Phlebotomy : A compentency-based approach Flashcards
What is plhebotomy
cut into a vein (phleobs- vein, and tome - to cut)
What percent of medical decisions are based on lab results?
70%
What is the primary role of phlebotomists?
- obtain blood specimens for testing
What do blood specimens test (list)
- levels of glucose, proteins, drugs ot blood cell countrs, atibodies, and infectious diseases
How to obtain blood?
- venipuncture or dermal (capillary) puncture
What are the 2 pairs of interchangelabe terms?
phlebotomy and venipuncture
dermal puncture and capillary puncture
When does the process of removing blood go back to
1400 BC (egyptians used leeches)
hipporates thought bloodletting rid body of impurities
What are barbers history with phlebotomy?
- they performed bloodletting procedures
- barber pole is linked to bloodletting : red = blood and white = bandage, pole = stick pt squeezed to make veins prominent
(Europe have red and white poles and America has RWB (blue = vein or patriotism)
usage of leeches in past?
- prescribed to remove blood that collected at newly transplanted tissue sites and to decrease the swelling following microsurgery (reconstruciton of small tussue structures)
- have anti coagulant and vasodilation properites
- now have medicinal leeches
What is venesection
- vein is pierced with sharp object (lancet) to drain blood
- thought to be effective at removing unwanted diseases from body
George washington and bloodletting
death of George Washington was believed to be the result of
excessive bloodletting in an attempt to treat a throat infection.
What is cupping?
- vacuum effect by pulling blood to capiullaries under heated glass
- then had a spring-loaded blox with multiple blades piercing skin to bleed (scards!)
who drew blood before phlebotomists?
- medical laboratory scientists (MLSs, formerly known as medical technologists) and medical laboratory technicians (MLTs) were responsible for collecting blood specimens
who established the princiupples and techniques phlebotomists must demosntrate mastery of?
- clinical and laboratory standards institute (CLSI)
role of phlebotomist?
- colleciton, processing, and transportation of blood specimes
- known as pre-examination
- removal of blood from donors with polycythemia
- may instruct patient on how to collect urine or fecal speciemn, and package blood, urine, fecal, cultures, and body fluids
- accepting incoming specimens, logging in specimes,routing specimens to proper departments
- quyality control testing and varical clinical and clerical duties
What is patient advocacy
- assist patients who are confused or overwhelmed by their healthcare needs and help them through the helathcare system (schedule appt, directions)
What is Point of care testing (POCT) + example
- performed at pt bedside or work area with portable instruments
- ex: blood glucose monitoring
- allow physician to diagnose quicker, speed up hosptial time
What must a phlebotomist must be familiar with?
- process, equipment, variables in venipuncture and dermal puncture (how to perform procuedres and handle specimen)
Table - duties and responsibilites of the phlebotomist?
Demonstrate professional attire, attitude, and communications
* Observe all safety regulations
* Know and follow the facility’s policies and procedures
* Properly identify patients
* Collect both venous and capillary blood specimens
* Select the correct specimen container for the specified tests
* Properly label, handle, and transport specimens following departmental policies
* Sort specimens received and process specimens for delivery to laboratory departments
* Perform computer operations and/or update log sheets where required
* Perform point-of-care testing and quality control checks
What is phlebotomy training ?
- hs diploma or equivalent
- training programs at hospital, tech and private schools, and community colleges
What agencies establish approved programs standards?
National Accrediting Agency for Clinical
Laboratory Sciences (NAACLS) and American Medical Technologists
(AMT)
What are phlebotomist role in inpt facilities
- hospital, nursing homes, rehab centers
- part of mmedical alb staff or PCTs
- physicians order tests to assist with eval of pt condition and phleb label, collect and transport
What are phlebotomist role in outpt facilities + ex of location
- physician offices, amulatory care centers, blood collection center, home healthcare, vet offices, health maintenance organizations (HMOs), American red corss, insurance companies
- collecting and processing blood specimens (resposiblities can differ)
What is the fastest growing outpatient setting ?
