Phlebotomy

By Group 1 Cejas, Lequerica, Zambrano, Milian, Joseph NMT 1312 Marshel

Objectives
Define phlebotomy and describe phlebotomy services List professional competences for phlebotomists List skills for effective communication Describe basic principles of quality and list examples of quality assessments for phlebotomy
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Definitions
Phlebotomy is derived from the Greek words phlebo, which relates to veins, and tomy, which relates to cutting. Phlebotomy is the incision of a vein for the purpose of collecting blood A phlebotomist is the individual who performs phlebotomy
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Duties
Primary Function
To assist the health care team in the accurate, safe, and reliable collection and transportation of specimens for clinical laboratory analyses

Other functions
Assist in the collection and transportation of specimens other than venous blood such as
Arterial blood Urine Tissues Sputum
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Typical Clinical Duties

Identify the patient correctly Assess the patient before blood collection Prepare the patient accordingly Perform the puncture Withdraw blood into the correct containers/tubes Assess the degree of bleeding & pain Assess the patient after the phlebotomy procedure

Typical Technical Duties

Manipulate small objects, tubes, and needles Select and use appropriate equipment Perform quality control functions Transport the specimens correctly Prepare/process the sample(s) for testing/analysis Assist in laboratory testing procedures, washing glassware, and cleaning equipment
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Typical Clerical Duties

Print/collate/distribute laboratory requisitions and reports Answer the telephone Answer all queries as appropriate Demonstrate courtesy in all patient encounters Respect privacy and confidentiality

Job Sites for Phlebotomists

Hospital Settings
Acute Care Hospitals Specialty Hospitals such as psychiatric, pediatric or cancer centers Hospital based clinics

Ambulatory Care
Health department clinics Community health centers School based clinics Prison health clinics Home health agencies Insurance companies Physician practices Mobile vans for blood donations Rehabilitation centers
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Competency
Phlebotomists must be able to
Apply knowledge of:
Principles of basic and special procedures Potential sources of error Standard operating procedures Fundamental biological characteristics

Select appropriate:
Course of action Equipment/methods/reagents

Prepare patient and equipment Evaluate

Specimen and patient situation Possible sources of error or inconsistencies Quality control procedures Common procedural/technical problems Appropriate actions and methods Corrective actions
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Other responsibilities
Adherences to organizational policies
Safety Infection control Fire & safety

Communication skills
Verbal Nonverbal Listening skills

Efficiency and quality

Productivity Quality
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Standards of Ethical Conduct for Health Care Professionals

Do no harm to anyone intentionally Perform according to sound technical ability and good judgment Respect patient rights Have regard for the dignity of all human beings
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Expected Character Attributes

Sincerity and compassion Emotional stability and maturity Accountability for doing things right Dedication to high standards of performance and precision Respect for patients dignity, privacy, confidentiality, and the right to know Propensity for cleanliness Pride, satisfaction, and self fulfillment in the job Working with team members Take pleasure in communicating with patients
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Competencies & Certifications

Phlebotomists must obtain
A high school diploma or equivalent Phlebotomy training via hospital, community college, or technical school Employers require phlebotomy certification via national certification examination
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Organizations
American Society for Clinical Pathology (ASCP) National Phlebotomy Association (NPA) American Society for Clinical Laboratory Science (ASCLS) National Credentialing Agency for Laboratory Personnel (NCA) American Medical Technologists (AMT) American Society of Phlebotomy Technicians (ASPT) National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) National Healthcare Association (NHA)

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These Organizations
Have an interest in promoting and improving the practice of phlebotomy Develope competency statements Provide guidelines for healthcare organizations to provide standard operating procedures Provide professional standards and code of ethics
NPA NPA ASCP ASCLS NCA AMT ASPT NHA ASCP ASCLS

Provide annual or other certification examinations

Provide educational programs

Accrediting of phlebotomy educational programs

NAACLS
NCA

Credentialing for laboratory personnel

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Communication
Consists of:
10 to 20% verbal messages 80 to 90% non verbal messages

Face to face communication is the most effective form of communication and is a part of a phlebotomists job every day Verbal interactions can be depicted as a communication loop.
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Basic Communication
Requires:
Sender Receiver Message

