Phlebotomy Practice and Quality Assessment

1. 1 Phlebotomy Practice and Quality Assessment

2. Chapter Objectives • Define phlebotomy and identify health professionals who perform phlebotomy procedures. • Identify the importance of phlebotomy procedures to the overall care of the patient. • List professional competencies for phlebotomists and key elements of a performance assessment. • List members of a health care team who interact with phlebotomists.

3. Chapter Objectives • Describe the roles of clinical laboratory personnel and common laboratory departments/sections. • Describe health care settings in which phlebotomy services are routinely performed. • Explain components of professionalism and desired character traits for phlebotomists. • Describe coping skills that are used for stress in the workplace.

4. Chapter Objectives • List the basic tools used in quality improvement activities and give examples of how a phlebotomist can participate in quality improvement activities. • Define the difference between quality improvement and quality control.

5. Phlebotomy Practice and Definition Clinical decisions are based on: • Standards of practice • Diagnostic testing (laboratory tests, x-rays, etc.) • Patient’s history • Observation of signs and symptoms

6. Phlebotomy Practice and Definition Clinical laboratory test results • Are performed primarily on blood specimens • Give an indication of abnormalities inside the body • Help health providers in clinical decision making

7. Phlebotomy Practice and Definition Definition of Phlebotomy • Derived from the Greek words, phlebo, which relates to veins, and tomy, which relates to cutting • Synonomous words are venesection or venisection. • Definition can be summarized as the incision of a vein for blood letting.

8. Phlebotomy Practice and Definition How are laboratory test results used in clinical decisions? • Diagnostic—are there abnormalities or medical conditions affecting the patient • Therapeutic—is the correct treatment or therapy being utilized • Monitoring—is the treatment or therapy effective

9. Phlebotomy Practice and Definition Phlebotomy practice • Ranges in scope, depth of detail • Can involve clinical, technical, or clerical functions • Settings range from inside laboratory to hospital, clinics, or home health care

10. Health Care Settings and Health Care Teams Know the members of the health care team • Learn the specialty and sub-specialty areas of health care and medicine • Learn about other health care professionals and their roles and responsibilities • Learn about all areas of the clinical laboratory and their functions

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17. Health Care Settings and Health Care Teams Become a professional and mature member of the health care team • Understand the mission of the organization, goals of the group, or project objectives • Know skills of team dynamics—active listening, setting group norms, etc. • Understand relevance and commitment to team goals

18. Health Care Settings and Health Care Teams Become a professional and mature member of the health care team • Show reliability and dependability in your work • Actively and respectfully participate in decisions • Learn to be flexible • Manage conflicts in a constructive manner

19. Health Care Settings and Health Care Teams Become a professional and mature member of the health care team • Contribute to the cohesion of the team • Contribute to problem solving strategies • Support and encourage other team members

20. The Clinical Laboratory and Specimen Collection Services • Clinical pathology: blood and other types of body fluids (and some tissues) are analyzed. • Examples: Blood, urine, sputum, synovial fluid, CSF, skin scrapings

21. The Clinical Laboratory and Specimen Collection Services • Anatomical pathology: autopsies are performed, histologic and cytologic procedures are performed on tissues and fluid specimens, surgical biopsies are analyzed.

22. Figure 1-1 Example of an Organizational Chart for a Clinical Laboratory

23. Figure 1-2 The Clinical Laboratory’s Workflow Pathway

24. The Clinical Laboratory and Specimen Collection Services Agencies that oversee clinical laboratories • U.S. Food and Drug Administration (FDA) • Centers for Medicare and Medicaid Services (CMS) • Clinical Laboratory Improvement Amendments (CLIA) • Occupational Safety and Health Administration (OSHA) • U.S. Department of Transportation (DOT)

25. The Clinical Laboratory and Specimen Collection Services Agencies that oversee clinical laboratories • The Joint Commission • College of American Pathologists (CAP) • International Association of Blood Banks (IABB) • Other credentialing agencies are involved in certifying and/or licensing laboratory personnel.

