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Chapter 7 1

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display

Booth, Wallace, and Fitzgerald

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Chapter 7 2


Chapter 7 3


Objectives

Describe certification for phlebotomists.

Identify the need for phlebotomy continuing education.

Define quality assurance (QA) as it pertains to phlebotomy.

Define quality control (QC) as it pertains to phlebotomy.

Upon completion of this chapter, you should be able to:

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Objectives Cont’d

List at least three factors that affect laboratory values.

Identify reasons for specimen rejection.

Define risk management.

Describe risk management issues of liability and safety as they relate to phlebotomy.

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Certification and Accreditation

Certification and Continuing Education

Certification

Process that ensures successful completion of academic and training requirements

Purpose of certification is to protect the public by setting standards for individuals working at various levels of responsibility

Accreditation

Process that evaluates the quality of the training programs

The National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) ensures that the competencies taught are adequate to provide accurate laboratory results

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Agencies Responsible for Phlebotomy Certification

Agencies Responsible for Phlebotomy Certification

• American Certification Agency (ACA)• American Society of Clinical Pathologists (ASCP)• National Certification Agency for Medical Laboratory

Personnel (NCA)• American Society of Phlebotomy Technicians (ASPT)• National Healthcareer Association (NHA)• National Center for Competency Testing (NCCT)• American Medical Technologists (AMT)

CertificationExamination

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Phlebotomy Continuing EducationRequired in order to

maintain certification

A lifelong process necessary

to stay current in your field!

Methods of obtaining continuing education:

Internet Seminars

Workshops Development Programs

Chapter 7 8


Apply Your Knowledge

Which process evaluates the quality of phlebotomy training programs?

ANSWER: Accreditation

BRAVO!

Chapter 7 9


Total Quality ManagementAn institution-wide concept that involves all members of the health care team in creating quality processes to improve customer satisfaction is total quality management (TQM).• This satisfaction is achieved as a result of both the

health care encounter and the accuracy of the results.

• Health care team members must do more than just the bare minimum in order to achieve customer satisfaction.

• Some health facilities ask patients to complete surveys or other rating systems to ascertain their level of satisfaction with the care they received.

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Total Quality Management Part 2Patients requiring phlebotomy services rate the

care they receive not just on lab results but also on the following:

• How long they had to wait for the procedure

• Presence or absence of bruising

to the site• Number of needlesticks or

attempts required• Their perception of the

phlebotomist (e.g., dress, communication skills)

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Quality Assurance in Phlebotomy

•System for evaluating performance, as in the delivery of services to consumers

•Set forth to guarantee quality patient care

•Uses specific indicators to track outcomes of patient care

•Performance improvement addresses the performance of all workers, not just clinical personnel

•Quality performance starts with the physician’s order and continues until the laboratory results are given

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Clinical Indicators and Outcome Evaluation

•Indicators are designed to assess areas of care that tend to cause negative outcomes.

•Help to ensure that the test results are as accurate and reliable as possible

Average

Poor

Indicator

Chapter 7 13


Clinical Indcts. and Outcome Eval. Part 2

Indicators measure the following:

• Quality

• Accuracy

• Timeliness

• Customer satisfaction

Evaluation is to show not only outcome, but also process, so that events can be retraced to improve quality

An unwanted outcome or negative outcome is called a variance.

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Apply Your KnowledgeThe core of total quality management is:A. Increased team member

participation

B. Increased customer satisfaction

C. Decreased liability claimsAnswer: B. The core of TQM is customer satisfaction.

Good Job!

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Phlebotomy Quality Control

Quality control is the process in which each procedural step is evaluated to guarantee quality patient outcomes.• In order to evaluate a process adequately,

parameters or limits must be established.

• Laboratory tests require preparation of both the equipment and the patient in order to ensure quality outcomes.

• Laboratory user manuals describe procedures and special preparations that must be followed.

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Phlebotomy Quality Control Part 2Quality Control Activities

• Checking supplies to be sure they are not outdated

• Checking for damaged equipment and/or supplies

• Calibrating equipment

• Performing function checks

• Validating results

• Documention of testing

Prior to using any equipment, it is important to ensure that it is functioning properly.

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Equipment used for point-of-care testing must undergo system checks.

• The system may have both a high and a low control

• If the system check yields a value outside the established parameter, it may warrant:

- Repair- Calibration- Replacement of the equipment

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Phlebotomy Quality Control Part 4Equipment must be accurate

and capable of duplicating results.

If a blood specimen were to be drawn on a patient at 0700, and again at 0705, we would expect the results to be similar.

