Phlebotomy and the Health Phlebotomy and the Health Care SettingCare Setting

Part 1Part 1

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

General Practice of General Practice of PhlebotomyPhlebotomy

There are over 25,000 possible There are over 25,000 possible laboratory tests, with around 500 laboratory tests, with around 500 performed in most institutions. performed in most institutions.

http://www.ascls.org/labtesting/index.http://www.ascls.org/labtesting/index.aspasp

Phlebotomists allow technicians and Phlebotomists allow technicians and technologists to focus on testing technologists to focus on testing blood.blood.

POCT – testing at bedside, may be POCT – testing at bedside, may be performed by phlebotomistperformed by phlebotomist

HistoryHistory

On the job trained – leads to bad On the job trained – leads to bad habits being handed to next habits being handed to next generationgeneration

Due to complexity formal training Due to complexity formal training programs developed.programs developed.

National certification availableNational certification available

History (continued)History (continued)

Phlebotomy from Phlebotomy from Greek words,Greek words, phlebophlebo, relates to , relates to veins, veins, tomytomy, , relates to cutting.relates to cutting.

Opening a vein to Opening a vein to collect bloodcollect blood

Three purposesThree purposes for collection for collection and analysis of laboratory and analysis of laboratory

samplessamples Diagnostic testing – what’s wrong Diagnostic testing – what’s wrong

with the patient?with the patient? Therapeutic assessment – is the drug Therapeutic assessment – is the drug

at the right therapeutic level?at the right therapeutic level? Monitoring patient’s condition – is the Monitoring patient’s condition – is the

patient getting better?patient getting better?

Professional EthicsProfessional Ethics

Principles of right and wrong Principles of right and wrong conduct for the profession.conduct for the profession. Do no harm intentionallyDo no harm intentionally Perform according to sound ability and Perform according to sound ability and

judgement.judgement. Do what you’re trained to do, no more.Do what you’re trained to do, no more. Deal with patients assigned, not those Deal with patients assigned, not those

you’re curious about.you’re curious about. Keep all patient information Keep all patient information

confidential.confidential.

National Phlebotomy National Phlebotomy AssociationAssociation

Represents the laboratory.Represents the laboratory. Gain and apply knowledge.Gain and apply knowledge. Maintain accuracy, reliability and Maintain 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 Perform specified skills as defined by

the hospital or laboratory standardsthe hospital or laboratory standards

Professional BehaviorProfessional Behavior

Character attributes for phlebotomists Character attributes for phlebotomists include: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 right Professional behavior involves doing the right thing when no one is watching.thing when no one is watching.

Working with Health Care Working with Health Care Team MembersTeam Members

Improving technical Improving technical skills.skills.

Effective communication Effective communication skillsskills

Participation in decision Participation in decision makingmaking

Problem solvingProblem solving

Communication Skills in the Communication Skills in the Patient Care EnvironmentPatient Care Environment

Patient’s will in first 30 seconds make a judgement Patient’s will in first 30 seconds make a judgement Critical to have all supplies available Critical to have all supplies available pleasant facial expression, neat appearance, and pleasant facial expression, neat appearance, and

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

Communication issues in the Communication issues in the home and ambulatory settingshome and 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.

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

Teaching PatientsTeaching Patients

Patient must cooperate for successful Patient must cooperate for successful procedureprocedure Must be given instructions, best to do Must be given instructions, best to do

verbal and writtenverbal and written Must have questions answeredMust have questions answered

Define “fasting” or “NPO” if Define “fasting” or “NPO” if necessary and reasons.necessary and reasons.

Timed testing must be clearly Timed testing must be clearly explained explained

Communication StrategiesCommunication Strategies

communication loop: communication loop: sender, sender, receiver receiver and filters.and filters.

Filters are damaging to effective communicationFilters are damaging to effective communication

FiltersFilters

Verbal Communication

Language barriers. Must translate medical terminology Use simple, honest terms look for facial expression indicating

understanding. If patient extends arm indicates

understanding and agreement

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.

Nonverbal communication.

Positive body language Smiling Good grooming Erect posture Face to face Zone of comfort

Negative body language/distracting

behaviors. Rolling eyes Nervous behaviors Deep sighs Crossed arms, Wrinkled forehead Throwing things

around Chewing gum Yawning

Name the EmotionName the Emotion

Listening skills

Lets patient know that your are truly interested.