Is complete:
when the sender receives feedback

Involves:
Showing empathy Showing respect Building trust Establishing rapport Listening actively Providing specific feedback Conveying the right message Using a professional tone of voice Using appropriate language

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Communication Loop

Starts when the message leaves the sender and reaches the receiver The receiver completes the loop by providing feedback to the sender Without feedback the sender has no way of knowing whether the message was accurately received or was somehow blocked by extraneous factors that can filter out meaning from a message Filters can be damaging to effective communication because they do not allow the loop to be completed

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Communications 3 Components
Verbal communication
The actual words that are spoken, the tone of voice

Nonverbal communication
Body language, gestures

Active listening
Using verbal & non verbal information to assess the situation
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Verbal Communication
Must use simple, everyday vocabulary particularly with children Avoid complex medical jargon Pts must not be told this wont hurt. Patient should be forewarned and prepared for pain. Efforts must be made to insure that sensory impairments such as deafness or blindness are overcome Ask Do you understand? or Do you want me to explain the procedure again? to verify that you are being heard & understood Must make efforts to communicate with patients who speak other languages Locate translators or translation services Tone of voice should match the words that are spoken. Avoid sarcasm Use calm soothing confident tones In emergency situations Require extra speed and accuracy without jeopardizing personal touch Be conscious of a patients privacy, dignity and individual needs Bedside manner Pleasant facial expression Neat appearance Minimize negative effects of the situation
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Basic Procedures When Encountering A Patient For The First Time in Hospital
Knock gently on the patients door Introduce yourself and state that you are from the hospital or laboratory, whichever is the case Inform the patient that his or her specimen must be collected for a test order by the physician
Indicate that this is a routine hospital procedure Avoid lengthy discussion of why a test was ordered. Refer this to the physician

Remain calm, compassionate, and professional and limit conversations to essential information Let the patient know how the procedure is going
This is going well it is almost over

Do not be distracted from the phlebotomy procedure by excessive talk or unrelated issues Before leaving the room, thank the patient for cooperating
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In A Clinic Or Home
You must also
Direct patient to sit in a chair with sides and arms or recline during the procedure Take time to find the nearest bathroom and bed in case of complications Find a phone or bring a cell phone to clarify lab orders Puncture site must be cared for appropriately and assurance must be made that patient is not bleeding.

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Patient Identification
Is essential In a Hospital
Must be accomplished by two of the following:
Checking if the test requisition labels and a unique identification number on the pts armband match Verbal confirmation from the patient Positive confirmation by a unit nurse

In a clinic or home
Should done meticulously and cautiously by:
Using drivers license or identification cards Confirming birthday, home address or social security

This process should be well documented

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Telephone Communications
Incoming Calls
Answer no later than 3rd Ring Try to smile & reflect positive phone voice Speak clearly and courteously Identify the department or doctors office Identify yourself stating your name & title Ask how you may help the caller Acquire information from the caller & record date & time If you cannot provide the proper response ask for assistance Ask the caller before putting them on hold Do not leave on hold for more that n 30 seconds without checking back Read back message to caller to ensure that you have the correct info Allow caller to hang up first Do not call to socialize State your name, where you are calling from & the purpose of your call Leave preferred times & phone numbers where you can be reached Thank receiver for taking your message

Outgoing

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Nonverbal Communication
Composes 80 to 90% of Communication Can be
Positive
Facilitates understanding

Negative
Hinders communication

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Positive Body Language

Includes:
Face to face positioning Relaxed hands, arms, shoulders Erect posture Eye contact, eye level Smiling Appropriate zone & comfort

Its Effects:
Aids communication Can make interactions more pleasant Can set stage for open lines of communication Promotes a sense of trust and honesty Prevents from making the patient feel neglected
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Zone of Comfort
Is the area of space around a patient where they feel comfortable in an interaction. If that zone is crossed, feeling of uneasiness may occur For most western cultures, there are four zones
Intimate space
Direct contact up to 18 inches For close relationships and health care workers who bathe, feed, dress, and perform venipunctures

Personal space
18 inches to 4 feet For interactions among friends and for many patient encounters

Social space
4 feet to 12 feet For most interactions of everyday life

Public space
More than 12 feet Lectures, speeches, etc.

