1. Phlebotomy and the Health-Care Delivery System
Chapter 1

2. Learning Objectives
State the traditional and expanding duties of the phlebotomist.
Describe the professional characteristics that are important for a phlebotomist.
Discuss the importance of communication and interpersonal skills for the phlebotomist within the laboratory, with patients, and with personnel in other departments of the hospital.
State and describe the three components of communication.
List the barriers to communication and methods to overcome them.

3. Learning Objectives (cont.)
Describe a phlebotomist using correct listening and body language skills.
State six rules of proper telephone etiquette.
Define cultural diversity and discuss the actions needed by a phlebotomist when encountering cultural diversity.
State the competencies expected of a certified phlebotomist.
Describe the functions of the nursing, support, fiscal, and professional hospital service areas and the functions of the departments contained in these services.
Describe the different types of health-care settings in which a phlebotomist may be employed.

4. Key Terms accreditation alternative medicine certification
confidentiality
continuing education
cross-training
cultural diversity
decentralization
diagnostic-related groups (DRGs)
phlebotomy
professionalism
samples
specimens
zone of comfort

5. History of Phlebotomy “Phleb”-vein “-otomy”-incision
Phlebotomy, defined
Incision into a vein
One of the oldest medical procedures
Blood-letting
Devices
Leeches
Significance of “barber pole”
Therapeutic phlebotomy

6. Role of the Phlebotomist
Collection of blood specimens for laboratory analysis
Has become a specialized area of clinical laboratory practice
Key player, no longer someone who just “takes blood”
Expanded role

7. Traditional Duties and Responsibilities
Correct identification of the patient prior to sample collection
Collection of the appropriate amount of blood by venipuncture or dermal puncture for the specified tests
Selection of the appropriate specimen containers for the specified tests
Correct labeling of all samples with the required information
Appropriate transportation of samples back to the laboratory in a timely manner
Effective interaction with patients and hospital personnel

8. Other Important Duties
Processing of samples for delivery to the appropriate laboratory departments
Performance of computer operations and record keeping pertaining to phlebotomy
Observation of all safety regulations, quality control checks, and preventive maintenance procedures
Attendance at continuing education programs

9. Changes in Phlebotomy Changes in health-care delivery
Efficiency and cost effectiveness
Patient-focused care
Cross-training
Decentralization of phlebotomy services

10. Changes in Phlebotomist Duties
Additional Duties
Training other health-care personnel to perform phlebotomy
Monitoring the quality of samples collected on the units
Evaluating protocols associated with sample collection
Performing basic bedside laboratory tests
Performing electrocardiograms
Performing measurement of patient’s vital signs
Collecting arterial blood samples (see Chapter 14)
Collection of samples from central venous access devices ([CVADs]; see Chapter 11)

11. Professional and Personal Characteristics for Phlebotomists
Service-oriented industry
Phlebotomists are the “face of the laboratory”

12. Professional and Personal Characteristics for Phlebotomists
Dependable
Cooperative
Committed
Compassionate
Courteous
Respectful
Honest
Integrity
Competence
Organized
Responsible
Flexible

13. Appearance Guidelines
Clean and unwrinkled clothing
Clean, appropriate footwear
Conservative jewelry and makeup
Perfume/cologne not recommended
Hair/facial hair clean, neat, and trimmed
Long hair pulled back
Proper personal hygiene
Proper fingernail length and maintenance
No artificial nails (Center for Disease Control guidelines)

14. Communication Skills for the Phlebotomist
Verbal skills
Listening skills
Nonverbal skills
Body language

15. Verbal Skills Verbal barriers Hearing impairment Emotional level
Patient education level
Age
Language barriers
Medications
Health status

16. Verbal Communication Barriers

17. Listening Skills Active listening Looking directly at the patient
Allowing patient time to express feelings
Allowing the patient time to describe why they are concerned
Providing feedback to the patient through appropriate responses
Encouraging patient communication by asking questions

18. Nonverbal Communication
Positive body language
Smiling
Eye contact
Display confidence
Negative body language
Shuffling
No eye contact
Acting distracted

19. Zone of Comfort

20. Cultural diversity
Customs
Beliefs
Religion
Values

21. Cultural Diversity Guidelines
Smile and use a friendly tone of voice.
Be alert to patients reactions.
Do not stereotype.
Be mindful of personal space.
Take time to explain procedures.
Make sure instructions are understood.
Show respect for their diversity.

