Presentation on theme: "Age Specific Care And Phlebotomy"— Presentation transcript:
1 Age Specific Care And Phlebotomy Terry Kotrla, MS, MT(ASCP)BBProfessorAustin Community College
2 What’s Up with this “Age Specific Care?” The Joint Commission for Accreditation of Healthcare Organizations (JCAHO) requires that all healthcare staff annually meet competency expectations in performing Age Specific Care.An interpretation of the standards and their intent relates to all staff members who assess, treat, and manage, or who work in areas that have direct impact on, patients in age-specific populations.Managers are being challenged to make sure their phlebotomists are not only proficient at phlebotomy, but proficient with all age groups.
3 Phlebotomy Applications Basic knowledge of human growth and developmentAge specific interpersonal skillsPsychological needsSocial needsAppropriate tone of voice, eye contact and active listening skillsTechnical expertise – physical skills
4 Age Specific Groups Neonate/Infant 0-1 Toddlers 1-3 Pre-School 4-5 yearsSchool Age 5-12 yearsAdolescent 13-18Young Adult 19-35Adulthood 36-65Late Adult 65+
5 Neonate/Infant Psycho-Social Needs Total dependence on parents/adultsOlder infant has fear of strangers and separation from parentParent may hold child and provide comfortPacify with bottle/pacifier or distract with toysPrimary interaction will be with parentIntroduce yourselfGentle, comforting tone of voiceCompassionate expression and body languageClearly explain the procedureOlder infants - talk slowly and make eye contact
6 Neonate/Infant – Fears/Safety Try not to separate from parent unless absolutely necessaryDo not perform venipunctures on infants less than 6 months of age unless absolutely necessaryFor heelsticks follow recommended procedures to the letter.Collect minimum amount of blood necessary
7 Toddlers 1-3 Years Psycho-Social Needs Try not to separate from parent unless absolutely necessary.Parent may assist by holding, explaining to and comforting the childFriendly, cheerful and empathetic manner.Speak before you touch, use child’s nameExplain procedure in soothing tone using age appropriate terms, children this age fear painEmphasize cooperationPraise child during procedureEncourage parent to praise child after procedure
8 Toddlers 1-3 Years – Fears/Safety Childproof area, no supplies in reachBe prepared, have all supplies needed to avoid delayNEVER say “This will not hurt”, rather use age appropriate terms and it’s ok for them to say “ouch”Distract with a toy or other objectIf appropriate, keep child informed on how much longer it will beBandaids may not be appropriate, child may swallow and choke.
9 Pre-School 4-5 years Psycho-Social Needs Parent may be present to provide emotional support and to assist in obtaining child's cooperation.Approach in friendly, cheerful & empathetic manner, use child’s name.Explain procedure in soothing tone using age appropriate terms, children this age fear painNEVER say “This will not hurt”, rather use age appropriate terms and it’s ok for them to say “ouch”Keep child informed on how much longer it will be.Praise for bravery, say “Thank you”
10 Pre-School 4-5 – Fears/Safety Child proof collection areaFear of painAvoid delays, have all equipmentAssemble equipment out of child’s eye sight.Use your best judgment whether to encourage child to look away.Involve child in after care by allowing selection of bandaid and sticker.
11 School Age 6-12 Psycho-Social Needs Increased language skills and self-control.Move from security seeking behavior towards independence.Try not to embarrass the child.Must communicate with them as an individual using age appropriate words and appropriate eye contact.May want parent to hold hand.Explain the procedure and why blood is needed.Be prepared to answer questions.
12 School Age 6-12 - Fears/Safety Younger ages fear of pain, older ages may “act” brave.Younger ages may need distraction such as a toy or other object.Explain use of equipment if appropriate.Reassure the patient during the procedure.Let them know how much longer.Explain the importance of maintaining pressure after completion of procedure.
13 Adolescent 13-18 Psycho-Social Needs Maintain privacy.Concerned with the present more than the future.Conscious of appearance.Actively involved in anything concerning the body.Engage in behaviors to establish they are an adult.May be hypersensitive or non-interactiveMay act hostile to hide fear.Important to assess the patient and use appropriate interpersonal skills.Take extra time for explanations and or preparation.