- amublatory care centers : walk-in facilities that patients can go to not only during the day but also after business hours and on weekends, when most physician offices are closed
What do phleb in ambulatory care centers do?
- chemistry, hematolgoy, urinalysis, serology,coagulation studies, and microbiology tests for minor conditions (sore throat, UTI, therapeutic drug monitoring)
- provide instructions to pt on how to collect urine, fecal, etc material
- obtain vital signs and transport pt
Role of phleb in physicians offices
- collecting and labeling variety of speicmen and transport ot reference lab (off site lab)
- pysican office lab may perform only basic lab tests according to certification by Clinical Laboratory Improvement Amendments (tests w/ small amt of erroneous results)
- basic tests include cholestoerl and nasal smears
Who are part of healthcare team
- Anesthesiology (anesthesiologists and nurse anesthetists)
- cardiology
- diagnositc imaging (radiology) (radiologic technicians and technologists)
- electrocardiography (nurses, med assistants, ECG tech)
- EEG (nurses and EEG tech, neurologists)
- emergency department
- endocrinolgoy
- general med (Physician, PA, NP)
- geriatrics (geronotolgists)
- internal med (osteopathic, PA< NP)
- nwonatology
- nephrology (nephrologists or urologists)
- neurology
- nuclear med
- nutrition and dietics
- ob/gyn
occupatoinal therapy - oncology
- orthoipedics
- pathology (medical lab personal often work close with)
- pediatrics
- pharmacy
- physical therapy
- psychiatry
- respiratory therapy
- surgery
- urology
What are hospital lab divided into?
- clinical pathology : lab analysis of body fluids and body tissues
- anatomical pathology : surgical specimens and sometiems autopsy
lab director vs pathologist
- lab director : administrative med lab sciensits
- pathologist : in charge of anatomical or clinical portion of lab
who is the lab director/ administrator clinical pathology in charge oif
- blood bank section supervisor
- clinical chemistry section supervison
- hematologysection supervisor
- microbiology section supervision
- Specimen Procurement Section Supervisor (phlebotomists, specimen processors)
What ar ehte specialties of medical labratory specialities?
- cytologu - look for cancer (main is pap smears)
- histology (human body tissues and cells - surgical specimens)
- cliniical chemistry (chemical constituents - enzymes, glucose, hormones, lipids, proteins, vitaminds, iron + nutrients, drugs, elements)
- hematology - study of blood and blood foring tissues
- immunohematology (blood bank) (donor transfusion)
- immunology and serology - body’s resistance to disease and foreign substances
- medical microbiology - microscopic organism
- molecular diagnostics - classification of diseases usign molecular and DNA testing
- toxicology (chemical on live organisms)
- urinalysis
What does hematolgoy include
complete blood counts, coagulation tests, bone marrow analysis, body fluid cell counts, and special tests for red blood cell and white
blood cell disorders.
What does immunohematolgy include
- screen donors and collect blood
- blood group, type analysis, cross-match, prepare and issue blood products, transfusion reaction investigations
Whatd does immnology/ serology include?
antinuclear antibody (ANA), Monospot, rapid
plasma reagin (RPR), and Group A streptococcus
(strep) screening.
What does molecular diagnostics include?
- molecular testing for infectious diseases : chlamydia, gonorrhea, and human papillomavirus
(HPV) - flow cytometry : classify leukemia and lymphoma
- DNA test : gene mutation and tumor cell ploidy anaysis
Who are the medical lab personnel
- med office staff
- medical transciptionists (path dictated reports)
- med lab assistants (MLAs) - phlebotomists trained to perform low compexity testing
- histologic technicians (HT) (prepare surgical specimens)
- histologists (HTLs)
- cytologists (CTs)
- patholgists
- pathologists assistants (PAs) - examine tissue and collect and examine autopsy specimens
- Medical laboratory technicians (MLTs), (formerly clinical laboratory technicians) have an associate’s degree and can perform low-complexity and some moderately complex laboratory testing other than cytology and histology.
