phb lec 1 phlebotomy and the health care setting part 1

8/3/2019 PHB Lec 1 Phlebotomy and the Health Care Setting Part 1

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Phlebotomy and the Health CarePhlebotomy and the Health Care

SettingSetting

Part 1Part 1

Terry Kotrla, MS, MT(ASCP)BBTerry Kotrla, MS, MT(ASCP)BB


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General Practice of PhlebotomyGeneral Practice of Phlebotomy

There are over 25,000 possible laboratoryThere are over 25,000 possible laboratorytests, with around 500 performed in mosttests, with around 500 performed in most

institutions.institutions. http://www.ascls.org/labtesting/index.asphttp://www.ascls.org/labtesting/index.asp Phlebotomists allow technicians andPhlebotomists allow technicians and

technologists to focus on testing blood.technologists to focus on testing blood. POCT testing at bedside, may bePOCT testing at bedside, may be

performed by phlebotomistperformed by phlebotomist
http://www.ascls.org/labtesting/index.asphttp://www.ascls.org/labtesting/index.asphttp://www.ascls.org/labtesting/index.asp


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HistoryHistory

On the job trained leads to bad habitsOn the job trained leads to bad habits

being handed to next generationbeing handed to next generation

Due to complexity formal trainingDue to complexity formal training

programs developed.programs developed.

National certification availableNational certification available


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History (continued)History (continued)

Phlebotomy fromPhlebotomy from

Greek words,Greek words, phlebophlebo,,

relates to veins,relates to veins, tomytomy,,relates to cutting.relates to cutting.

Opening a vein toOpening a vein to

collect bloodcollect blood


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Three purposesThree purposesfor collection andfor collection and

analysis of laboratory samplesanalysis of laboratory samples Diagnostic testing whats wrong with theDiagnostic testing whats wrong with the

patient?patient?

Therapeutic assessment is the drug atTherapeutic assessment is the drug atthe right therapeutic level?the right therapeutic level?

Monitoring patients condition is theMonitoring patients condition is the

patient getting better?patient getting better?


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Professional EthicsProfessional Ethics

P r in c i p le s o f r i g h t and w r on gr in c i p le s o f r i g h t and w r on gcondu c t f o r th e p r o f e s s ion .ondu c t f o r th e p r o f e s s ion .

Do no harm intentionallyDo no harm intentionally Perform according to sound ability andPerform according to sound ability andjudgement.judgement.

Do what youre trained to do, no more.Do what youre trained to do, no more. Deal with patients assigned, not those youreDeal with patients assigned, not those youre

curious about.curious about. Keep all patient information confidential.Keep all patient information confidential.


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National Phlebotomy AssociationNational Phlebotomy Association

Represents the laboratory.Represents the laboratory.

Gain and apply knowledge.Gain and apply knowledge.

Maintain accuracy, reliability andMaintain accuracy, reliability and

reproducibility of results.reproducibility of results.

Respect patients bill of rights.Respect patients bill of rights.

Perform specified skills as defined by thePerform specified skills as defined by the

hospital or laboratory standardshospital or laboratory standards


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Professional BehaviorProfessional Behavior

Character attributes for phlebotomists include:Character attributes for phlebotomists include: Sincere interest in health care.Sincere interest in health care.

Accountability for doing things right.Accountability for doing things right. Dedication to high standards of performance.Dedication to high standards of performance.

Propensity for cleanliness.Propensity for cleanliness.

Pride, satisfaction, and self-fulfillment in the job.Pride, satisfaction, and self-fulfillment in the job.

Professional behavior involves doing the rightProfessional behavior involves doing the right

thing when no one is watching.thing when no one is watching.


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Working with Health Care TeamWorking with Health Care Team

MembersMembers Improving technical skills.Improving technical skills.

Effective communicationEffective communication

skillsskills Participation in decisionParticipation in decision

makingmaking

Problem solvingProblem solving


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Communication Skills in the PatientCommunication Skills in the Patient

Care EnvironmentCare Environment

Patients will in first 30 seconds make a judgementPatients will in first 30 seconds make a judgement Critical to have all supplies availableCritical to have all supplies available pleasant facial expression, neat appearance, and professionalpleasant facial expression, neat appearance, and professional

manner.manner. Introduce yourself and state your missionIntroduce yourself and state your mission Remain calm, compassionate and professionalRemain calm, compassionate and professional Thank patientThank patient


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Communication issues in the homeCommunication issues in the home

and ambulatory settingsand ambulatory settings More length introduction and explanation.More length introduction and explanation.

Location of sample collection areaLocation of sample collection area

Must know location of restroom and bed.Must know location of restroom and bed.

May need a phone to clarify orders.May need a phone to clarify orders.

Procedure must be fully explained.Procedure must be fully explained. Meticulous patient identification.Meticulous patient identification.

Must ensure care of puncture site.Must ensure care of puncture site.


