Phlebotomy and the Health Care
Setting
Part 1
Terry Kotrla, MS, MT(ASCP)BB
General Practice of Phlebotomy
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There are over 25,000 possible laboratory
tests, with around 500 performed in most
institutions.
http://www.ascls.org/labtesting/index.asp
Phlebotomists allow technicians and
technologists to focus on testing blood.
POCT – testing at bedside, may be
performed by phlebotomist
History
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On the job trained – leads to bad habits
being handed to next generation
Due to complexity formal training
programs developed.
National certification available
History (continued)
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Phlebotomy from
Greek words, phlebo,
relates to veins, tomy,
relates to cutting.
Opening a vein to
collect blood
Three purposes for collection and
analysis of laboratory samples
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Diagnostic testing – what’s wrong with the
patient?
Therapeutic assessment – is the drug at
the right therapeutic level?
Monitoring patient’s condition – is the
patient getting better?
Professional Ethics
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Principles of right and wrong conduct
for the profession.
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Do no harm intentionally
Perform according to sound ability and
judgement.
Do what you’re trained to do, no more.
Deal with patients assigned, not those you’re
curious about.
Keep all patient information confidential.
National Phlebotomy Association
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Represents the laboratory.
Gain and apply knowledge.
Maintain accuracy, reliability and
reproducibility of results.
Respect patients bill of rights.
Perform specified skills as defined by the
hospital or laboratory standards
Professional Behavior
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Character attributes for phlebotomists include:
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Sincere interest in health care.
Accountability for doing things right.
Dedication to high standards of performance.
Propensity for cleanliness.
Pride, satisfaction, and self-fulfillment in the job.
Professional behavior involves doing the right
thing when no one is watching.
Working with Health Care Team
Members
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Improving technical skills.
Effective communication
skills
Participation in decision
making
Problem solving
Communication Skills in the Patient
Care Environment
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Patient’s will in first 30 seconds make a judgement
Critical to have all supplies available
pleasant facial expression, neat appearance, and professional
manner.
Introduce yourself and state your mission
Remain calm, compassionate and professional
Thank patient
Communication issues in the home
and ambulatory settings
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More length introduction and explanation.
Location of sample collection area
Must know location of restroom and bed.
May need a phone to clarify orders.
Procedure must be fully explained.
Meticulous patient identification.
Must ensure care of puncture site.
Patient Interview
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Inpatient – MUST use 3-way ID
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Ask patient their full name
Compare to information on requisition
Compare requisition to armband
No armband NO draw
Outpatient settings require some additional
information.
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DOB
DL
Social Security Number
Teaching Patients
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Patient must cooperate for successful
procedure
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Must be given instructions, best to do verbal
and written
Must have questions answered
Define “fasting” or “NPO” if necessary and
reasons.
Timed testing must be clearly explained
Communication Strategies
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communication loop:
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sender,
receiver
and filters.
Filters are damaging to effective communication
Filters
Verbal Communication
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Language barriers.
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Must translate medical terminology
Use simple, honest terms
look for facial expression indicating
understanding.
If patient extends arm indicates
understanding and agreement
Verbal Communication
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Hearing disabilities/impairments
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English as a second language
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write down instructions
Learn sign 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.
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Positive body
language
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Smiling
Good grooming
Erect posture
Face to face
Zone of comfort
Negative body language/distracting
behaviors.
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Rolling eyes
Nervous behaviors
Deep sighs
Crossed arms,
Wrinkled forehead
Throwing things around
Chewing gum
Yawning
Name the Emotion
Listening skills
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Lets patient know that your are truly
interested.
Does not depend on intellect or
intelligence
Tips for active listening.
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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
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Phlebotomy is done
standing up, good
posture essential to
protect back and
neck.
Stand erect, avoid
slouching.
Appear relaxed.
Grooming
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Physical appearance communicates impression.
Neat, clean hair.
Clean, well groomed fingernails/hands.
Uniform or business casual clothing.
Clean, pressed lab coat.
Personal hygiene.
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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
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Nutrition- eat right
Exercise regularly
Get enough rest
Benefits
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improves attitude,
Improves appearance
helps reduce stress.
Quick Tips for Dealing with Stress
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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
can bring stress and fitness into your life. Keep them handy and
review them often.
Give yourself a break. Get a good night's sleep. Get away from it
all.
Eat a healthy diet.
Talk it out.
Spend time with family and friends.
Take a course. For fun or self improvement.
Relax with a good book, a great movie or your favorite music.
Exercise. Walk. Jog. Swim. Go to the gym.
Set priorities.
Schedule your time.
Find alternative sources of satisfaction.
Increase your awareness of what causes you stress.
Take action! Address the person or situation that's causing you
stress. And, if you're still not sure how to manage, talk to your
health care professional
Protective Equipment and Clothing
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PPE is NOT optional
Employers MUST provide
Includes:
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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
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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
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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
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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
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Have right to privacy with patient
Leave and come back later.
If timed or STAT request ask permission to
collect specimen.
Health Care Organizations
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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 Hospitals
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Mission
Bed size
Ownership: federal, state, teaching or nongovernmental
Length of stay
Type of care provided.
Location.
Relationship to other health facilities.
Department of Clinical Laboratory
Medicine
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Composed of two
major areas:
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Clinical pathology
analyzes blood, body
fluids, and biopsy
materials
Anatomic pathology
involved in autopsies,
cytology and surgical
pathology.
Clinical Laboratory Improvement
Act of 1988
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http://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.
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Waived
Moderate complexity tests
High complexity tests
Laboratory Director - medical
director
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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
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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
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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 Supervisors
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Larger hospitals have large laboratory sections requiring
a supervisor with extensive experience and education in
a lab specialty.
They aid the lab directory by
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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)
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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)
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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.
Phlebotomist
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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.