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Phlebotomy > Module 2: Safety and Compliance > Flashcards

Module 2: Safety and Compliance Flashcards

1
Q

regulatory bodies

A
  • Occupational Safety and Health Administration (OSHA)
  • The Joint Commission
  • College of American Pathologists
  • Clinical Laboratory and Standards Institute (CLSI)
  • Centers for Disease Control and Prevention (CDC)
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2
Q

goals of regulatory bodies

A
  • create regulations and policies
  • high-quality care
  • accurate test results
  • encourage the use of safety measures
  • detect problem areas
  • find solutions that create positive changes
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3
Q

regulations

A
  • blood pathogens standard
  • clinical laboratory improvement amendments (CLIA)
  • needlestick safety and prevention act
  • good laboratory practice
  • national accrediting agency for clinical laboratory science
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4
Q

OSHA

A
  • regulates workplace safety
  • biologic hazards and hazardous chemicals
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5
Q

bloodborne pathogens standard

A
  • protects phlebotomists from exposure to body fluids
  • requires implementation of practices and engineering controls to prevent exposure incidents
  • guidelines for training
  • use of PPE
  • availability of hep B immunization
  • exposure control plan
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6
Q

when to perform hand washing

A

before and after direct contact with every pt

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7
Q

PPE for venipuncture

A
  • gloves
  • replace if they tear and between each pt
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8
Q

PPE for splash risk

A
  • goggles
  • face mask or full face shield
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9
Q

where to dispose of sharps

A

OSHA-approved, puncture-proof, leakproof sharps container

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10
Q

when to stop filling and lock the sharps container

A

3/4 full

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11
Q

steps after accidental exposure to body fluids

A
  • administer first aid
  • medical examination
  • sign consent form (you and pt) to test for HIV, HBV, HCV
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12
Q

things to document in sharps log after needlestick

A
  • date and time of the incident
  • type of sharps used
  • who was involved without names (pt or staff)
  • location
  • detailed description of how the incident occurred
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13
Q

things on safety data sheets (SDS)

A
  • protective measures
  • chemical name
  • trade name
  • manufacturers name, address, and emergency phone number
  • handling and storage
  • actions to take in case of accidental exposure
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14
Q

The Joint Commission

A
  • accredits and certifies healthcare organizations in the US
  • independent and nongovernmental
  • pt safety and quality of care
  • national pt safety goals (NPSG): two-factor pt identification
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15
Q

Clinical and Laboratory Standards Institute (CLSI)

A
  • standards and guidelines to help labs achieve accreditation
  • up-to-date info and safest measures for blood tests
  • guidelines for venipuncture, dermal puncture, and phlebotomist safety
  • establishes the order of draw
  • quality control, pt care, risk reduction, time-saving measures, cost-saving measures
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16
Q

Centers for Disease Control and Prevention (CDC)

A
  • identify and educate about infections, illnesses, and disease prevention
  • guidelines for PPE, sharps handling, hand hygiene
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17
Q

CDC recommendations to improve safety and reduce disease transmission

A
  • always wear gloves when handling any body fluid
  • activate needle safety immediately after use
  • dispose of sharps immediately into an approved container
  • wash hands with soap and water before and after pt care
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18
Q

what increases accidental needlestick injuries

A
  • use butterfly or syringe method
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19
Q

when do needlesticks most often occur

A
  • disposing of the needle
  • attempting to recap the needle
  • removing the needle from adapter after use
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20
Q

HIPPA regulations

A
  • pt protected health information (PHI) is confidential
  • regulates the authorized release of PHI
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21
Q

what info does HIPAA protect

A
  • pt demographic
  • treatments
  • medications
  • disgnostic testing
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22
Q

what info does HIPAA not protect

A
  • info without any way to identify the pt
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23
Q

who can get pt information

A
  • those who have a direct need for info and legitimate involvement in pt care (requesting provider, medical specialists, nurses, billing, accounting)
  • pt signs consent form to share info with someone else
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24
Q

inpatient identification

A
  • two or three-factor identification
  • identification band on the wrist or ankle
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25
Q

outpatient identification

A
  • ID including a photo usually required
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26
Q

techniques for locating a good vein

A
  • warming area
  • wiping with alcohol
  • lower limb below heart level
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27
Q

sites to avoid in venipuncture

A
  • inside of wrist: potential ulnar nerve damage or inadvertent arterial access
  • legs and feet of pt with diabetes: possible infection
  • basilic vein: last choice if all other veins are inaccessible, close to brachial artery
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28
Q

how many attempts at venipuncture should you make

A

two attempts

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29
Q

when to stop the venipuncture procedure

A
  • hematoma develops
  • pt shows signs of seizure or loss of consciousness
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30
Q

slapping a pts vein could lead to what charge

A

battery

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31
Q

threatening to move forward with a procedure without consent could lead to what charge

