Professional Documents
Culture Documents
Objectives
Define phlebotomy and describe phlebotomy services List professional competences for phlebotomists List skills for effective communication Describe basic principles of quality and list examples of quality assessments for phlebotomy
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Definitions
Phlebotomy is derived from the Greek words phlebo, which relates to veins, and tomy, which relates to cutting. Phlebotomy is the incision of a vein for the purpose of collecting blood A phlebotomist is the individual who performs phlebotomy
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Duties
Primary Function
To assist the health care team in the accurate, safe, and reliable collection and transportation of specimens for clinical laboratory analyses
Other functions
Assist in the collection and transportation of specimens other than venous blood such as
Arterial blood Urine Tissues Sputum
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Ambulatory Care
Health department clinics Community health centers School based clinics Prison health clinics Home health agencies Insurance companies Physician practices Mobile vans for blood donations Rehabilitation centers
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Competency
Phlebotomists must be able to
Apply knowledge of:
Principles of basic and special procedures Potential sources of error Standard operating procedures Fundamental biological characteristics
Select appropriate:
Course of action Equipment/methods/reagents
Other responsibilities
Adherences to organizational policies
Safety Infection control Fire & safety
Communication skills
Verbal Nonverbal Listening skills
Organizations
American Society for Clinical Pathology (ASCP) National Phlebotomy Association (NPA) American Society for Clinical Laboratory Science (ASCLS) National Credentialing Agency for Laboratory Personnel (NCA) American Medical Technologists (AMT) American Society of Phlebotomy Technicians (ASPT) National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) National Healthcare Association (NHA)
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These Organizations
Have an interest in promoting and improving the practice of phlebotomy Develope competency statements Provide guidelines for healthcare organizations to provide standard operating procedures Provide professional standards and code of ethics
NPA NPA ASCP ASCLS NCA AMT ASPT NHA ASCP ASCLS
NAACLS
NCA
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Communication
Consists of:
10 to 20% verbal messages 80 to 90% non verbal messages
Face to face communication is the most effective form of communication and is a part of a phlebotomists job every day Verbal interactions can be depicted as a communication loop.
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Basic Communication
Requires:
Sender Receiver Message
Is complete:
when the sender receives feedback
Involves:
Showing empathy Showing respect Building trust Establishing rapport Listening actively Providing specific feedback Conveying the right message Using a professional tone of voice Using appropriate language
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Communication Loop
Starts when the message leaves the sender and reaches the receiver The receiver completes the loop by providing feedback to the sender Without feedback the sender has no way of knowing whether the message was accurately received or was somehow blocked by extraneous factors that can filter out meaning from a message Filters can be damaging to effective communication because they do not allow the loop to be completed
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Communications 3 Components
Verbal communication
The actual words that are spoken, the tone of voice
Nonverbal communication
Body language, gestures
Active listening
Using verbal & non verbal information to assess the situation
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Verbal Communication
Must use simple, everyday vocabulary particularly with children Avoid complex medical jargon Pts must not be told this wont hurt. Patient should be forewarned and prepared for pain. Efforts must be made to insure that sensory impairments such as deafness or blindness are overcome Ask Do you understand? or Do you want me to explain the procedure again? to verify that you are being heard & understood Must make efforts to communicate with patients who speak other languages Locate translators or translation services Tone of voice should match the words that are spoken. Avoid sarcasm Use calm soothing confident tones In emergency situations Require extra speed and accuracy without jeopardizing personal touch Be conscious of a patients privacy, dignity and individual needs Bedside manner Pleasant facial expression Neat appearance Minimize negative effects of the situation
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Basic Procedures When Encountering A Patient For The First Time in Hospital
Knock gently on the patients door Introduce yourself and state that you are from the hospital or laboratory, whichever is the case Inform the patient that his or her specimen must be collected for a test order by the physician
Indicate that this is a routine hospital procedure Avoid lengthy discussion of why a test was ordered. Refer this to the physician
Remain calm, compassionate, and professional and limit conversations to essential information Let the patient know how the procedure is going
This is going well it is almost over
Do not be distracted from the phlebotomy procedure by excessive talk or unrelated issues Before leaving the room, thank the patient for cooperating
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In A Clinic Or Home
You must also
Direct patient to sit in a chair with sides and arms or recline during the procedure Take time to find the nearest bathroom and bed in case of complications Find a phone or bring a cell phone to clarify lab orders Puncture site must be cared for appropriately and assurance must be made that patient is not bleeding.
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Patient Identification
Is essential In a Hospital
Must be accomplished by two of the following:
Checking if the test requisition labels and a unique identification number on the pts armband match Verbal confirmation from the patient Positive confirmation by a unit nurse
In a clinic or home
Should done meticulously and cautiously by:
Using drivers license or identification cards Confirming birthday, home address or social security
Telephone Communications
Incoming Calls
Answer no later than 3rd Ring Try to smile & reflect positive phone voice Speak clearly and courteously Identify the department or doctors office Identify yourself stating your name & title Ask how you may help the caller Acquire information from the caller & record date & time If you cannot provide the proper response ask for assistance Ask the caller before putting them on hold Do not leave on hold for more that n 30 seconds without checking back Read back message to caller to ensure that you have the correct info Allow caller to hang up first Do not call to socialize State your name, where you are calling from & the purpose of your call Leave preferred times & phone numbers where you can be reached Thank receiver for taking your message
Outgoing
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Nonverbal Communication
Composes 80 to 90% of Communication Can be
Positive
Facilitates understanding
Negative
Hinders communication
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Its Effects:
Aids communication Can make interactions more pleasant Can set stage for open lines of communication Promotes a sense of trust and honesty Prevents from making the patient feel neglected
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Zone of Comfort
Is the area of space around a patient where they feel comfortable in an interaction. If that zone is crossed, feeling of uneasiness may occur For most western cultures, there are four zones
Intimate space
Direct contact up to 18 inches For close relationships and health care workers who bathe, feed, dress, and perform venipunctures
Personal space
18 inches to 4 feet For interactions among friends and for many patient encounters
Social space
4 feet to 12 feet For most interactions of everyday life
Public space
More than 12 feet Lectures, speeches, etc.
