Patient and Specimen Requirements Flashcards
where is the lab order entered?
electronic medical record (EMR)/ electronic health record (EHR)
OR
hospital information system (HIS) or laboratory information system (LIS) (this is computerized physician order entry - CPOE)
if outpatient official requestion form to lab by physician on telepone or fax
some labs may provide physician offices with access to LIS for purpsoe of ordering tests and accessign results, making physician offices clients
@hat happens when a lab test is ordered
- put in HIS and is recieved on computer in LIS and provided an accession number (day of year (1-365 - Julian day - an test number)
- LIS prints requisition in label
what must a lab test requisition in form of computer label must contain ?
- pt name
- pt medical record number
- pt location
- bar code
- lab accession mumber
- requesting physician
- blood volume and tube type
- test status
- test performed
- pt age and gender
- DOB
- date and time of test
- lag section to which specimen should be delivered to
What does it mean if a specimen is STATE (ST), ASAP, or routine (RT)
- STATE (ST) = immediately
- ASAP = as soon as possible
- routine - ckkectuib tune as schedukles
requistion should contain :
● Patient’s name
● Patient’s date of birth
● Patient’s medical record number
● Patient’s location (if inpatient)
● Ordering physician’s name
● Type of test to be performed
● Test status (timed, fasting, STAT, ASAP)
● Date and time the test is to be performed
+ other requirements
what to do when greeting a pt
- smile, calm and pleasant
= identify by first name or from lab (depending on facility)
-greeting is super important cause pt may be nervous - knock and wait for a response before opening if door is closed or open
- open door slowly after a few sec and greet pt before proceeding in to room
venipuncture on children
- dont lie and say it wont heart
- distract children
- truth - you will feel a little quick sting
- comfort children
- approach child as adult
venipuncture on geriatric patients
- elderly pt may be sensory impaired but dont automatically raise voice, in long term care ask abt special assistance before entering
how to wake up pt
- gently wake up by nudging bed, talk in a soft manner, don’t turn on bright lights, give pt opportunity to shielf eyes from light, never draw from sleeping pt bc they could jerk
how to respond to pt questions
- state tests r routine by physicians and more info ask physician
- do not discuss test with pt, tjat os [hysician results
what are ethics?
- moral philophy varied by indv, religion, social status or heritage
whis code of thics
- set of written or unwritten ruiles, procedures, or guildeines that specify values, actions and choices
what is the law
- rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority
- if ,llaw is violated civil or ciminal case
- lawsuit have plaintiff (suing) and defendant (sued)
What is respondeat superior
- latin for let the master answer
- emplouer is responsible for act opf employees if acts r performed out of scope of employees duties
type of lawsuits against phlebotomist?
- assault (threat of harm)
- battery (act of bodily harm)
- neglience - malpractice - negligence to perform in matter expected by profession
What are the 4 Ds of malpractice?
Duty—the professional owes a duty of care to the accuser. (The healthcare
provider is expected to care for the patient. For example, a phlebotomist is
expected to perform venipunctures.)
● Derelict—the professional breaches the duty of care to the patient.
(The healthcare provider acts outside the standards expected
of his profession. For example, if the phlebotomist repeatedly
explores with the needle [probes] when drawing blood.)
● Direct cause—the breach of the duty of care to the patient is a
direct cause of the patient’s injury. (The care outside the standards of the profession causes the patient’s injury. For example,
repeated probing causes nerve damage to the patient.)
● Damages—there is a legally recognizable injury to the patient.
(The injury is deemed severe enough to warrant compensation.
For example, nerve damage caused by repeated probing is severe
enough to cause the patient not to be able to use her computer
and her job requires 8 hours a day of computer use.)
how to prevent malpractice cases as a phlebotomist?
- care abt pt
- communicate with pt
- be competent
What are patient rights?