A

assault

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32
Q

quality control

A
  • measure of precision
  • how well an instrument is functioning to produce consistent results
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33
Q

quality assurance

A
  • ensuring a test is as accurate as possible
  • adhering to policies/procedures, quality control testing, equipment maintenance
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34
Q

equipment log

A

monitors equipment maintenance and quality control testing

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35
Q

when to perform quality control procedures

A
  • daily or when opening new lot of supplies
  • after recording multiple errors
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36
Q

what to record after performing quality control procedure

A
  • time and date procedure was run
  • results
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37
Q

when to clean lab equipment

A
  • several times a day
  • according to guidelines
  • if the equipment is visibly contaminated
38
Q

what happens when the centrifuge is unbalanced

A
  • makes weird noises
  • is vibrating
  • causes broken tubes and inaccurate results
39
Q

how to balance centrifuge

A
  • place tubes of same size and volume directly across from one another
40
Q

first step when troubleshooting

A

check if the equipment is turned on and is connected to an outlet

41
Q

what is included on a repair report

A
  • date
  • description of issue
  • steps taken to try and fix the problem
42
Q

quality control for CLIA-waived tests

A
  • never reuse supplies or use beyond expiration date
  • run external controls when opening new package of supplies, beginning of day, when several results are out of range
43
Q

ways to ensure quality control for glucometers

A
  • external controls
  • matching test strip codes to glucometer codes
  • reviewing expiration dates
44
Q

what should you check every time you perform blood glucose testing

A

the code on the testing strips

45
Q

what to do about defective strips

A

contact the manufacturer and follow the instructions for sending back the strips

46
Q

National Institute for Occupational Safety and Health (NIOSH)

A
  • federal agency
  • develop new knowledge in occupational safety and health
  • updates workplace safety regulations annually
  • identified that incorrect sharps disposal is a significant cause of sharps injuries
47
Q

NIOSH sharps container criteria

A
  • functionality: leakproof and puncture-proof, durable for transport, secure closure
  • accessibility: easy to operate, within easy reach, below eye level
  • visibility: clearly visible fill level and biohazard symbol
  • accommodation: minimal training, easy to operate, safe mounting system
48
Q

how often should employees participate in bloodborne pathogen training

A

annually

49
Q

steps after accidental needlestick

A
  • clean with antiseptic (iodine, soap and water)
  • notify immediate supervision
  • document in sharps log and incident report form
  • have medical exam asap
50
Q

how long after exposure to HIV should postexposure prophylaxis occur

A

2 hours

51
Q

steps after splash of body fluid into eyes, nose, or mouth

A
  • flush with large amounts of water
  • report exposure to immediate supervisor
  • medical exam
52
Q

standard precautions

A
  • essential for all pt encounters
  • hand hygiene, PPE
  • consider all body fluids from all pts as infectious
  • protect workers
53
Q

droplet precautions

A
  • droplets larger than 5 microns in diameter
  • rubella, meningitis, diphtheria, mumps, pertussis, influenza
  • wear a mask
54
Q

contact precautions

A
  • direct contact or contact with the environment (indirect)
  • diphtheria, herpes simplex, scabies, hepatitis A, respiratory syncytial virus, wound/skin infections (MRSA, VRE, C. diff)
  • gloves and gown
55
Q

airborne precautions

A
  • droplets smaller than 5 microns in diameter
  • varicella, tuberculosis, measles
  • wear mask or N95 respirator
  • spans larger distance than droplet and longer time or virility
56
Q

standard precautions regarding gloves

A
  • wash hands before and after wearing gloves
  • wear when handling body fluids
  • replace between each pt and procedure
  • nitrile or vinyl (not latex)
  • fit properly
  • check for holes or rips
57
Q

examples of times to wear gloves

A
  • handling specimen containers
  • venipuncture
  • dermal puncture
  • any procedure with potential for interacting with body fluids
  • processing specimens
58
Q

how to remove gloves

A
  • grab glove on palm of nondominant hand
  • pull glove off by turning it inside out
  • transfer to palm of dominant gloved hand
  • slip non gloved hand under cuff of dominant hand glove
  • pull two gloves off together and turn inside out
  • dispose in biohazard container
59
Q

used to clean area for venipuncture

A
  • alcohol wipe, 70%
  • benzalkonium chloride if allergic to alcohol
60
Q

when to not use alcohol to cleanse skin and what to use instead

A
  • determining blood alcohol levels
  • povidone-iodine or soap and water
61
Q

what to use to clean skin for bacterial testing of blood

A
  • povidone-iodine and alcohol
  • chlorhexidine gluconate rubbed on skin for 30 seconds
62
Q

how to clean blood spills

A
  • 1:10 solution of sodium hypochlorite (bleach) and water
  • let the solution sit for 20 mins before cleaning up with paper towels
  • dispose of towels in a biohazard bin
63
Q

how long to scrub hands when handwashing

A

20 seconds

64
Q

% alcohol concentration for hand sanitizer

A

60%

65
Q

how long to rub hand sanitizer in

A
  • 30 seconds
  • until hands are dry
66
Q

what to do if pt shows signs of syncope or loses consciousness during blood collection