14 Adolescent 13-18 - Fears/Safety Embarrassed to show fear.Adolescent male has greater potential for fainting.Periodically check for pre-syncope signs.Be aware of sudden silence in a previously talkative patient or extremely talkative after previously silent.Keep up a running conversation to distract the patient.Stress importance of post-phlebotomy care.
15 Young Adult 19-35 Psycho-Social Needs Reflect on interests, goals and aspirations for the future.Focused on preservation and maintenance of health.May work and play too hard and sacrifice sleep, nutrition and exercise.May experience anxiety, stress and depression related to work, marriage, parenting and social expectations.
16 Young Adult 19-35 Psycho-Social Needs (Continued) More involved with healthcare decisions, may ask questions which put you “on the spot”.Communicate in a professional manner.Explain why you cannot answer certain questionsDo not patronize or talk down to the patient.Clearly and honestly explain the procedureAvoid negative body languageEye contact critical, promotes sense of trust but be aware of cultural differences.
17 Young Adult 19-35 - Fears/Safety Can possess same fears as pediatric patient.Confidence and professionalism are essential to set patient at ease.Be aware of signs of syncope, especially in fasting or GTT patients.Stress importance of post-phlebotomy care.
18 Adulthood 36-65 Psycho-Social Needs Generativity vs stagnationPrepares for empty nestAdapts to aging process.Older, wiser and more likely to be at peace with society and self.Health problems may require prescription drugs.Interpersonal skills the same as the young adult.Hair thins, skin wrinkles and sags, weight gain, changes in sight, hearing, memory or judgement, longer recovery time
19 Adulthood 36-65 - Fears/Safety Rarely fearful of the procedure.Stress post-phlebotomy site care ESPECIALLY for patients on anti-coagulant therapy.Site should always be checked before patient leaves.
20 Late Adult 65+ Psycho-Social Needs Aging process continues.Reduced attention span and memory.Experiences anxiety over loss, isolation and changes.Reflect on their lives and come to accept death.Due to loneliness may take more of your time.Challenges due to neurological and physical disabilities.
21 Late Adult 65+ - Fears/Safety “Normal” older adults not a problemPatients with physical or neurological problems can present very challenging problems.Ask for assistance if limbs must be manipulated or held still.Take GREAT care to select your equipment.Provide exceptional after care to prevent bruising.Bandaids MAY NOT be appropriate for elderly patients with “paper thin” skin.
22 Assessing Competence Observation Educational Packet and Test If all groups are being assessed VERY time consumingSubjective in natureEducational Packet and TestMany commercially available but many parts may not apply to your facilityCreate your own – requires educational expertise
23 ObservationDefine competencies to be observed for each age group, both interpersonal and technicalDefine/describe levels of performance and grading system for each competency listedDescriptions must be objective criteria NOT subjectiveGrading: Satisfactory, needs improvement, unsatisfactoryAllow employees to review competencies so they know what is expected.Develop remediation plan for N and UAllow review of study materialsAllow critiqued practiceObserve again
24 Example Age 0-12 months Communicate verbally with the patient. AcceptableUnacceptableNeeds ImprovementSoft, calm, soothing tone of voiceAngry, gruff, loud tone of voice.Nervous, excited, anxious tone of voice.No remediation necessaryDemonstrate appropriate tone of voice, critique practice, retest
25 Educational Packet and Test Find resources from journals and textbooksMaterials should be applicable to YOUR institutionInclude case study scenarios to illustrate “best practices”Create test questions from materialsGood questions HARD to createBeta test and revise based on input from test groupAllow remediation for missed questions
26 Revision the Necessary Evil Materials should be reviewed regularlyDuring first year several revisions may be necessary to clarify materials and questionsObtain feedback from test subjects and use to improve materials (use brief questionnaire)Keep Materials CurrentMost difficult taskTake a day once/year to research the topicTake another day to make quality revisions
27 Summary Define the age specific categories Create study materials based on your institution’s unique patient populationDefine competenciesConduct annual assessments, observation, written test or combinationDevelop remediation planResearch and revise annually
28 One solution…Network. Why recreate the wheel One solution…Network! Why recreate the wheel? Get the best of the best by working with your colleagues!
29 References http://www.averalabnet.com/newsletters/JanFeb02.pdf Age-Specific Techniques in Phlebotomy Competency (3/10/2003) Advance For Laboratory ProfessionalsUTMB Clinical Pathology Services,Please keep an eye on my web page for a sample test:Questions or comments please me: