Download presentation
Presentation is loading. Please wait.
1
Phlebotomy Practice and Quality Assessment
1 Phlebotomy Practice and Quality Assessment
2
Chapter Objectives Define phlebotomy and identify health professionals who perform phlebotomy procedures. Identify the importance of phlebotomy procedures to the overall care of the patient. List professional competencies for phlebotomists and key elements of a performance assessment. List members of a health care team who interact with phlebotomists.
3
Chapter Objectives Describe the roles of clinical laboratory personnel and common laboratory departments/sections. Describe health care settings in which phlebotomy services are routinely performed. Explain components of professionalism and desired character traits for phlebotomists. Describe coping skills that are used for stress in the workplace.
4
Chapter Objectives List the basic tools used in quality improvement activities and give examples of how a phlebotomist can participate in quality improvement activities. Define the difference between quality improvement and quality control.
5
Phlebotomy Practice and Definition
Clinical decisions are based on: Standards of practice Diagnostic testing (laboratory tests, x-rays, etc.) Patient’s history Observation of signs and symptoms
6
Phlebotomy Practice and Definition
Clinical laboratory test results Are performed primarily on blood specimens Give an indication of abnormalities inside the body Help health providers in clinical decision making
7
Phlebotomy Practice and Definition
Definition of Phlebotomy Derived from the Greek words, phlebo, which relates to veins, and tomy, which relates to cutting Synonomous words are venesection or venisection. Definition can be summarized as the incision of a vein for blood letting.
8
Phlebotomy Practice and Definition
How are laboratory test results used in clinical decisions? Diagnostic—are there abnormalities or medical conditions affecting the patient Therapeutic—is the correct treatment or therapy being utilized Monitoring—is the treatment or therapy effective
9
Phlebotomy Practice and Definition
Ranges in scope, depth of detail Can involve clinical, technical, or clerical functions Settings range from inside laboratory to hospital, clinics, or home health care
10
Health Care Settings and Health Care Teams
Know the members of the health care team Learn the specialty and sub-specialty areas of health care and medicine Learn about other health care professionals and their roles and responsibilities Learn about all areas of the clinical laboratory and their functions
11
Table 1-1
12
Table (cont)
13
Table (cont)
14
Table (cont)
15
Table (cont)
16
Table (cont)
17
Health Care Settings and Health Care Teams
Become a professional and mature member of the health care team Understand the mission of the organization, goals of the group, or project objectives Know skills of team dynamics—active listening, setting group norms, etc. Understand relevance and commitment to team goals
18
Health Care Settings and Health Care Teams
Become a professional and mature member of the health care team Show reliability and dependability in your work Actively and respectfully participate in decisions Learn to be flexible Manage conflicts in a constructive manner
19
Health Care Settings and Health Care Teams
Become a professional and mature member of the health care team Contribute to the cohesion of the team Contribute to problem solving strategies Support and encourage other team members
20
The Clinical Laboratory and Specimen Collection Services
Clinical pathology: blood and other types of body fluids (and some tissues) are analyzed. Examples: Blood, urine, sputum, synovial fluid, CSF, skin scrapings
21
The Clinical Laboratory and Specimen Collection Services
Anatomical pathology: autopsies are performed, histologic and cytologic procedures are performed on tissues and fluid specimens, surgical biopsies are analyzed.
22
Figure 1-1 Example of an Organizational Chart for a Clinical Laboratory
23
Figure 1-2 The Clinical Laboratory’s Workflow Pathway
24
The Clinical Laboratory and Specimen Collection Services
Agencies that oversee clinical laboratories U.S. Food and Drug Administration (FDA) Centers for Medicare and Medicaid Services (CMS) Clinical Laboratory Improvement Amendments (CLIA) Occupational Safety and Health Administration (OSHA) U.S. Department of Transportation (DOT)
25
The Clinical Laboratory and Specimen Collection Services
Agencies that oversee clinical laboratories The Joint Commission College of American Pathologists (CAP) International Association of Blood Banks (IABB) Other credentialing agencies are involved in certifying and/or licensing laboratory personnel.
26
The Clinical Laboratory and Specimen Collection Services
Clinical Laboratory Departments Administrative Office Supervisory/management personnel Physicians or scientists overseeing specific areas of the clinical laboratory Technical experts and staff perform tests and report results
27
The Clinical Laboratory and Specimen Collection Services
Clinical Laboratory Personnel Pathologists and/or PhD specialists Administrative/Management staff Technical supervisors or specialists Clinical Laboratory Scientists or Medical Technologists
28
The Clinical Laboratory and Specimen Collection Services
Clinical Laboratory Personnel Medical Technicians or Clinical Laboratory Technicians Medical Assistants Phlebotomists
29
The Clinical Laboratory and Specimen Collection Services
Clinical Laboratory Personnel Other personnel involved in the clinical laboratory-laboratory information operators/programmers, clerical staff, quality management staff, safety and infection control staff, biomedical equipment specialists, etc.