26. The Clinical Laboratory and Specimen Collection Services Clinical Laboratory Departments • Administrative Office • Supervisory/management personnel • Physicians or scientists overseeing specific areas of the clinical laboratory • Technical experts and staff perform tests and report results

27. The Clinical Laboratory and Specimen Collection Services Clinical Laboratory Personnel • Pathologists and/or PhD specialists • Administrative/Management staff • Technical supervisors or specialists • Clinical Laboratory ScientistsorMedical Technologists

28. The Clinical Laboratory and Specimen Collection Services Clinical Laboratory Personnel • Medical Technicians or Clinical Laboratory Technicians • Medical Assistants • Phlebotomists

29. The Clinical Laboratory and Specimen Collection Services Clinical Laboratory Personnel • Other personnel involved in the clinical laboratory-laboratory information operators/programmers, clerical staff, quality management staff, safety and infection control staff, biomedical equipment specialists, etc.

30. Competencies, Certification, and Professionalism for Phlebotomists Phlebotomy Education & Certification • High school diploma or equivalent • Length of training ranges from a few weeks to months • Pass a national certification examination • Attend continuing education (CE) programs

31. Table 1-2

32. Competencies, Certification, and Professionalism for Phlebotomists Clinical Duties for Phlebotomists • Identify patients correctly • Assess patients prior to specimen collection procedures • Prepare patients accordingly • Perform specimen collection procedures

33. Competencies, Certification, and Professionalism for Phlebotomists Clinical Duties for Phlebotomists • Collect blood specimens into the correct containers/tubes • Label blood specimen tubes at the bedside • Assess the degree of discomfort, pain, or bleeding • Assess the patient after the specimen collection procedure

34. Competencies, Certification, and Professionalism for Phlebotomists Technical Duties for Phlebotomists • Manipulate small objects, tubes, needles • Select and use appropriate equipment • Perform quality control functions

35. Competencies, Certification, and Professionalism for Phlebotomists Technical Duties for Phlebotomists • Transport specimens correctly • Prepare/process the specimen for testing/analysis • Assist in laboratory testing procedures as needed

36. Competencies, Certification, and Professionalism for Phlebotomists Clerical duties for phlebotomists • Print/distribute laboratory requisitions and/or reports • Answer the telephone • Answer all queries appropriately • Demonstrate courtesy in all patient encounters • Respect privacy and confidentiality

37. Competencies, Certification, and Professionalism for Phlebotomists Respect • Confidentiality • Coworkers • Courteous behaviors • Tolerance of differences • Effective communication

38. Competencies, Certification, and Professionalism for Phlebotomists Service • Shift focus from oneself to others • Commitment to one’s job duties

39. Competencies, Certification, and Professionalism for Phlebotomists Support • Follow organizational policies/procedures • Maintain clean work space • Report errors or damaged equipment/supplies • Respectfully disagree

40. Competencies, Certification, and Professionalism for Phlebotomists Growth • Learn more about your job • Learn more about other aspects of your organization

41. Figure 1-3 Picture of Professionalism

42. Competencies, Certification, and Professionalism for Phlebotomists • Professional Organizations for Phlebotomists • American Society for Clinical Pathology • National Phlebotomy Association • American Society for Clinical Laboratory Science • National Healthcareer Association • Many others as well…

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44. Table 1-4

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46. Table 1-4 (cont)

47. Competencies, Certification, and Professionalism for Phlebotomists Ethical Standards for Phlebotomists • Do no harm intentionally • Perform according to sound technical ability and good judgment • Respect patients’ rights • Confidentiality and privacy • Right to know about their treatment • Right to refuse treatment

48. Competencies, Certification, and Professionalism for Phlebotomists Character Traits for Phlebotomists • Sincerity and compassion • Emotional stability and maturity • Accountability for doing things right

49. Competencies, Certification, and Professionalism for Phlebotomists Character Traits for Phlebotomists • Dedication to high standards of performance and precision • Respect for patients’ dignity, privacy, confidentiality, and the right to know • Propensity for cleanliness

50. Competencies, Certification, and Professionalism for Phlebotomists Character Traits for Phlebotomists • Pride, satisfaction, and self-fulfillment in the job • Working with team members • Enjoy communicating with patients