22. Telephone Skills Telephone manners Promptness Politeness
Transferring calls
Attempt to help first, give patient transfer number
Provide accurate information
Placing calls on hold
Check for emergency
Speak clearly
Ask for read-back of information provided
Read-back National Patient Safety Goal

23. Importance of Phlebotomy Education
Structured programs—Combining classroom (didactic) with clinical practice
Hospitals
Community college
Technical institutions
Use national training guidelines
National Accrediting Agency for Clinical Laboratory Sciences (NAACLS)

24. NAACLS Phlebotomy Competencies
Knowledge of the health-care system and medical terminology
Knowledge of infection control
Knowledge of basic anatomy and physiology and anatomic terminology related to the laboratory and the pathology of body systems
Understanding of the importance of sample collection and integrity for patient care

25. NAACLS Phlebotomy Competencies
Knowledge of collection equipment, tube additives, special precautions, and interfering substances associated with laboratory tests
Performance of standard operating procedures in collecting samples
Understanding of requisitions, sample transport, and sample processing
Understanding of quality assurance and quality control in phlebotomy
Use of effective and appropriate communication skills

26. Phlebotomy Education and Certification
Certification requirements
Certification examinations
Computer adaptive testing
Professional organization membership
Continuing education
Required for licensure
Maintain certification

27. Phlebotomy Certifying Organizations
American Society for Clinical Pathology (ASCP)
National Center for Competency Testing (NCPT)
American Medical Technologists (AMT)
American Society of Phlebotomy Technicians (ASPT)
National Phlebotomy Association (NPA)
National Healthcareer Association (NHA)

28. Phlebotomist Certification

29. Continuing Education Required for licensure Maintain certification
Licensure in only two states
Louisiana
California
Maintain certification
ASCP-Certified Maintenance (CM)
Requires nine Certified Maintenance Points per 36-month cycle

30. Health-Care Delivery System
Employment settings
Hospital
Physician office laboratories (POL)
Health maintenance organizations (HMO)
Reference laboratories
Urgent care centers
Nursing homes
Home health-care agencies
Blood donor centers

31. Hospital Patient Care Areas

32. Hospital Organization

33. Hospital Services Nursing Services--Direct patient care
Support Services--Maintain the physical hospital building and services
Fiscal Services--Business management of hospital services
Professional Services--Assist in diagnosis and treatment of disease

34. Nursing Services
Cardiac Care Unit (CCU), Emergency Department (ED), Intensive Care Unit (ICU), Nursery, and Operating Room (OR)
Health-care Members
Registered Nurse (RN)
Licensed Practical Nurse (LPN)
Certified Nursing Assistant (CNA)
Unit clerk
Surgical technologist

35. Support Services Food service Grounds care Housekeeping
Human Resources
Laundry
Maintenance
Purchasing
Security

36. Fiscal Services Accounting Admitting Business office
Credit and collection
Data processing
Medical records

37. Professional Services
Radiology
X-ray
CT scans
MRI
Radiation therapy
Cancer treatment
Nuclear medicine
Organ scans
Laboratory tests
Occupational therapy (OT)
Daily living functions
Pharmacy
Medications

38. Professional Services
Physical therapy (PT)
Treatments
Respiratory therapy
Breathing disorders
Cardiovascular testing
ECGs
Stress Tests
Imaging
Clinical laboratory
Diagnostic testing

39. Other Health-Care Settings
Physician office laboratories (POLs) and group practices
Health maintenance organizations (HMOs)
Reference laboratories
Government- and hospital-sponsored clinics
Specialty clinics
Wellness clinics
Alternative medicine clinics
Home health care