Phlebotomy and the Health-Care Delivery System

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 • 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