MLS 123 MODULE 1 Understanding Phlebotomy

ALTERNATIVE LEARNING MODULE FOR MLS 123 AND MLS 123L
PRINCIPLES OF
MEDICAL LABORATORY SCIENCE PRACTICE 2
Department of Medical Laboratory Science

SCHOOL OF NATURAL SCIENCES
MLS 123
Second Semester 2020-2021
COURSE LEARNING OUTCOMES

At the end of the course, you should be able to:
1. Trace the evolution of phlebotomy and how it
became a practice
2. Describe who is a phlebotomist and what are the
roles of a phlebotomist
3. Know the proper disinfection and
decontamination procedures, the safety
guidelines and the other pertinent safety
protocols in the laboratory
4. Identify the parts and functions of the body’s
cardiovascular system, particularly the anatomic
locations which can be utilized to collect blood
samples
5. Recall the materials and equipment used in the
performance of a phlebotomy procedure
6. Enumerate the preanalytical variables that could
affect the patient’s test results
7. Discuss and perform the different blood collection
techniques, as well as point of care testing
8. Identify when and how to troubleshoot when
problems are encountered during a phlebotomy
procedure
9. Know the proper etiquette when dealing with a
patient and provide the proper patient care
10. Characterize the specimen handling and
processing techniques
11. Discuss the importance and proper technique of
an arterial puncture
12. Describe the concept of quality assurance in the
context of the practice of phlebotomy
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COURSE INTRODUCTION
Dear future Medical Laboratory Scientists,
This course will enable you to understand the basic concepts and techniques in blood extraction that
will always be part of you as a Medical Laboratory Scientist.
The topics and concepts that you will learn this second semester is interrelated to the concepts
learned from the previous semester in the course MLS 112, Principles of Medical Laboratory Science
Practice 1. In this regard, you will be learning the art of extracting blood sample from patients.
Specimen collection, handling, and processing remains one of the primary areas of preanalytical
error. Therefore, careful attention to each phase is necessary to ensure proper subsequent testing
and reporting of meaningful results.
The primary role of a medical laboratory scientist is to aid the physician in the diagnosis and treatment
of diseases. Hence, this course will provide an avenue for you to know the importance of phlebotomy,
and other special techniques to obtain blood sample which is one of the most important steps to
provide accurate results.
With everything said, we pray that you will enjoy what you will learn this semester and will take into
heart the concepts and principles not only until you finish this course but until you become
professionals in the future. A blessed semester to each and every one of you!
Best regards,
MLS 123 and 123L Facilitators

AY 2020-2021
MODULE 1
UNDERSTANDING PHLEBOTOMY
MODULE CONTENTS
COURSE LEARNING OUTCOMES ............................................................................................... 1

COURSE INTRODUCTION ............................................................................................................ 2
MODULE CONTENTS .................................................................................................................... 3
MODULE INTRODUCTION ............................................................................................................ 4
MODULE OBJECTIVES ................................................................................................................. 4
MODULE SELF MONITORING FORM .......................................................................................... 4
MODULE 1: UNDERSTANDING PHLEBOTOMY ......................................................................... 5
UNIT 1: PHLEBOTOMY AT A GLANCE ..................................................................................... 5
Engage ..................................................................................................................................... 5
Explore ..................................................................................................................................... 7
Explain.................................................................................................................................... 10
Elaborate ................................................................................................................................ 13
Evaluate ................................................................................................................................. 14
UNIT 2: HEALTHCARE AND COMMUNICATION ................................................................... 15
Engage ................................................................................................................................... 15
Explore ................................................................................................................................... 17
Explain.................................................................................................................................... 23
Elaborate ................................................................................................................................ 25
Evaluate ................................................................................................................................. 27
REFERENCES .............................................................................................................................. 28
MODULE INTRODUCTION
This module introduces you to the world and practice of phlebotomy. You will learn the history of
phlebotomy, its importance, what it is and who performs it. You will also be taking a look at an
overview of the healthcare setup, as well as a review on communication. You will see how
communication plays an important role in interacting with your future patient to deliver the best care
and practice the proper etiquette in your future encounters.
MODULE OBJECTIVES
After you are done reading and doing the tasks in this module, you are expected to be able to:
1. Describe the evolution of phlebotomy and the role of the phlebotomist in today’s healthcare
setting.
2. Discuss the traits that form the professional image of the phlebotomist.
3. Distinguish the different types of healthcare setting.
4. Explain the basic concepts of communication as they relate to healthcare settings.
MODULE SELF MONITORING FORM