A
  • stop procedure
  • place pressure at venipuncture site
  • protect pt, assist to floor or to reclining position
  • monitor pt breathing
  • place cold cloth on back of pt neck or wrists
67
Q

CAB

A
  • AHA recommendation for priority when pt is unresponsive
  • chest compressions, airway assessment, rescue breathing
68
Q

steps for adult CPR

A
  • call 911
  • find defibrillator
  • begin CPR: compressions at 100 to 120 bpm at 3.8 to 5 cm (1.5 to 2 in) depth
  • 30 compressions to 2 breaths
  • place pt in recovery position (lateral recumbent) and monitor breathing
69
Q

when does irreversible brain damage occur after a lack of oxygen

A

4 to 6 minutes

70
Q

steps for infant CPR

A
  • call 911
  • begin CPR: use two fingers to provide 30 compressions at 100 to 120 bpm and 3.8 cm (1.5 in) depth
  • 30 compressions to 2 breaths
71
Q

steps if pt starts seizing

A
  • stop blood draw
  • call for assistance
  • gently lower to floor or leave them if they’re in a safe position
  • do not lift or restrain pt
72
Q

steps if pt reports nausea during blood collection

A
  • stop procedure
  • cold washcloth on forehead
  • provide emesis bin or trash can
  • place vomit in biohazard container
  • offer to rinse mouth and clean face
  • notify nurse or provider
73
Q

symptoms of shock

A
  • cold and clammy hands
  • blurry vision
  • rapid and weak pulse
74
Q

steps if pt is in shock

A
  • call for help
  • remain with pt
  • shock position: pt lying flat with legs elevated 12 in
  • keep pt warm
  • loosen tight clothing
75
Q

steps for general excessive bleeding

A
  • apply pressure
  • call for assistance
  • elevate limb if bleeding from the limb
76
Q

steps for excessive bleeding after venipuncture

A
  • hold pressure for at least 5 minutes or until the bleeding stops
  • add more gauze if needed (do not remove gauze already on site)
  • call for assistance if bleeding continues
  • apply pressure bandage
  • advise pt to keep the bandage on for at least 1 hour and avoid heavy lifting
  • monitor for other issues
  • document to provide guidance for future blood collections
77
Q

what to do if pt experiences severe pain during blood collection

A
  • indicates nerve involvement
  • stop procedure
  • pt needs medical evaluation if pain doesn’t stop
78
Q

petechiae

A
  • small red dots
  • do not need to stop procedure
  • indicates platelet issues
  • apply adequate pressure after procedure
79
Q

info needed for accidental exposure log

A
  • how exposure happened
  • by what means it occurred (eye splash, needlestick)
  • equipment involved
  • safety measures on equipment
  • PPE used
  • where incident occurred
  • type of procedure being performed
  • situation surrounding exposure
80
Q

info needed for sharps injury log

A
  • date
  • type of equipment involved and brand name
  • where exposure took place
  • brief description of how exposure occurred
81
Q

chain of custody

A
  • used when specimen is evidence in legal case
  • record of all steps that took place
  • who handled the specimen
  • time, date, and name of collector
  • every person who handles specimen should sign and date the form
82
Q

classes of fires

A
  • A: materials like wood, paper, cloth
  • B: liquids like paints, oils, gasoline
  • C: electrical equipment like appliances, wiring, electronic
  • D: metals like sodium, magnesium, titanium
83
Q

when should you dispose of PPE

A

before leaving pt room

84
Q

type of precaution for streptococcal pharyngitis

A

droplet

85
Q

things causing inaccurate glucometer readings

A
  • too much blood used: inaccurately high levels
  • too little blood used: inaccurately low levels
  • first drop used: contains tissue fluid, inaccurately low levels
  • test strip left open: strips absorb moisture, inaccurately low levels
86
Q

glucose tolerance test (GTT)

A
  • timed test
  • requires multiple blood draws at set intervals
87
Q

minimal PPE required when aliquoting blood specimens

A
  • face shield
  • gloves
88
Q

greatest risk of exposure to what pathogen from needlestick injury

A
  • hep B: 6-30%
  • hep C: 1.8%
  • HIV: 0.3%
89
Q

department that processes cholesterol, troponin, and HDL

A

chemistry

90
Q

steps of PPE removal

A
  • gloves
  • goggles
  • gown
  • mask
91
Q

PPE for pneumonia

A
  • gloves
  • mask

Phlebotomy (9 decks)

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