30
Competencies, Certification, and Professionalism for Phlebotomists
Phlebotomy Education & Certification High school diploma or equivalent Length of training ranges from a few weeks to months Pass a national certification examination Attend continuing education (CE) programs
31
Table 1-2
32
Competencies, Certification, and Professionalism for Phlebotomists
Clinical Duties for Phlebotomists Identify patients correctly Assess patients prior to specimen collection procedures Prepare patients accordingly Perform specimen collection procedures
33
Competencies, Certification, and Professionalism for Phlebotomists
Clinical Duties for Phlebotomists Collect blood specimens into the correct containers/tubes Label blood specimen tubes at the bedside Assess the degree of discomfort, pain, or bleeding Assess the patient after the specimen collection procedure
34
Competencies, Certification, and Professionalism for Phlebotomists
Technical Duties for Phlebotomists Manipulate small objects, tubes, needles Select and use appropriate equipment Perform quality control functions
35
Competencies, Certification, and Professionalism for Phlebotomists
Technical Duties for Phlebotomists Transport specimens correctly Prepare/process the specimen for testing/analysis Assist in laboratory testing procedures as needed
36
Competencies, Certification, and Professionalism for Phlebotomists
Clerical duties for phlebotomists Print/distribute laboratory requisitions and/or reports Answer the telephone Answer all queries appropriately Demonstrate courtesy in all patient encounters Respect privacy and confidentiality
37
Competencies, Certification, and Professionalism for Phlebotomists
Respect Confidentiality Coworkers Courteous behaviors Tolerance of differences Effective communication
38
Competencies, Certification, and Professionalism for Phlebotomists
Service Shift focus from oneself to others Commitment to one’s job duties
39
Competencies, Certification, and Professionalism for Phlebotomists
Support Follow organizational policies/procedures Maintain clean work space Report errors or damaged equipment/supplies Respectfully disagree
40
Competencies, Certification, and Professionalism for Phlebotomists
Growth Learn more about your job Learn more about other aspects of your organization
41
Figure 1-3 Picture of Professionalism
42
Competencies, Certification, and Professionalism for Phlebotomists
Professional Organizations for Phlebotomists American Society for Clinical Pathology National Phlebotomy Association American Society for Clinical Laboratory Science National Healthcareer Association Many others as well…
43
Table 1-3
44
Table 1-4
45
Table (cont)
46
Table (cont)
47
Competencies, Certification, and Professionalism for Phlebotomists
Ethical Standards for Phlebotomists Do no harm intentionally Perform according to sound technical ability and good judgment Respect patients’ rights Confidentiality and privacy Right to know about their treatment Right to refuse treatment
48
Competencies, Certification, and Professionalism for Phlebotomists
Character Traits for Phlebotomists Sincerity and compassion Emotional stability and maturity Accountability for doing things right
49
Competencies, Certification, and Professionalism for Phlebotomists
Character Traits for Phlebotomists Dedication to high standards of performance and precision Respect for patients’ dignity, privacy, confidentiality, and the right to know Propensity for cleanliness
50
Competencies, Certification, and Professionalism for Phlebotomists
Character Traits for Phlebotomists Pride, satisfaction, and self-fulfillment in the job Working with team members Enjoy communicating with patients
51
Competencies, Certification, and Professionalism for Phlebotomists
Appearance, Grooming, and Physical Fitness Posture Grooming and personal hygiene Personal protective equipment (PPE) Dress code
52
Figure 1-4 Keeping a Healthy Mind and Body
53
Competencies, Certification, and Professionalism for Phlebotomists
Tips for Dealing with Stress Find time for privacy and relaxation Associate with gentle people Seek humor Exercise (target at least 30 min/day)
54
Competencies, Certification, and Professionalism for Phlebotomists
Tips for Dealing with Stress Nutrition and vitamins Hobbies and social activities Balanced schedule Journal writing
55
Competencies, Certification, and Professionalism for Phlebotomists
Tips for Dealing with Stress Reading Avoid harmful habits (smoking, alcohol or drug abuse) Seek assistance when needed
56
Quality Improvement and Assessment
Perceptions of Quality CLSI—“degree to which a set of inherent characteristics fulfills requirements” Others—“excellence,” “high standards,” or “superiority” Categories of quality—“scientific or technical” and “nontechnical or interpersonal”
57
Quality Improvement and Assessment
Quality in health care uses three major concepts Efficacy—the health care services provided have a positive impact on the patient’s health, that is, the patient improves or gets well. Appropriateness—procedures performed on the patient are the correct ones for that particular condition or illness.