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Negative Body Language

Includes
Slouching, shrugged shoulders Rolling eyes, wandering eyes Staring blankly or at the ceiling Rubbing eyes, excessive blinking Squirming, tapping foot, pencil, etc. Deep signing, groaning Crossing arms, clenching fist Wrinkling forehead Thumbing though books or papers Stretching yawning Peering over eyeglasses Pointing finger at someone Is distracting Prevents effective communication Caused discomfort, uneasiness Can convey boredom, negative or defensive emotions Can make patients nervous, hurried or anxious

Its Effects

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Active Listening
Helps close the communication loop by ensuring that the message sent can indeed be repeated and understood May have important ramification in the test results Steps include
Get Ready by concentrating on the speaker Pause occasionally to mentally summarize what you have said Verify that you are listening by letting the speaker know using phrases such as Oh very interesting I see Avoid making hasty judgments Verify the conversation with feedback Pay attention to body language Maintain eye contact Use encouragement Practice, practice , practice

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Cultural Sensitivity
Culture influences decisions and behaviors in many aspects of life If a healthcare worker is unsure or unaware of acceptable patterns of behaviors for a patient, the recommended action is to follow the patients lead Observe mannerisms, gestures and facial expressions.
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Professional Appearance
Good Posture
Erect posture conveys confidence and pride in job performance Poor posture conveys laziness and apathy

Grooming
Instills confidence in a person Examples:
Neatly combed hair Clean fingernails Pressed uniform

Hygiene
Is important in preventing the spread of infectious disease Examples:
Clean teeth, hair and body Clean, wrinkle free clothes
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Nutrition, Rest, & Exercise

Good Health Improves the health care workers:
Appearance Attitude Job performance Ability to cope with stress

Good health can be achieved by:

Appropriate eating habits Rest during lunch & break periods Off-duty exercising

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Family & Visitors

Family members & Visitors are often more difficult to deal with than the patient. Any requests made beyond your scope of work should be referred to the appropriate health care team member If there are several visitors in the room while blood specimens are being drawn they may be asked to step into the hall Family members can be asked to stay during a procedure if the patient feels they need emotional support Children should be accompanied by a parent of legal guardian Blood should not be drawn when a physicians, priests, or chaplain is meeting in private with the patient, unless it is a timed or STAT specimen. Family and visitors are NOT permitted in the laboratory
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Quality Assurance
The area where phlebotomists have the greatest impact is on constantly improving services that are provided to stake holders or customers Quality improvement efforts of phlebotomy services often involve evaluating the following:
The health care workers technique Complications, such as hematomas Recollection rates resulting from contamination Multiple sticks on the same patient
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Stakeholders(Customers)
External
Local community Insurance companies that pay for services Employers who pay for services for their employees Grant agencies and/or foundations that provide funding Federal or state agencies OSHA,CDC, etc. Accrediting agencies- Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), CAP Advocacy groups AARP Inpatients & outpatients Patient families and friends Patient support groups Clinical laboratory staff Pathologists and other medical doctors Students Research staff Volunteers

Internal

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Quality Assessment
Quality Assessment for phlebotomy involves reviewing:
Structures
Physical structure
Facilities where service is provided Supplies & equipment

Personnel structure
Staff directors & supervisor

Management & administrative structure

Procedural manuals Record keeping

Processes
What is done to the patient or client Involves evaluation of patient records for complications, correct technical skills, correct documentation procedures, etc.

Outcomes
What is accomplished for the patient Involves chart reviews

Customer satisfaction
Via questionairre, mailout, or telephone call
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 Flow Charts

Tools & Exercises for Performance Assessment

Breaks process into components Shows frequency of problematic events

Pareto Charts Cause and Effect (Ishikawa) Diagrams

Identify interactions between equipment, people methods, supplies, etc.

Plan-Do-Check-Act cycle (PDCA)

For assessing and making positive changes

Line graphs, histograms, scatter diagrams.