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Its Effects
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Active Listening
Helps close the communication loop by ensuring that the message sent can indeed be repeated and understood May have important ramification in the test results Steps include
Get Ready by concentrating on the speaker Pause occasionally to mentally summarize what you have said Verify that you are listening by letting the speaker know using phrases such as Oh very interesting I see Avoid making hasty judgments Verify the conversation with feedback Pay attention to body language Maintain eye contact Use encouragement Practice, practice , practice
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Cultural Sensitivity
Culture influences decisions and behaviors in many aspects of life If a healthcare worker is unsure or unaware of acceptable patterns of behaviors for a patient, the recommended action is to follow the patients lead Observe mannerisms, gestures and facial expressions.
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Professional Appearance
Good Posture
Erect posture conveys confidence and pride in job performance Poor posture conveys laziness and apathy
Grooming
Instills confidence in a person Examples:
Neatly combed hair Clean fingernails Pressed uniform
Hygiene
Is important in preventing the spread of infectious disease Examples:
Clean teeth, hair and body Clean, wrinkle free clothes
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Quality Assurance
The area where phlebotomists have the greatest impact is on constantly improving services that are provided to stake holders or customers Quality improvement efforts of phlebotomy services often involve evaluating the following:
The health care workers technique Complications, such as hematomas Recollection rates resulting from contamination Multiple sticks on the same patient
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Stakeholders(Customers)
External
Local community Insurance companies that pay for services Employers who pay for services for their employees Grant agencies and/or foundations that provide funding Federal or state agencies OSHA,CDC, etc. Accrediting agencies- Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), CAP Advocacy groups AARP Inpatients & outpatients Patient families and friends Patient support groups Clinical laboratory staff Pathologists and other medical doctors Students Research staff Volunteers
Internal
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Quality Assessment
Quality Assessment for phlebotomy involves reviewing:
Structures
Physical structure
Facilities where service is provided Supplies & equipment
Personnel structure
Staff directors & supervisor
Processes
What is done to the patient or client Involves evaluation of patient records for complications, correct technical skills, correct documentation procedures, etc.
Outcomes
What is accomplished for the patient Involves chart reviews
Customer satisfaction
Via questionairre, mailout, or telephone call
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Flow Charts
Brainstorming
Used to stimulate creative solutions in a group
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Analytical Phase
Happens during testing
Preanalytical Phase
Outside the laboratory
Patient identification and information
Correct venipuncture or skin puncture
Isolation techniques
Appropriate use of supplies and equipment
Standard precautions
Appropriate transportation and handling
Centrifugation
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Postanalytical
Reporting results
Appropriate follow-up repeat testing
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When restocking
collection tubes with a shelf life nearest the current date at the front of the shelf so that these tubes are first be cognizant of expiration dates
Phlebotomists should know how to store or preserve specimen tubes if the blood specimen is not to be tested immediately if consecutive unsuccessful attempts on different patients, his her technique must be reviewed, modified, or improved when too much blood is taken for laboratory analysis, the patient may become anemic, so blood conservation become priority
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A phlebotomist is someone who collects blood specimens primarily via venipuncture Phlebotomists duties include clinical duties such as the venipuncture & patient care, technical duties such as quality control & specimen transport, and clerical duties such as answering phones & filling out proper documentation A phlebotomist must have proper training, at least a high school diploma and carry national certification Phlebotomists must be mature, accountable, work with the highest ethical standards, adhere to organizational policies, and be able to apply their knowledge correctly, efficiently, and precisely Communication involves sender, receiver & message and is complete when the sender receives feedback from the receiver Verbal & nonverbal communication as well as active listening are the components of communication Verbal communication should be face to face, in calm & confident tones, avoiding negative language and should be used effectively when: encountering & identifying the patient and using the telephone. Nonverbal communication should be positive not negative and makes up 80-90% of all communication Personal hygiene, zone of comfort and culture should also be factored when dealing with a patient Quality assurance is the area where phlebotomists have the greatest impact on their field Phases of specimen collection include the preanalytical, analytical & postanalytical phases with the preanalytical phase being the one most relevant to phlebotomy 45
Summary
Questions
Phlebotomy is derived from the greek words phlebo which relates to ________ and tomy which relates to cutting. Veins To become a phlebotomist you must have at least a high school diploma, training, and ___________. National certification The three components of communication are verbal, nonverbal and _________. Active listening When do you know a message has been communicated? When the senders receives feedback Non verbal communication makes up __________ % of all communication. 80 90 % Phlebotomists are usually involved in which phase of specimen collection? Preanalytical
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Sources
Phlebotomy Handout
Chapter 1 Phlebotomy Practice and Quality Assessment Basics
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THANK YOU
HAVE A GREAT DAY!
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