58
Quality Improvement and Assessment
Quality in health care uses three major concepts Caring functions—services provided to the patient are available, timely, effective, safe, efficient, respectful, and sensitive to the patient’s needs.
59
Quality Improvement and Assessment
Stakeholders/Customers External stakeholders are individuals or groups outside the organization. Internal stakeholders are individuals or groups within a health care organization itself.
60
Quality Improvement and Assessment
Quality Initiatives Standards of practice—CLSI Educational programs—NAACLS Certification and licensure—ASCP, NPA, etc Advocacy groups—ASCP, ASCLS
61
Quality Improvement and Assessment
Quality Initiatives Code of ethics Job competencies Continuing education
62
Quality Improvement and Assessment
QI Models Different approaches to quality management and assessment Six Sigma: data-driven; define, measure, analyze, improve, control (DMAIC) Lean Six Sigma: also incorporates speed, efficiency, quick action CLSI: 12 Quality System Essentials (QSE)
63
Quality Improvement and Assessment
Quality improvement efforts involve Health care worker’s technique Patient identification procedures Waiting times, turn around times Complications due to blood collection
64
Quality Improvement and Assessment
Quality improvement efforts might focus on Multiple sticks on the same patient Duplicate test orders Customer satisfaction
65
Quality Improvement and Assessment
Negative impacts (usually preventable) Misidentification of a patient Hospital-acquired infections due to poor cleansing techniques Poor venipuncture technique that causes pain, nerve damage Lengthy waiting time, rude behavior, or messy work sites
66
Quality Improvement and Assessment
Tools for Quality Performance Assessment Reviewing the analytic and nonanalytic parts of the laboratory Check sheets Flow-charts or process maps Run charts Statistical tests
67
Quality Improvement and Assessment
Tools for Quality Performance Assessment Analytically, clinical laboratory scientists and technicians use data collection to ensure Test sensitivity Specificity Precision and accuracy
68
Quality Improvement and Assessment
Tools for Quality Performance Assessment Nonanalytic data can be used to assess the timeliness of responses to Requests Turnaround time for reporting test results Effective communication
69
Quality Improvement and Assessment
Tools for Quality Performance Assessment Flow charts Demonstrate steps in a process Shows decision points in the process Provide a pathway to a goal
70
Figure Flow Chart
71
Quality Improvement and Assessment
Tools for Quality Performance Assessment Pareto charts: Bar charts that show frequency of problematic events Pareto Principle: “80% of the trouble comes from 20% of the problems”
72
Figure Pareto Chart
73
Quality Improvement and Assessment
Tools for Quality Performance Assessment Cause and effect diagrams Ishikawa diagram Demonstrates the factors that contribute to a specific outcome
74
Figure 1-7 Cause-and-Effect Diagram
75
Quality Improvement and Assessment
Tools for Quality Performance Assessment Plan-Do-Check-Act Cycle (PDCA) Line graphs, histograms, scatter diagrams Brainstorming
76
Quality Improvement and Assessment
Important Factors Affecting Quality in Specimen Collection Services Phases of the Laboratory Testing Process Preexamination Examination Postexamination
77
Figure 1-8 Laboratory Testing Cycle: Preexamination to
Examination to Postexamination
78
Quality Improvement and Assessment
Basic Requirements for a Quality Specimen Use standard precautions Identify and assess the patient correctly Use correct anticoagulants and preservatives Label, handle, and transport the specimens appropriately and in a timely manner
79
Quality Improvement and Assessment
Basic Requirements for a Quality Specimen Correct timing of venipunctures, when necessary Correct processing of specimens No more than 2 sticks
80
Quality Improvement and Assessment
Quality Control: A Key Component of Laboratory Quality Assessment QC is a part of everyday laboratory practice QC measures make the testing process more accurate and precise
81
Quality Improvement and Assessment
QC measures set the parameters for analytical procedures Making sure that test results reflect what they are supposed to measure Making sure that test results are reproduced time after time
82
Quality Improvement and Assessment
QC measures set the parameters for analytical procedures Setting performance standards and acceptable ranges for each test or procedure Differentiating which result is OK to report from and which is not OK to report from
83
Quality Improvement and Assessment
Examples of QC Temperature checks of specimen refrigerators Calibrations for centrifuges Positive and negative controls for screening tests Monitoring expiration dates for venipuncture tubes
84
Future Trends in Phlebotomy Practice
Standardization and Globalization (ISO) Electronic Medical Records (EMR) Smaller, Faster Laboratory Testing (nanotechnology) Direct Access Testing (DAT) or Direct to Customer (DTC) Education/Certification
Similar presentations