Represent performance trends

Brainstorming
Used to stimulate creative solutions in a group

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Phases of Specimen Collection

Preanalytical Phase
Happens before testing

Analytical Phase
Happens during testing

Post Analytical Phase

Happens after testing

Phlebotomists are primarily involved in the preanaylitical phase

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Preanalytical Phase
Outside the laboratory
Patient identification and information
Correct venipuncture or skin puncture

Isolation techniques
Appropriate use of supplies and equipment

Standard precautions
Appropriate transportation and handling

Inside the laboratory

Sample treatment
Identification of aliquots

Specimen registration and distribution

Appropriate storage

Centrifugation
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Analytical & Postanalytical Phases

Analytical
Testing the specimen

Postanalytical
Reporting results
Appropriate follow-up repeat testing

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Basic Requirements for a Quality Control Specimen

Use universal standard precautions Identify, assess, and properly prepare the patient Avoid medication interference if possible Collect specimens from the correct patients and label appropriately Use correct anticoagulants and preservatives Collect a sufficient amount of blood Use devices that minimize accidental needle sticks Handle specimens carefully Collect fasting specimens in a timely fashion and verify that they are actually fasting samples Allow specimens without anticoagulants to stand 30 minutes Transport specimens to the clinical laboratory in a timely fashion Document

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Quality Assessment For Specimen Collection Services

Worker response time Patient waiting time Time required for completion of the phlebotomy procedure Percentage of successful blood collections on the first attempt Number of successful blood collections on the second attempt Daily blood loss per patient due to venipunctures Number and size of hematomas Number of patients who faint Amount of time spent and number of telephone calls needed to acquire appropriate identification Number of redraws due to inadequate specimens Turnaround times of designated laboratory tests Number of incomplete forms, documents, logs, etc. number of specimens received in incorrect tubes Contamination rate for blood cultures Patient satisfaction questionnaires Frequency complaints

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Important Factors Affecting Quality

Anticoagulants and preservatives
Phlebotomists are responsible for
filling specimen tubes in the correct order so that carryover of anticoagulants to other tubes will not occur mixing the specimens wit the anticoagulant promptly after blood is drawn

When restocking
collection tubes with a shelf life nearest the current date at the front of the shelf so that these tubes are first be cognizant of expiration dates

Phlebotomists should know how to store or preserve specimen tubes if the blood specimen is not to be tested immediately if consecutive unsuccessful attempts on different patients, his her technique must be reviewed, modified, or improved when too much blood is taken for laboratory analysis, the patient may become anemic, so blood conservation become priority

Number of blood collection attempts

Blood loss due to phlebotomy

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Equipment & Preventative Maintenance

Phlebotomist must participate in quality control checks and preventative maintenance of laboratory instruments such as
Thermometers Sphygmomanometers Centrifuges
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A phlebotomist is someone who collects blood specimens primarily via venipuncture Phlebotomists duties include clinical duties such as the venipuncture & patient care, technical duties such as quality control & specimen transport, and clerical duties such as answering phones & filling out proper documentation A phlebotomist must have proper training, at least a high school diploma and carry national certification Phlebotomists must be mature, accountable, work with the highest ethical standards, adhere to organizational policies, and be able to apply their knowledge correctly, efficiently, and precisely Communication involves sender, receiver & message and is complete when the sender receives feedback from the receiver Verbal & nonverbal communication as well as active listening are the components of communication Verbal communication should be face to face, in calm & confident tones, avoiding negative language and should be used effectively when: encountering & identifying the patient and using the telephone. Nonverbal communication should be positive not negative and makes up 80-90% of all communication Personal hygiene, zone of comfort and culture should also be factored when dealing with a patient Quality assurance is the area where phlebotomists have the greatest impact on their field Phases of specimen collection include the preanalytical, analytical & postanalytical phases with the preanalytical phase being the one most relevant to phlebotomy 45

Summary

Questions
Phlebotomy is derived from the greek words phlebo which relates to ________ and tomy which relates to cutting. Veins To become a phlebotomist you must have at least a high school diploma, training, and ___________. National certification The three components of communication are verbal, nonverbal and _________. Active listening When do you know a message has been communicated? When the senders receives feedback Non verbal communication makes up __________ % of all communication. 80 90 % Phlebotomists are usually involved in which phase of specimen collection? Preanalytical
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Sources
Phlebotomy Handout
Chapter 1 Phlebotomy Practice and Quality Assessment Basics

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THANK YOU
HAVE A GREAT DAY!

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