To help you keep track of your tasks for this module, you are provided with a self-monitoring form
below. Take the time to tick on the “YES” box for each activity that you finish. Be reminded about
pending events that you are yet to do. Remember that your success in achieving the module
objectives depends entirely on how conscientious you are of your progress.
Schedule Activities Completed

Yes No
Unit 1: Engage  
Week 2 Unit 1: Explore  
Unit 1: Explain  
Unit 1: Elaborate  
Unit 1: Evaluate  
– 10 points
Unit 2: Engage  
Unit 2: Explore  
Unit 2: Explain  
Unit 2: Elaborate  
Unit 2: Evaluate  
– 15 points
Do Read Quiz Submit
MODULE 1
UNIT 1: PHLEBOTOMY AT A GLANCE
This unit will engage you to the introductory concepts of phlebotomy particularly involving the
historical perspective and a familiarization of the phlebotomist. An understanding of phlebotomy from
a historical perspective helps the phlebotomist appreciate the significance of his or her role in
healthcare today. In the same way, knowing how to extract blood samples from patients does not
make one a phlebotomist. A phlebotomist must be well-mannered, possesses the traits of a
healthcare professional, continuously earns the expected credentials required of a phlebotomist, and
abides with the regulations and laws related to phlebotomy procedures.
Unit Learning Objectives:

At the end of this unit, the student will be able to:
1. Create an understanding of phlebotomy
2. Describe the evolution of phlebotomy
3. Identify the roles of the phlebotomist in today’s healthcare setting.
4. Describe the traits that form the phlebotomist’s professional image.
5. Identify and discuss regulations and laws related to phlebotomy
Introduction to Phlebotomy
Phlebotomy (derived from the Greek words phlebos, “vein,” and tome,“incision”) is the act of
drawing or removing blood from the circulatory system through a cut (incision) or puncture in order to
obtain a sample for analysis and diagnosis. Phlebotomy is also done as part of the patient's treatment
for certain blood disorders. The amount of blood drawn depends on the purpose of the phlebotomy
Venipuncture is the collection of blood from a vein which is usually done for laboratory
testing.
Goals of Phlebotomy:
✓ Obtain blood for diagnostic purposes and monitor treatment
✓ Collect blood for transfusion
✓ Phlebotomy that is part of treatment (therapeutic phlebotomy) is performed to treat
polycythemia vera, a condition that causes an elevated red blood cell volume (hematocrit)
✓ Prescribed for patients with disorders that increase the amount of iron in their blood to
dangerous levels, such as hemochromatosis, hepatitis B, and hepatitis C
Task: Listed below are terms related to phlebotomy that you will encounter in your study of PMLS 2
this semester. Highlight the words indicated below, and provide a definition of each word.
The Phlebotomist
A phlebotomist is a person responsible for drawing blood from patients for laboratory tests,
transfusions, or donation. Phlebotomists are trained to collect blood via venipuncture, finger pricks,
or in the case of infants, heel pricks. Phlebotomists typically work in hospitals, medical offices, clinics,
diagnostic laboratories, and blood donation centers. Though other medical personnel, such as nurses
or medical assistants, might draw blood, phlebotomists specialize in the phlebotomy procedure.
Duties and Responsibilities of a Phlebotomist