Does not depend on intellect or intelligence

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

Posture

Phlebotomy is done standing up, good posture essential to protect back and neck.

Stand erect, avoid slouching.

Appear relaxed.

Grooming

Physical appearance communicates impression. Neat, clean hair. Clean, well groomed fingernails/hands.. Uniform or business casual clothing. Clean, pressed lab coat.

Personal hygiene.

Bathe regularly Wash hair Use deodorant Brush teeth, use

mouth spray or breath mints through out the day.

No perfume or after shave

Good health habits

Nutrition- eat right Exercise regularly Get enough rest Benefits

improves attitude, Improves appearance helps reduce stress.

Quick Tips for Dealing with StressQuick Tips for Dealing with Stress Follow the "G-E-T S-T-R-E-S-S F-I-T" plan for a healthier, more Follow the "G-E-T S-T-R-E-S-S F-I-T" plan for a healthier, more

enjoyable life. Here are 12 easy-to-remember tips on how you enjoyable life. Here are 12 easy-to-remember tips on how you can bring stress and fitness into your life. Keep them handy can bring stress and fitness into your life. Keep them handy and review them often. and review them often.

GGive yourself a break. Get a good night's sleep. Get away from ive yourself a break. Get a good night's sleep. Get away from it all. it all.

EEat a healthy diet.at a healthy diet. TTalk it out.alk it out. SSpend time with family and friends. pend time with family and friends.

TTake a course. For fun or self improvement. ake a course. For fun or self improvement. RRelax with a good book, a great movie or your favorite music. elax with a good book, a great movie or your favorite music. EExercise. Walk. Jog. Swim. Go to the gym. xercise. Walk. Jog. Swim. Go to the gym.

SSet priorities. et priorities. SSchedule your time. chedule your time.

FFind alternative sources of satisfaction. ind alternative sources of satisfaction. IIncrease your awareness of what causes you stress. ncrease your awareness of what causes you stress. TTake action! Address the person or situation that's causing you ake action! Address the person or situation that's causing you stress. And, if you're still not sure how to manage, talk to your stress. And, if you're still not sure how to manage, talk to your health care professionalhealth care professional

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 of samples.

Due to latex sensitivity, a variety of gloves in appropriate sizes must be provided.

Patient’s 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

Issues in Specimen Collection

Deliver quality of care regardless of the demeanor of the patient.

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, especially confrontations.

Family, visitors and significant others

May be more difficult to deal with than the patient.

Make requests or demands that are not part of your 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.

Physicians, priests, chaplains

Have right to privacy with patient Leave and come back later. If timed or STAT request ask permission to

collect specimen.

Health Care Organizations

Primary care facilities maintain and monitor normal health and prevent diseases through immunization.

Secondary care have doctors who are specialists in a particular group of diseases, organ systems or one organ.

Tertiary care provides highly specialized care, geared to treating unusual or complex problems and utilize sophisticated diagnostic instruments.

Acute care hospital, hospital stay of 30 days or less. Long term care, stays longer than 30 days Ambulatory care. Home health services

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.

Department of Clinical Laboratory Medicine

Composed of two major areas: Clinical pathology

analyzes blood, body fluids, and biopsy materials

Anatomic pathology involved in autopsies, cytology and surgical pathology.

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, proficiency testing, and investigation of complaints

Laboratory testing classified according to complexity and personnel standards. Waived Moderate complexity tests High complexity tests

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 those obtained during biopsy, surgery, autopsy and bone marrow.

All problems or abnormal results obtained by the techs are referred to the pathologist.

Laboratory Director - Administrative Technologist

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.

Technical SupervisorsTechnical Supervisors

Larger hospitals have large laboratory sections requiring a supervisor with extensive experience and education in a lab 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.

Clinical Laboratory Scientist (CLS), Medical Technologist

(MT) B.S. in laboratory science or biologic science which must

include didactic 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.

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

Has obtained education through a hospital based 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 or complex procedures on patient samples.

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 to the 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 proper collection of urine and semen samples, as well as delivering and processing specimens in the lab.

Must be able to deliver specimens in a timely fashion, maintain accurate records/logs, and exhibit professional conduct and attitude at all times.