1. Booth, Wallace, and Fitzgerald
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PowerPoint ® Presentation to Accompany
Phlebotomy for Health Care Personnel
Booth, Wallace, and Fitzgerald
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2. Practicing Phlebotomy
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3. Objectives Learning Outcomes Describe certification for phlebotomists.
Upon completion of this chapter, you should be able to:
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.
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4. Learning Outcomes (cont'd)
Objectives Cont’d
Learning Outcomes (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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5. Certification and Accreditation
Certification and Continuing Education
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
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
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6. 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)
Certification
Examination
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7. Phlebotomy Continuing Education
Required in order to maintain certification
Methods of obtaining continuing education:
Internet Seminars
Workshops Development Programs
A lifelong process necessary
to stay current in your field!
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8. Apply Your Knowledge
Which process evaluates the quality of phlebotomy training programs?
ANSWER: Accreditation
BRAVO!
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9. Total Quality Management
Quality Assurance in Phlebotomy
An 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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10. Total Quality Management Part 2
Quality Assurance in Phlebotomy
Patients 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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11. 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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12. 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
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13. Clinical Indcts. and Outcome Eval. Part 2
Clinical Indicators and
Outcome Evaluation
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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14. Apply Your Knowledge Apply Your Knowledge
The core of total quality management is:
A. Increased team member participation
B. Increased customer satisfaction
C. Decreased liability claims
Answer: B. The core of TQM is customer satisfaction.
Good Job!
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15. Phlebotomy Quality Control
Quality Control in Phlebotomy
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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16. Phlebotomy Quality Control Part 2
Quality Control in Phlebotomy
Quality 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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17. Phlebotomy Quality Control
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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18. Phlebotomy Quality Control Part 4
Equipment 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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19. Factors Affecting Laboratory Values
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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20. Specimen Rejection Specimen Rejection Reasons 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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21. 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 immediately
Great!
Answer: A. When results do not mirror earlier results and do not agree with the patient’s symptoms, always repeat the test.
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22. 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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23. Risk Mangmt. and Reg. Agencies Part 2
Risk Management
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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24. 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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25. 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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26. Risk Mangmt. and Reg. Agencies Part 3
Risk Management
OSHA
Health Care
Personnel Issues
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
Exposure to bloodborne pathogens is a serious risk to health care employees
Phlebotomists must adhere to CDC and OSHA guidelines
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27. Risk Mangmt. and Reg. Agencies Part 4
Risk Management
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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28. Risk Mangmt. and Reg. Agencies Part 5
Risk Management
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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29. 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?
The physician
The patient
The phlebotomist
Great!
Answer: C. The phlebotomist should NEVER perform any skill he or she is not fully trained to perform.
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30. 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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31. 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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32. 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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33. 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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