✓ Prepare patients for collection procedures associated with laboratory samples
✓ Collect routine skin puncture and venous specimens for testing as required
✓ Prepare specimens for transport to ensure stability of sample
✓ Maintain patient confidentiality
✓ Perform quality-control checks while carrying out clerical, clinical, and technical duties
✓ Transport specimens to the laboratory
✓ Comply with all procedures instituted in the procedure manual
✓ Promote good relations with patients and hospital personnel
✓ Assist in collecting and documenting monthly workload and recording data
✓ Maintain safe working conditions
✓ Perform appropriate laboratory computer operations
✓ Participate in continuing education programs
✓ Collect and perform point-of-care testing (POCT)
✓ Perform quality-control checks on POCT instruments
✓ Perform skin tests
✓ Prepare and process specimens
✓ Collect urine drug screen specimens
✓ Perform electrocardiography
✓ Perform front-office duties, current procedural terminology coding, and paperwork
Official Recognition of Phlebotomists: How to become a recognized phlebotomist?
All healthcare professionals can be trained to obtain blood through phlebotomy. However, not all
healthcare professionals can be recognized as an official phlebotomist. The following must be
obtained to legally work as a phlebotomist:
a. Certification
Certification is a voluntary process by which an agency grants recognition to an individual who has
met certain prerequisites in a particular technical area. Certification indicates the completion of
defined academic and training requirements and the attainment of a satisfactory score on an
examination. This is confirmed by the awarding of a title or designation.
Phlebotomist certification is signified by initials that the individual is allowed to display after his or her
name. Examples of international US agencies that certify phlebotomists, along with the title and
corresponding initials awarded are written on the table below:
Certification Agency Certification Title Certification Initials
American Medical Registered Phlebotomy RPT (AMT)
Technologists Technician
American Certification Agency Certified Phlebotomy CPT(ACA)
Technician
American Society for Clinical Phlebotomy Technician PBT(ASCP)
Pathology
National Center for National Certified Phlebotomy NCPT(NCCT)
Competency Testing Technician
National Healthcareer Certified Phlebotomy CPT(NHA)
Association Technician
Note: In the Philippines, phlebotomy trainings are usually provided by certified organizations such as
the Philippine National Red Cross. Completion of the training will earn you a phlebotomy certificate,
however this certificate does not equate to a recognized phlebotomist’s license.
b. Licensure
Licensure is the act of granting a license. A license in healthcare is an official document or permit
granted by a state agency that gives legal permission for a person to work in a particular health
profession. Without a license, it would be against the law for a person to practice that profession.
Typically, the individual must meet specific education and experience requirements and pass an
examination before the license is granted. The license indicates competency only at the time of
examination. As a demonstration of continued competency, states normally require periodic license
renewal, by either reexamination or proof of continuing education.
c. Continuing Education
Continuing education is designed to update the knowledge or skills of participants and is generally
geared to a learning activity or course of study for a specific group of health professionals, such as
phlebotomists. Many organizations, such as the American Society for Clinical Pathology (ASCP), the
American Society for Clinical Laboratory Sciences (ASCLS), and the American Medical Technologists
(AMT), sponsor workshops, seminars, and self-study programs that award continuing education units
(CEUs) to those who participate. The most widely accepted CEU standard, developed by the
International Association for Continuing Education and Training (IACET), is that 10 contact hours
equal one CEU.
Traits Expected of a Phlebotomist as a Professional
A. Professionalism
This is defined as the conduct and qualities that characterize a professional person. As part of a
service-oriented industry, persons performing phlebotomy must practice professionalism. The
public’s perception of the phlebotomy profession is based on the image created by the phlebotomist’s
conduct and appearance. Appropriate clothing, proper personal hygiene, and physical well-being
contribute to a professional appearance.
Besides displaying a professional appearance, a person performing phlebotomy is required to display
attitudes, personal characteristics, and behaviors consistent with accepted standards of professional
conduct. Some of the personal behaviors and characteristics that make up this professional image,
are as follows:
➢ Self-Confidence
A phlebotomist who exhibits self-confidence has the ability to trust his or her own
personal judgment. Your perception of yourself has an enormous impact on how others
perceive you. The more self-confidence you have, the more professional you appear. Many
factors affect being perceived as self-confident; for example, erect posture, professional
appearance, courage, and tactfulness in communication.
➢ Integrity