- defned by American Hospital association in doc called Patient Care Partnership: Understanding Expectations, Rights and Responsibilities (formerly the
Patient’s Bill of Rights) - right to refuse care, be treated with respect, have all record and info classifed as confidential, be informed abt purpose and expectedresults of treatment, and access to medical records
What is informed consent for phlebotomy
- inform pt of procedure using simple language
- “im here to draw your blood”
- of no english use hand gesture , demostration or other means to get idea
- use translator, only family in extreme emergency situatiosn
- sign consent form
What forms does consent take ?
written agreements, spoken words, implicit or unspoken/implied actions, and
appointments for tests
what is expressed consent?
- the pt is informed of the procedure and process and sign consent form
- ex are drug and alchohgol screening and HIV testing
what is implied consent
if pt extend arm but does not acknowledge
- do not draw if not clear (ex: not speak english)
when is it okay not to draw someones blood
- when pt is recieving radiation treatment and phlebotomist is pregnamt or irate pt infected with hepatitis or AIDS might compromise the phlebotomists safety
When is written consent okay?
- if minor child or pt is mentally incompetent and is having blood drawn
what are the three isntances in which a pt cannot refuse consent?
: the patient is a minor
under the age of 18 and consent was obtained from the parent or guardian, the
patient has a mental impairment (not able to understand), or the patient has
been ordered by law to have his or her blood drawn.
What to do if pt refuses blood draw
- expain physican ordered test and test is needed
- if continued to refuse leave room and inform practitiioner + document pt refused
What is HIPAA?
Health Insurance Portability and Accountability Act (HIPAA)
- in response to info being transfered electronically for medical transaction
- do not discuss pt info other than pt unless pt says it is okay
- dont share info with other healthcare professionals unless it is for pt treatment
how to abide by hippa
● Close patients’ room doors when caring for them or discussing their health.
● Do not talk about patients in public places.
● Turn computer screens that contain patient information so that passersby
cannot see the information.
● Log off computers when you are done.
● Do not walk away from patient medical records; close them when leaving
how to properly identify patient?
- according to the JRC use at least 2 pt identifiers not the room number
- in acute care check armband, pt first and last nambe, hospital number, DOB, physican name
3 step process for pt identification
- Ask the patient to state and spell his or her full name and state his or her date of
birth. Be sure that you do not call the patient by name prior to this because patients
with altered mental states may simply repeat the name they hear (if pt can not state name find person ti state bame for you). - Compare the name on the test requisition form/slip and preprinted labels (if provided) to the patient’s response.
- Confirm the patient’s identity by checking the medical record number, patient armband, or some other form of government-issued identification, such as a driver’s
license. (See Figure 7-8.)
what is the most important tep in venipuncture?
- proper pt identification
how to idnetify inpatient
0 check ID vand and if pt doesnt have one wait till they do unless said otherwise
- make sure ID matches info on requisition (name, DOB< med record number)
- dont rely on card outside door, wall or bed or even just wristbands
- can skan barcode on id band
- if id not on wrist check ankle
- if pt can not speak check with healchare prof, relative or friend if info is right
how to idnetify outpatient?