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Patient InterviewPatient Interview

Inpatient MUST use 3-way IDInpatient MUST use 3-way ID Ask patient their full nameAsk patient their full name Compare to information on requisitionCompare to information on requisition Compare requisition to armbandCompare requisition to armband No armband NO drawNo armband NO draw

Outpatient settings require some additionalOutpatient settings require some additionalinformation.information. DOBDOB DLDL Social Security NumberSocial Security Number


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Teaching PatientsTeaching Patients

Patient must cooperate for successfulPatient must cooperate for successfulprocedureprocedure

Must be given instructions, best to do verbalMust be given instructions, best to do verbaland writtenand written

Must have questions answeredMust have questions answered

Define fasting or NPO if necessary andDefine fasting or NPO if necessary andreasons.reasons.

Timed testing must be clearly explainedTimed testing must be clearly explained


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Communication StrategiesCommunication Strategies

communication loop:communication loop: sender,sender, receiverreceiver

and filters.and filters. Filters are damaging to effective communicationFilters are damaging to effective communication


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FiltersFilters


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Verbal Communication

Language barriers. Must translate medical terminology

Use simple, honest terms look for facial expression indicating

understanding.

If patient extends arm indicatesunderstanding and agreement


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Verbal Communication

Hearing disabilities/impairments write down instructions Learn sign language

English as a second language Use non-verbal cues like sign language Find an interpreter

Use Age appropriate language Be aware of tone of voice and inflection Emergency situations require exceptional

communication skills.


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Nonverbal communication.

Positive bodylanguage

Smiling Good grooming

Erect posture

Face to face

Zone of comfort


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Negative body language/distracting

behaviors. Rolling eyes

Nervous behaviors

Deep sighs Crossed arms,

Wrinkled forehead

Throwing things around

Chewing gum Yawning


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Name the EmotionName the Emotion


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Listening skills

Lets patient know that your are trulyinterested.

Does not depend on intellect orintelligence


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Tips for active listening.

Concentrate on speaker Use the silent pause Use phrases such as I see, Oh, periodically Keep personal judgments to yourself. Verify with feedback, paraphrase. Mentally summarize Sense and address non-verbal signs Maintain eye contact Encourage patient to expand Paraphrase to ensure understanding


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Posture

Phlebotomy is donestanding up, good

posture essential toprotect back andneck.

Stand erect, avoid

slouching. Appear relaxed.


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Grooming

Physical appearance communicates impression. Neat, clean hair. Clean, well groomed fingernails/hands..

Uniform or business casual clothing. Clean, pressed lab coat.


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Personal hygiene.

Bathe regularly Wash hair

Use deodorant Brush teeth, use

mouth spray or breathmints through out the

day. No perfume or after

shave


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Good health habits

Nutrition- eat right

Exercise regularly

Get enough rest

Benefits improves attitude,

Improves appearance

helps reduce stress.


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Quick Tips for Dealing with Stressuick Tips for Dealing with Stress

Follow the "G-E-T S-T-R-E-S-S F-I-T" plan for a healthier, moreFollow the "G-E-T S-T-R-E-S-S F-I-T" plan for a healthier, moreenjoyable life. Here are 12 easy-to-remember tips on how youenjoyable life. Here are 12 easy-to-remember tips on how youcan bring stress and fitness into your life. Keep them handy andcan bring stress and fitness into your life. Keep them handy andreview them often.review them often.

G ive yourself a break. Get a good night's sleep. Get away from itive yourself a break. Get a good night's sleep. Get away from itall.all.

Eat a healthy diet.at a healthy diet. Talk it out.alk it out. Spend time with family and friends.pend time with family and friends.Take a course. For fun or self improvement.ake a course. For fun or self improvement. Relax with a good book, a great movie or your favorite music.elax with a good book, a great movie or your favorite music. Exercise. Walk. Jog. Swim. Go to the gym.xercise. Walk. Jog. Swim. Go to the gym.

Set priorities.et priorities.Schedule your time.chedule your time. F ind alternative sources of satisfaction.ind alternative sources of satisfaction.Increase your awareness of what causes you stress.ncrease your awareness of what causes you stress.Take action! Address the person or situation that's causing youake action! Address the person or situation that's causing you

stress. And, if you're still not sure how to manage, talk to yourstress. And, if you're still not sure how to manage, talk to your

health care professionalhealth care professional


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Protective Equipment and Clothing

PPE is NOT optionalPPE is NOT optional Employers MUST provideEmployers MUST provide Includes:Includes:

gowns, gloves, masks, laboratory coats and face shields.

Safety equipment for processing and disposing ofsamples. Due to latex sensitivity, a variety of gloves in appropriate

sizes must be provided.


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Patients Bill of Rights Respectful and considerate care Accurate information Informed consent. Patient refusal of blood test Privacy Strict confidentiality Advance directives Information about the identity and role of personnel

involved in his or her care. Information about research procedures involved in his or

her care Billing


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Issues in Specimen Collection

Deliver quality of care regardless of the demeanor of thepatient.