Results that do not match previous results, expected results, or the patient’s clinical symptoms require repeating the test.

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The results of tests for potassium and other blood samples can be affected by:

•Prolonged tourniquet placement

•The dietary state of the patient

•Incorrect volume of blood drawn into the tube

•The order of draw

•Any special instructions regarding a sample

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Specimen RejectionReasons for Rejecting a Specimen

• Specimen lacks proper identification

• Hemolyzed blood samples

• Incorrect tube for the specimen

• Improper handling of the specimen

• Contamination of the specimen

• Clotted specimens in an anticoagulated tube

• Inadequate sample to perform the test

• Incorrect time for specimen collection

• Outdated equipment

• No date or time on the specimen

• Label does not match the requisition

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Apply Your Knowledge Part 3

You have just collected a blood glucose specimen and the result is much higher than all other previous readings. Which of the following actions would be best?A. Repeat the test

B. Contact the physician immediately

C. Record the results immediatelyAnswer: A. When results do not mirror earlier results and do not agree with the patient’s symptoms, always repeat the test.

Great!

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Risk Management and Reg. Agencies

Risk Management departments generate policies and procedures to protect from loss or injury.

These departments are designed to protect the institution from litigation and liability.

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Risk Mangmt. and Reg. Agencies Part 2

Patient Issues Related to Phlebotomy

• Venipuncture procedures, if improperly performed, can cause temporary or permanent injury to the extremity.

• Most injuries resulting from phlebotomy procedures are considered to be either malpractice or negligence.

• The burden of proof always resides with the patient.

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Comn. Causes Of Liability for Phlebotomists

Common Causes of Liability for Phlebotomists

•Misidentification of the patient•Breach of confidentiality•Improperly labeled specimens•Performing venipuncture without

consent•Injury to nerves or blood vessels•Poor sterile technique resulting in

patient infection•Permanent scarring or disfigurement•Acting outside the scope of practice•Starting an IV or performing ABGs•Mishandling a specimen

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Preventing Liability Suits

• Be aware of standards of care

• Do not perform procedures you are not fully trained to do

• Avoid destructive and unethical criticism of other team members

• Communicate with tact and professionalism when dealing with patients

• Always document results and variances immediately

• Do not give false reassurance to patients

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Health Care Personnel Issues

•Exposure to bloodborne pathogens is a serious risk to health care employees

•Phlebotomists must adhere to CDC and OSHA guidelines

OSHA

•Mandated that all health care facilities maintain exposure action plans

•All employees at greatest risk are to be given the hepatitis B vaccination free of charge

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OSHA Hazardous Communication Standard

• Also called OSHA HazCom

• Governs the identification of potentially harmful chemicals in the workplace

• All essential information must be labeled for all chemicals. The information is kept on material safety data sheets (MSDS).

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MSDS books are available for all health care personnel.

MSDS Sheets:

• Provide emergency information about the chemical product for immediate treatment in the event contact with it occurs

• Indicate specific data about each substance, such as:

- Whether it is flammable- What other agents react with it- How to dispose of it

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Apply Your Knowledge Part 4

The physician has requested that Bob draw ABGs. Bob indicated that he was not trained fully to do ABGs, but the physician insisted that someone perform it STAT, so Bob does it. The patient sustains temporary paralysis of her arm. Who is liable in this situation?

A. The physicianB. The patientC. The phlebotomist

Answer: C. The phlebotomist should NEVER perform any skill he or she is not fully trained to perform.

Great!

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CHAPTER SUMMARY Certification ensures successful

completion of an examination by a certifying body and sets standards for practice.

Phlebotomy continuing education is necessary to ensure that knowledge and skills are up to date.

Quality assurance (QA) is a system that guarantees quality patient care by evaluating processes.

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CHAPTER SUMMARY Quality Control (QC) ensures accuracy by

setting standards for procedures, equipment, validating results, and accurate documentation.

Factors that affect lab values include extended tourniquet use, dietary intake, volume of blood, order of draw, and handling of the specimen.

Specimen rejection can occur for many reasons, including improper ID, hemolysis, incorrect tube handling, and improper labeling

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CHAPTER SUMMARY Risk management identifies policies

and procedures to protect patients, employees, and the employer from loss or injury

Phlebotomist should work within their scope of practice.

Phlebotomists must follow standard precautions and utilize MSDS information when necessary

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END OF CHAPTER 7

Success means having the courage, the determination, and the will to become the person you believe you were meant to be.

-- George Sheehan

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