- identify with gov issues photo id (fullname and DOB) before registered and tests r ordered
- check three way match with electronic order, info on labels, and pt statement of name and dob
how to label specimen
- label all speciment immeidatelby using computer generated labels or writing info with permanent marker
- include:
- ● Patient’s full name
● Patient’s date of birth
● Unique patient identifier (medical record number or other number used by
the facility)
● Specimen collection time and date (printed or recorded on the label after
collection)
● Collector’s identification (name, initials, or operator identification,
recorded after collection)
and could include
● Patient location
● Ordering physician
● Computer accession number (unique number in a sequence)
● Specimen requirements (test ordered, tube type, special handling)
● Other comments or special instructions
how does altitude impact lab tests
- normal ranges r determined based on population at sea level
- at higher elevation there r higher RBC and hemoglobin abd yrates (byproducts of protein degradition)
how does geographical location impact lab tests
- people in high automobile traffice areas may have higher levels of lead and carboxyhemoglbin in their blood
- lead and zinc could be found in higher concentration in those living near smelting plants and ppl were water is hard may have higher lipid and magnesium levels
what tests does nonfasting affect
Glucose
Lipid profile
* Total cholesterol
* HDL
* LDL
* VLDL
* Triglycerides
what tests does stress affect
Adrenal hormones
Fatty acids
Lactate
White blood cells
what tests does posture affect
Albumin
Bilirubin
Calcium
Enzymes
Lipids
Total protein
Red blood cells
White blood cells
what tests does execerse affect
Aldolase
Creatinine
Fatty acids
Lactate
Sex hormones
AST
CK
LD
White blood cells
What tests does diurnal variations affect
Cortisol
Serum iron
White blood cells
what tests do alchohol affect
Lactate
Triglycerides
Uric acid
GGT
HDL
what tests do tobaccoaffect
Catecholamines
Cortisol
Hemoglobin
White blood cells
how does temperature impact lab tests
temp change distributon of water btwn tissue and blood - more water in bv decrease analytic and less increase
- plasma protein drop during acute or severe heat
- electrolyrtes r unblanaced after sweating
how does hydration impact lab tests
dehydration means concentrtion of substances in blood increase (hemoconcentration), leading ot persistent vomiting, diarrhea, diabetic acidosis or indequate fluid intake
hemodiluation can lead to decreas econcentration of substanced in bloo
- blood cell count and chenistry tests r most commonly affcted by imbalanced in hydration
how does posture, exercise and stress impact lab tests
- lack of activity cause stissues to allow more water to enter blood, diluting plasma (esp in bedridden pt)
- strenous exercises causes elevated WBC, aterations in coagulation system and fluctaution in various enzuymes and chenical levels
what s the patient basal state?
- pt at rest, fasting for at least 12 hours (no exercise in the morning!)
what is diurnal variation/ rhythm?
- analyteat diff time of day
- hormones such as testoernoe decrease during afternoon while others like TSH increase in evening, WBC may rise during day
- specimen for hormones must often be drawn at time of day corresponding with diurnal variation
how can crying affect blood tests?
if infant is crying leukocytes increase and it takes 60 min to return to normal
What is therapeutic drug monitoring
- monitoring abt of therapeutic drug in blood to know if dose is appropriate
What is peak level
- specimen collected when serum drug level is at its highest, shortly after med is given
What are trough levels
- drug levels are at their lowest, immediately before next dose
what occurs if blood is drawn shortly after a meal?
- serum may appear cloudy or lipedmic as their are large amt of fatty compounds in blood after meal, interefering with lab tests (severe lipedemic have appearance similar to milk)
What are interfering substances?
- substances tha can alter lab tests
- could contribute to abn color of bdoy fluids
- ex: erytthrmycin and B12 add orange and yellow color to blood and urine
- medication can also alter elvel of chemicals (such as enzyymes) such as statins that may cause elevation in liver enzumes
What is the Health Information Technology for Economic
and Clinical Health (HITECH) Act
- passed in 2010 the bill encourages use of electronic health records (EHRs) and hipes 90% of doc and 70% of hospital use EHR by end of edcade
- secure real time access to pt info
What is EHR?
- electrnoically sotred record of pt health info gnerated over 1 or multiple encounters
- include info on pt demographics, progress notes, problems, meds, vital signs, PMH, immunzation, lab data, radiology reports
What is found in the hospital setting for lab info
- lab into in EHR include lab test results, collection date and time, who colllected, recieve and performed on specimen, and comments during collection verification
What is an EMR?
- emr r medical record used by dr fir duagnoses and treatment
EMR vs EHR?
EHRs are health records that cover more information, encompassing the total health of the patient. EMRs and EHRs both track data over time;
easily identify which patients are due for preventive screenings or checkups,
such as blood pressure readings or vaccinations; and help monitor and improve
the quality of care within the practice. The difference lies in the ability of EHR
systems to travel from facility to facility and from one healthcare provider to
another in a secure way. EHRs are used by laboratories and other specialists and
allow all members of the healthcare team to access the latest patient information, providing for coordinated patient-centered care.
How does a phlebotomist track specimen
- ## include info of time of draw and phlebotomist info