- Medical laboratory scientists (MLSs), (formerly medical technologists or clinical laboratory scientists) have a bachelor’s degree
and can perform high-complexity testing other than cytology and histology.
What can Medical laboratory technicians and scientists do outside of lab?
- information systems (LIS),
- marketing and outreach coordination
- customer service
- education of medical laboratory and other medical personnel.
- laboratory administrator or laboratory manager
What legislative establishes all laboratories receiving federal funds, regardless of size, type, or location, would meet the same standards and be certified by the federal government ?
- ## Clinical Laboratory Improvement Amendments (CLIA ’88)
What was made to regulate labs and establish qualifcations for phleb?
Centers for Medicare & Medicaid
Services (CMS
What are 2 accrediting agencies that help ensure a high standarde of care for pts?
The Joint
Commission (TJC) and the College of American Pathologists (CAP)
Who oversees Centers for Medicare and medicaid Services (CMS) plus what was the former name?
- Department of Helath and Human Services (HHS)
- previously known as Helath care Financying Administation (HCFA)
What does CMS do?
- establish regulations to implement CLIA ‘88 as well as the Commission
on Office Laboratory Accreditation (COLA) for accrediting physician office
laboratories (POLs).
What is the old name for Clinical and Laboratory Standards Institue (CLSI) and what is it’s function
- formerly the National
Committee for Clinical Laboratory Standards (NCCLS) - nonprofit, private,
educational organization that develops and publishes national and international
standards for clinical laboratory testing procedures
What is included in the pre-analytics/ pre-examination stage ?
Every step in the testing process that occurs before the actual
performance of a laboratory test, including
* ordering and requisitioning of tests
* patient identification
* specimen collection processes, including prioritization
* integrity of the specimen (handling and transport)
What is included in the analytics/ examination stage ?
Every step in the testing process that occurs during the actual
performance of a laboratory test, including
* quality assurance of equipment and reagents
* adherence to SOP (standard operating procedures)
* quality control procedures
* test analysis and interpretation
* resolution of result discrepancies
What is included in the post analytics/ post-examination stage ?
Every step in the testing process that occurs after the actual
performance of a laboratory test, including
* reporting of results
* ensuring proper handling of critical results
* follow-up on reflex testing
* documentation of errors in reporting
* documentation of variances to reporting SOP
* documentation on corrective action
* specimen storage after testing
What is the CDC responsibile for phleb
categorizing newly developed lab tests as waived mod compex or highly compes
What is Environmental protection agencyt (EPA)
- ensure healthcare providers follow medical waste tracking act (MWTA)
what is the medical waste tracking act (MWTA)
efines medical waste (laboratory specimens and items contaminated by blood or body fluids)
and establishes acceptable practices for treatment and disposal of this waste.
department of transportation (DOT) phleb
- requirements for safe packaging and transport of biological hazardious and other hazardous materials (HAZMATS) such as used or expuired lab chemicals
What do the nuclear regulatory commission (NRC) do phelb
The Nuclear
Regulatory Commission (NRC) regulates handling and disposal of radioactive
materials (radionuclides used in therapy/ irradiate blood products for transfusion- pt need wbc to be deactivated before transfusion)
FDA phleb
approves medical and diagnostic equipment, pharmaceuticals, reagents
(chemicals used for testing), and diagnostic tests before these can be marketed.
The FDA also regulates content-labeling requirements. Blood and blood products
are considered pharmaceuticals
American Assocation of blood banks (AABB)
- international non prfit that sets standards and educational programs for blood donor and recipient safety-
- accredit blood banks
american society for histocompatibility and immunogenetics
(ASHI)
- Inspects and accredits laboratories that perform
histocompatibility testing
What does professionalism include?
- sincrete interest
- standard of excellence
- training
- accountability
- pride in work
- well groomed and prof appearance
- certified
appearance
closed toe shoes, no high heels, socsk
- good posutre
- well rested
fresh breath
- no body odor
- clean hair
- minimal facial hair
-no facial or tongue iercing
- no tattoos
- lab jhacket and specificied shoes
what is the communication loop
1) sender
2) messange
3) reciever
4) feedback
communcation and customer service
- Ensure that you are neat and well groomed before approaching a patient.
