarantee bruising. To do the testing in a GTT we are intentionally and deliberately going against the very recommendations and instructions we are required to give the patient. If the patient complains about developing a bruise, it is the collector that is blamed. Shit rolls downhill, and KRONOS gives it a helping hand with a big fucking metaphorical broom. I think this is why they sometimes employ morons. By employing enough people who couldn’t find their own arse with a mirror on a stick and a YouTube video tutorial, pathology collectors as a whole, remain under respected, under-appreciated, and thus can be under paid.

While on the topic of pay, KRONOS pays its collection staff less than award wages. One of the largest Pathology companies in the WORLD, underpays the unfortunate souls at the bottom of their food chain, the bulk of its staff are paid less than a living wage. Obviously, KRONOS needs to make savings somewhere, their liaison budget is outrageous. The liaison budget is used for brown nosing Drs. This involves among other things, buying Drs lunch. Direct bribery is frowned upon, but well-paid medical professionals can call KRONOS and put in a lunch order for the entire practice, and specify what they want, and a KRONOS minion will waive their corporate credit card and come running. GPs will shamelessly call their KRONOS liaison and put in an order for hundreds of dollars’ worth of food to be delivered and will specify the restaurant and email through their menu selection. One particularly greedy, entitled and arseholish GP would use this to feed her dinner party guests. She would put in a ‘lunch order’ for cocktail party food to feed 30 people and tell the liaison to have it delivered to her private home address at 7pm on a Saturday night. KRONOS was happy to fund private dinner parties for GPs, but negotiated an enterprise agreement that allows them to under-pay the majority of its workforce. This is why they are a multi-national multi-billion-dollar company.

Another bull shit rule that exists involves the disposal of vacutainer barrels. Working in a medical industry, there is a lot of contaminated waste and sharps waste that needs to be disposed of. Sharps and contaminated waste need to be incinerated. Sharps bins disposal costs are calculated by weight. Obviously, in an attempt to save precious pennies, the company makes rules and regulations designed to discourage proper contaminated waste disposal. Needles must go in the sharp’s bins, but barrels, contaminated tourniquets, basically anything not a needle must be put in a regular bin. Hermes Labs, however uses reusable aluminium tin sharps boxes that enable you to discard the whole needle and vacutainer without de notching. This minimises the risk of needle stick injuries. Hermes Labs sharps containers have a flap that folds down and then pops back up when you throw in your medical waste so no one can stick their hand in there and go fishing. I'm not sure why anyone would do that but if it was left in an inappropriate place at least a child could not harm themselves. At KRONOS there have been several incidents where parents were not supervising their brats and the little shit tried to stick their hand into a sharp’s container. One woman who couldn’t be bothered being an even mediocre parent, put the lids on the sharps containers when the collector was out of the room. When the collector eventually went to dispose of the needle, they couldn’t. They had to walk across a waiting room holding a contaminated needle to dispose of it in another room. This is so far outside of safety guidelines that it's not funny. The mother then proceeded to lecture the collector on how un-child safe it was to have sharps bins where her unsupervised brat could reach it. She threatened to make a complaint about how un-child friendly the collection room was. We are not running a day care centre; we deal in biohazards and need to be able to dispose of them safely. Everyone else’s safety takes precedence over your ‘right’ to neglect your child in public places.

Under the old policy, we reused the vacutainers unless they were visibly contaminated. We de-notched the needle and threw the barrel in a bucket of bleach. Every 4 hours we transferred the barrels into another container of bleach. At the end of the day they were washed, and left to dry overnight. The current policy however, states that we discard all vacutainers after a single use. Unless the barrel is covered in visible and extensive blood, it is to be put in a specimen bag and then disposed in a bin in the spin room. They even designed special black bags for the barrels. Special in that they paid good money for regular black plastic shopping bags to make it look like they were doing something. The only time you are allowed to dispose of a barrel in a sharps bin, is when it is so contaminated that it would attract a whopping big fine if someone saw it in the regular bin. For obvious reasons you are not allowed to put biohazards in council bins, but KRONOS borders obscenely close to violating this in their attempts to pinch the pennies. The black bags are then tied up and chucked in the regular bins at the end of the day. We are throwing away thousands of kilos of possibly contaminated rubbish in council bins to be dumped in council landfills, where they will probably take hundreds of years to break down, because it costs less than doing the right thing. For some reason we are not allowed, under any circumstances to throw the barrels in the rubbish bins in the collection rooms. I suspect it is because they buy cheap shit bin bags that are prone to splitting, and they don’t want a bag splitting and the council discovering that a multi-billion-dollar company is sending medical waste to the public tip. The ‘sharps bags’ are far sturdier than the bin bags, specifically designed to hide their shady practices. You, the taxpayer, are paying for the unsafe and unsanitary disposal of the biggest pathology company in the country’s medical waste.

After this new policy was implemented, each area manager started visiting sites and inspecting the sharps bins for rogue barrels. Due to health and safety laws, there is a line on the biohazard sharps bins that allows you to know when it is unsafe to fill any further. Once the sharps are full, we apply the lid on top which is meant to seal it completely to prevent any lids coming off and causing an unnecessary needle stick injury to the people that dispose of the containers. A memo stating that too many barrels were being disposed of in the sharps bins was released. They insisted that people were disposing of non-contaminated barrels into the sharps containers and not following the stupid policy of transferring them from one room to the next, then into another container with a bag, that is then added to the same rubbish it would go into anyway, as if we just threw it directly into the bin that is directly underneath us in the collection room. If they were incinerating them straight away, how did the company know that the barrels where in the sharp containers? Had they reopened them against policy and looked inside, potentially contaminating themselves and opening themselves to a needle stick injury. I sure hope they didn’t, but it does seem the only logical answer as to why they knew how those barrels were in there. (Side note: One of my former co-workers throws every barrel in the sharps bin and absolutely refuses to de-notch a needle. She says de-notching a needle causes it to ‘flick’ releasing blood from the tip. The fine blood splatter around the sharps bins proves this to be the case. KRONOS fixed this problem by putting laminated paper behind the sharps bins so you could wipe away the evidence and continue to be exposed to aspirated blood, because $$).

Sheer stupidity permeated everything KRONOS does. Our head of customer relations, Virginia, is a dangerous moron. She will throw a collector under the bus without a care in the world, but is fiercely loyal to the bullies and hypocrites in management and training positions. The entire hierarchy at KRONOS is designed to demean the people at the bottom of the food chain, so they break and ask no questions and no longer expect to be treated like humans.

This chapter makes it sound like I hate my job, but it’s not the job I hate, its KRONOS and its stupid bullshit. The best part of the job is some of the people you meet. As collectors, we meet people from all walks of life. Some are entitled arseholes, some are hilarious, and more than a few are fucking delightful. It is the hilarious patients that make it worthwhile. It is the delightful ones that make you go on. It is the hot footballers and bearded men that brighten up your day. And it is knowing the work that you do is making a difference in people's health and people's lives that gets you out of bed in the morning. Even if KRONOS doesn’t appreciate pathology collectors, and even if some patients take us for granted, what we do is important, and we have the power to touch people (in a non-sexual way. Unless they are hot of course) and in turn we are touched by them and their stories.