Integrity as a concept has to do with a personal feeling of “wholeness” deriving from
honesty and consistency of character; this can be seen in the person’s actions, values, and
beliefs. Professional standards of integrity or honesty require a person to do what is right
regardless of the circumstances and in all situations and interactions. For example, a
phlebotomist often functions independently and may be tempted to take procedural shortcuts
when pressed for time. A phlebotomist with integrity understands that following the rules for
collection is essential to the quality of test results; therefore, he or she respects those rules
without fail.
➢ Compassion
Compassion means being sensitive to a person’s needs and willing to offer
reassurance in a caring and humane way. A phlebotomist may show compassion by
appreciating the fear that illness or the unknown generates, by using empathy to sense others’
experiences, and by demonstrating a calm and helpful demeanor toward those in need.
➢ Self-Motivation
A person with motivation finds the workplace stimulating no matter what the tasks may
entail. Motivation is a direct reflection of a person’s attitude toward life. A phlebotomist who
exhibits self-motivation takes initiative to follow through on tasks, consistently strives to
improve and correct behavior, and takes advantage of every learning opportunity that may
come along. A phlebotomist who is motivated makes every effort to provide excellence in all
aspects of patient care in which he or she is involved.
➢ Dependability
Dependability and work ethic go hand in hand. An individual who is dependable and
takes personal responsibility for his or her actions is extremely refreshing in today’s
environment. A phlebotomist who works hard and shows constant, reliable effort and
perseverance is a valuable asset to a healthcare organization.
➢ Ethical Behavior
A phlebotomist should know that there are policies designed to regulate what should
or should not be done by those who work in the healthcare setting. This system of policies or
principles is called a code of ethics. Ethics are centered on an individual’s conduct. Ethical
behavior means making the right personal choices that help to maintain a high level of respect
for the phlebotomist. In healthcare, ethical behavior requires conforming to a standard of right
and wrong conduct so as to avoid harming patients in any way. A code of ethics, although not
enforceable by law, leads to uniformity and defined expectations for the members of that
profession. The Hippocratic oath includes the phrase primum non nocere, which means “first
do no harm.” The primary objective in any healthcare professional’s code of ethics must
always be to safeguard the patient’s welfare.
➢ Personal grooming
The phlebotomist’s appearance will directly affect the patient’s perception of trust. No
one would want a blood extraction from someone who looks like a carrier of infection. Always
look professional with clean and ironed scrubs. Hair needs to be pulled back, and nail care is
also important. Long nails and finger nail polish are not permitted as they can harbor bacteria.
B. Confidentiality
Patient confidentiality serves to protect both the patient and the practitioner. The healthcare provider
must recognize that all patient information is absolutely private and confidential. Healthcare providers
are bound by ethical standards and various laws to maintain the confidentiality of each person’s health
information. Unauthorized release of information concerning a patient is considered an invasion of
privacy.
The Evolution of Phlebotomy
Since very early times, people have been fascinated by blood and have believed in some
connection between the blood racing through their veins and their well-being. From this belief, certain
medical principles and procedures dealing with blood evolved, some surviving to the present day. It
was thought that removal of the excess body fluids would restore balance. The process of removal
and extraction became the treatment and could be done either by expelling disease materials through
the use of drugs or by direct removal during surgery.
Venesection
One important surgical technique performed during the earlier periods was venesection
(cutting a vein), used in the process of bloodletting. Venesection, which comes from the Latin words
vena, “vein,” and sectio, “cutting”— was the most common method of general bloodletting. It involved
cutting into a vein with a sharp instrument and releasing blood in an effort to rid the body of evil spirits,
cleanse the body of impurities, or, as in Hippocrates’ time, bring the body into proper balance. It often
meant withdrawing large quantities of blood from a patient to cure or prevent illness and disease.
Today, venesection is another word for phlebotomy.
Stone Age
Some authorities believe phlebotomy dates back to the last period of the Stone Age, when
crude tools were used to puncture vessels and allow excess blood to drain out of the body.
Barber Surgeons
Early in the Middle Ages, barber–surgeons flourished. By 1210, the Guild of Barber–Surgeons
had been formed; it divided the surgeons into Surgeons of the Long Robe and Surgeons of the Short
Robe. Soon the Short Robe surgeons were forbidden by law to do any surgery except bloodletting,
wound surgery, cupping, leeching, shaving, tooth extraction, and enema administration.
To distinguish their profession from that of the