- Approach the patient with an upright and open posture and a smile.
- Address the patient with respect using the patient’s name and verify his or her
identity by asking the date of birth. - Maintain eye contact with the patient during your introduction.
- Respectfully request to draw the blood.
- Do not enter the patient’s personal space to draw the blood until you have verbal
or nonverbal approval. - Thank the patient for his or her cooperation when you have finished the procedure.
what is the brocheure by american hospital association called?
The patient care partnership -created to help pt understand what they should expect during hospital stay regarding rights and responsibility
what does the patient care partnership include
ecpect high quality cre, safe and clean environment, involvement in care, protection of privacy, helo when leaving hospital, help with billing
what is a kinesic slip?
if verbal and noverbal cues do not match
what is proxemics ?
- study of an indv concept and use of space
what are the difference zones?
- intimate (1-18 in)
- personal (1.5-4 ft)
- social (4-12 ft)
- public (12+ ft)
what is primary care ?
medical care by physicians or other healthcare professional (first contact in healthcare systme)
what is secondaery care
specialist or special facility (refferal)
what is tertiary care
high specialized medical care with advanced and complex procuedreus for investigation and treatment of certain disorders
what qualifies a hospital?
- parmaenet inpt bed
- 24 hr nursing
- therapeutic and diagnostic servicews
- organized medical staff
What are PHS agencies and what do tehy provide
- public health service
- vital statistics collection
- health edication
- cancer HT DM screening
- public health nursing services
- TB screening
- immunization and vaccination
- operation of helath centers
- STD clinics
who are clinical lab assistants
- aka CA or MLA
- person with phleb experience and skills in speicmen processing nad basic lab testing
what itnervals does JTC evaluate organizations?
- 3 years for most
- 2 years for labs
what is the survey analysis for evaluating risk (SAFER)
- help HCO priotritize aznd focus corrective actions by providing a visual representation of the survey results
- provides an on-site, post-survey tool called the SAFER Matrix (illustrates likelihood of harm to a pt bc noncompliance)
- requirements for imporovenet in 60 days
what does TJC do for reported concern?
- requiest written response to concern from org
- incorporate the concern into a quality monitoring database that is used to indetify trends
- conduct an onsite unannouncend assessment of org
- review the reported concern
what is a sentinel event (SE)
- unfavorable event that is unexpected and results in death or serious physical or psychological unjury
- HCO is required to perfom analysis of cause ,develop action plan, implement imporvements and monitor them
what is the TJC’s national patient safety goals
- part of overall CQI requirement for accreditation
- promte and enforce major changes
what are the NPSGs for clinical lab
- identify pt
- improve staff communicatio
- prevent infection
What are good lab practices
- keep manufactuer current product insert for lab tet in use
- follow manufacturere instructions
- be sure to proplery identify pt
- label pt specimen for testing
- inform pt of test prep
- read product insertion before test
- follow storage requirement for test kit
- dont mix componenet of different kits
- record pt tests in proper p[lace
what is the internation organization of standardization (ISO)
independent NGO iternational of 162 national standards bodies
- sthare knowledge and develop voluntary international standards for many industries including healthcare
- chose ISO bc ios bc isos means equal
what is a tort?
- wrongful act other than breach of contract committed against person property repation or other legally protected right
trot exaples?
- assault, battery, breach of confideintialty, fraud, invasion of privacy, malpractice, neglience, not meeting standards of care, and vicarious liability
what is res ipsa loquitur
the thing speaks for itslef
- rule of evidence in negligence (if break fo duty is so aobvious it does not need further explanation)
what is respondeat superior
let master respond
empluoer is liabel for actions of employeee
whati s staute of limitation ?
- law sets length of time after injury person can file lawsuit
what is the litigation process?
- 10% of malpractice lawsuits go to court
- phase 1 is when pt become awarer of injury
- phase 2 is consulting attorney (deposition)
- hase 3 (trial)
- phase 4 (appeal of jury decisions)