Laboratory tests and results are strictly confidential. All records must be secured and accessed only by those

individuals who need them. Patient has the right to know your name, position

(especially if you are a student), description of procedure,

and ultimately has the right to refuse. Document any unusual occurrences, especiallyconfrontations.


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Family, visitors and significant

others May be more difficult to deal with than the

patient.

Make requests or demands that are not part ofyour job duties. Refuse requests to get food or water, as patient

may be NPO, have them contact the nurse.

Ask there cooperation in reassuring the patient. You can ask family/visitors to step outside during

blood collection if necessary.


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Physicians, priests, chaplains

Have right to privacy with patient

Leave and come back later.

If timed or STAT request ask permission tocollect specimen.


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Health Care Organizations

P r ima ry c a re facilities maintain and monitor normalhealth and prevent diseases through immunization.

Seconda ry c a re have doctors who are specialists in aparticular group of diseases, organ systems or one organ. Te r t i a r y c a re provides highly specialized care, geared totreating unusual or complex problems and utilizesophisticated diagnostic instruments.

Acu te ca re hospital, hospital stay of 30 days or less. Long t e rm c a r e , stays longer than 30 days Am bu l a to r y c a r e . Hom e he a l th s e r v i ce s


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Classification of HospitalsClassification of Hospitals

Mission

Bed size

Ownership: federal, state, teaching or non-governmental

Length of stay

Type of care provided. Location.

Relationship to other health facilities.


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Department of Clinical Laboratory

Medicine Composed oftw o

m a jo r a r ea s :

Clinical pathologyanalyzes blood, bodyfluids, and biopsymaterials

Anatomic pathologyinvolved in autopsies,cytology and surgicalpathology.


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Clinical Laboratory Improvement

Act of 1988 http://www.cms.hhs.gov/clia/default.asphttp://www.cms.hhs.gov/clia/default.asp Established regulations concerning qualifications

of personnel, periodic inspections, proficiencytesting, and investigation of complaints

Laboratory testing classified according tocomplexity and personnel standards.

Waived Moderate complexity tests High complexity tests
http://www.cms.hhs.gov/clia/default.asphttp://www.cms.hhs.gov/clia/default.asphttp://www.cms.hhs.gov/clia/default.asp


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Laboratory Director - medical

director A pathologist with extensive education in pathology. Aid the patient's physician in the correlation of laboratory

results with disease states.

Assist in setting up lab protocols and determining the"menu" of laboratory testing to offer.

Involved with interpretation of tissues such as thoseobtained during biopsy, surgery, autopsy and bone

marrow. All problems or abnormal results obtained by the techsare referred to the pathologist.

L b t Di t Ad i i t ti


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Laboratory Director - AdministrativeTechnologist

Title held will be dependent on facility - Lab Manager,Chief Technologist, Technical Director.

May be OJT or have additional education in management

and administration. Oversees administrative and technical services such as

establishing lab policies and procedures, hiring lab workers, maintaining the budget, providing orientation/training of new employees, providing continuing education (CE) for staff and assigning duties based on qualification of the staff.


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Technical SupervisorsTechnical Supervisors

Larger hospitals have large laboratory sections requiring asupervisor with extensive experience and education in alab specialty.

They aid the lab directory by preparing work schedules for their department, ordering departmental supplies, providing training, maintaining Standard Operating Procedure (SOP) manuals, assist in budget preparation, perform employee evaluations, discipline, hiring and firing of personnel.

Cli i l L b t S i ti t (CLS)


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Clinical Laboratory Scientist (CLS),Medical Technologist (MT)

B.S. in laboratory science or biologic science which must includedidactic and clinical training in laboratory medicine.

B.S. plus one additional year in a hospital based program. B.S. which includes clinical laboratory science education, either a

3+1 or 2+2. These individuals perform all bench work using basic to advanced

techniques. Perform preventive maintenance (PM) on equipment,

troubleshooting, performs and evaluates quality control (QC),participates in continuing education, and teaches CLS and CLT

students.


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Clinical Laboratory Technician (CLT),Medical Laboratory Technician (MLT)

Has obtained education through a hospitalbased 2 year certificate program or

associate degree at the college level. Under the direct supervision of a CLS

performs routine tests and procedures. CLTs free up the CLS to trouble shoot

equipment or perform advanced orcomplex procedures on patient samples.


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PhlebotomistPhlebotomist

H.S. graduate or equivalent. Training varies - OJT or structured program. Collects blood specimens from adults, children and babies using

appropriate technique and equipment. Identification of the patient is the most critical step.

Must understand and follow to the letter all precautions related tothe collection of blood specimens, whether others follow or not. May also be responsible for starting and collecting specimens for

glucose tolerance tests (GTT), bleeding times, blood cultures,instructing patients on these procedures as well as the propercollection of urine and semen samples, as well as delivering andprocessing specimens in the lab.

Must be able to deliver specimens in a timely fashion, maintainaccurate records/logs, and exhibit professional conduct and attitudeat all times.

phb lec 1 phlebotomy and the health care setting part 1

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