Long Robe surgeon, barber–surgeons placed a striped
pole, from which a bleeding bowl was suspended, outside
their doors. The pole represented the rod squeezed by
the patient to promote bleeding and the white stripe on
the pole corresponded to the bandages, which were also
used as tourniquets. Soon, decorated ceramic bleeding
bowls were created and were passed down from one
generation to the next. These bowls, which often doubled
as shaving bowls, usually had a semicircular area cut out
on one side to facilitate placement of the bowl under the
chin. An example of a bleeding bowl is shown in the
image.
Excessive phlebotomy is thought to have contributed to George Washington’s death in

1799, when he was diagnosed with a throat infection and the physician bled him four times in
2 days. It was because of Washington’s request to be allowed to die without further medical
intervention that the physician did not completely exsanguinate him, or remove all his blood.
17th – 18th century
During the 17th and early 18th centuries, phlebotomy was considered a major therapeutic
(treatment) process, and anyone willing to claim medical training could perform phlebotomy. The
lancet, a tool used for cutting the vein during venesection, was perhaps the most prevalent medical
instrument of the times. The usual amount of blood withdrawn was approximately 10 mL, but
excessive phlebotomy was common.
Cupping and Leeching
Phlebotomy was also accomplished by cupping and leeching. The art of cupping required a
great deal of practice to maintain the high degree of dexterity necessary to avoid appearing clumsy
and thus frighten the patient away. Cupping involved the application of a heated suction apparatus,
called the “cup,” to the skin to draw the blood to the surface. Then the capillaries in that area were
severed by making a series of parallel incisions with a lancet or “fleam.”
Fleams
The typical fleam was a wide double-edged blade at right
angles to the handle. Eventually, multiple fleams were
attached and folded into a brass case for easy carrying. The
blades were wiped clean with only a rag; therefore, they
readily transmitted a host of blood-borne infections from
patient to patient. Fleams were used for general phlebotomy
to open an artery or, more commonly, a vein to remove large
amounts of blood. An example of multiple fleams are shown
in the image.
Leeches
For more localized bloodletting, leeches were used. This procedure involved enticing the
Hirudo medicinalis, a European medicinal leech, to the spot needing
bloodletting with a drop of milk or blood on the patient’s skin. After
the leech engorged itself with blood (about an hour), it was allowed
to drop off.
By the mid-18th century, leeching

was widely practiced in Europe,
especially in France. Leeches were
kept in special vessels that were
filled with water and had perforated
tops, so that the leeches could
breathe. Early leech jars were glass
and later ones were ceramic.
Phlebotomy at Present
The practice of phlebotomy continues to this day; however, principles and methods have
improved dramatically. Today, phlebotomy is performed to:
› Obtain blood for diagnostic purposes and to monitor prescribed treatment
› Remove blood for transfusions at a donor center
› Remove blood for therapeutic purposes, such as treatment for polycythemia, a
disorder involving the overproduction of red blood cells
Phlebotomy is primarily accomplished by one of two procedures:

› Venipuncture, which involves collecting blood by penetrating a vein with a needle and
syringe or other collection apparatus
› Capillary puncture, which involves collecting blood after puncturing the skin with a
lancet
Legal Issues in Phlebotomy
Phlebotomists are an integral part of a modern medical team. As such, their jobs encompass
much more than the simple mechanics of blood withdrawal. An important part of a phlebotomist’s
education involves learning about the ethical and legal questions associated with the field of
phlebotomy. This article will provide you with a brief overview of some of the major legal issues faced
by phlebotomists every day.
Informed Consent
Every medical professional must make sure that his or her patients understand and consent
to every procedure. In most instances, the patient has the right to an explanation of what medical
procedure is being performed and why. If the patient is a minor, her parents or guardians must provide
consent on her behalf. Phlebotomists must also bear in mind that the patient has the right to refuse
consent. Even if a doctor has ordered a blood draw or injection, the patient has the right to refuse any
venipuncture.
Assault
If a phlebotomist threatens someone with a needle, they have committed assault. Simply put,
assault is defined as making someone fear that you will use force to harm them. This can be a
sensitive issue for phlebotomists because many people have a fear of needles and the pain
associated with venipuncture. A well-trained phlebotomist will know how to deal with patients in a
safe and legal manner.
Battery
Assault simply involves causing someone to fear that bodily harm will come to them. For the
crime of battery to take place, actual physical contact must occur. In phlebotomy, this can be an issue
if a phlebotomist forces an injection on a patient against their will. If a phlebotomist intentionally holds
a patient down or uses more force than necessary, he has committed battery. This can not only end
a career; it can lead to ruinous lawsuits and criminal charges.
Another issue that falls into the category of assault and battery is use of a contaminated
needle. Even if no excessive force is used, a dirty needle can cause life-altering harm to a patient. A
phlebotomist is legally responsible for ensuring the sterility of all equipment in his or her care.
Confidentiality
A patient has the right to know that their personal information will not be spread by the medical
professionals who are in charge of their care. Blood withdrawals are often associated with testing for
sensitive diseases, and phlebotomists will be privy to confidential information about many patients.
They have a legal obligation to maintain their patients’ privacy. A patient has a right to confidentiality
regarding any identifying information, including their diagnosis, treatment, and even birthday.
Negligence
Negligence involves four elements: duty, breach, cause, and harm. This essentially means
that for a patient to sue a medical practitioner, they must show that the practitioner failed in executing
their duty to the patient, which was the direct cause of harm. Following basic phlebotomy principles
is one of the best ways for a phlebotomist to help prevent charges of negligence. Some examples of
situations indicating negligence in phlebotomy are:
The phlebotomist left the uncapped, used needle on the bedside of a newborn baby causing
multiple punctures on the skin of the baby.
The phlebotomist forgot to remove the tourniquet on the patient’s arm which was only
discovered after 4 hours, causing a severe discoloration on the patient’s arm and affected the
blood flow.
The phlebotomist extracted blood from the wrong patient.
The phlebotomist did not assist the elderly patient after phlebotomy which caused injury to the
patient.
Malpractice
Malpractice is a term for the type of civil lawsuits that patients generally bring against medical
practitioners who have failed to follow the standard of care. If a phlebotomist is facing a malpractice
suit, they are not in danger of going to jail, but they may face other severe consequences. Depending
on their jurisdiction and the severity of the harm caused, a jury may award the injured party a
significant financial reward.
How Ready Am I To Be A
Phlebotomist?
Full Name: Date of Submission:

Instructor:
Subject: Course and Year:
Title of the Activity
Creative Essay. Using all the knowledge you gained from this module, write about how do you feel
about being a phlebotomist someday? What are your fears? Did you have any past traumatic
experience with phlebotomy as a patient? Do you think you are ready to be the one extracting blood
this time? (10 points)
MODULE 1
UNIT 2: HEALTHCARE AND COMMUNICATION
Healthcare today has evolved into an integrated delivery system offering a full range of
services intended to ensure that the patient gets what is needed at the right time and in the right way.
In addition to physicians, nurses, and patient support personnel, allied health professionals such as
clinical laboratory personnel play a role in the delivery of patient care. The clinical laboratory serves
a vital role in the healthcare system, providing physicians with some of medicine’s most powerful
diagnostic tests.
Unit Learning Objectives:

At the end of this unit, the student will be able to:
1. Develop an understanding of the healthcare setting
2. Understand the role of the phlebotomist in the healthcare setting
3. Determine the importance of communication in the healthcare setting
4. Explain the importance of effective communication
5. Describe the elements of the communication process
6. Describe the obstacles to the communication process
7. Appreciate the importance of effective communication as applied to phlebotomy
8. Learn age-based communication in phlebotomy procedures
The Healthcare Setting
HEALTHCARE DELIVERY
Two general categories of facilities, inpatient (non-ambulatory) and outpatient (ambulatory), support
all three (primary, secondary, and tertiary) levels of healthcare.
Outpatient Inpatient
o Offer routine care in physician’s office to o Offer specialized instrumentation and
specialized care in a freestanding technology to assist in unusual diagnoses
ambulatory setting and treatments
o Serve tertiary care practitioners
o Serve primary care physicians who assume o Usually requires that patients stay overnight
ongoing responsibility for maintaining or longer
patients’ health
o Serve secondary care physicians who
perform routine surgery, emergency
treatments, therapeutic radiology, and so on
in same-day service centers
According to the World Health Organization, healthcare facilities are hospitals, primary
healthcare centers, isolation camps, burn patient units, feeding centers and others. In emergency
situations, health-care facilities are often faced with an exceptionally high number of patients, some
of whom may require specific medical care (e.g., treatment of chemical poisonings).
The Different Types of Healthcare Settings
Types Services Offered and Description

Hospital Primary task is to provide short-term care for people with severe
health issues
Ambulatory Surgical Offer a safe environment for the surgery and basic monitoring
Center during the initial post-operation hours
Doctor’s Office Provide routine care as well as treatment for acute conditions
Urgent Care Clinic Walk-in clinics that offer outpatient care immediately
Nursing Home Designed for patients who require constant care but do not need
to be hospitalized and cannot be cared for at home
Health Facilities in the Philippines (DOH AO 0012-A series of 2012, amended 2015)
The Classification of Health Facilities is based on:
A. Ownership:
1. Government
2. Private
B. Scope of services:
1. General Facilities/Hospital
Examples:
o UP Philippine General Hospital
o Jose Reyes Memorial Medical Center
2. Specialty Centers/Hospitals
Examples:
o Philippine Heart Center
o National Kidney and Transplant Institute
C. Functional capacity: Refer to the table below
Communication
Communication is a skill. It is the way by which information is exchanged or transmitted. This

dynamic and constantly changing process involves three components such as verbal skills, nonverbal
skills, and ability to listen.
The Elements of the Communication Process
The Sender has an Idea to Communicate
This idea to be communicated can be the result of thought or feeling and can be influenced
by the circumstances of the current situation, as well as the sender's mood, physical condition,
culture, heritage, or background. The sender simply has something they want to communicate to
someone else.
Example: A phlebotomist wants to tell the patient that the patient must relax and keep still
while the procedure is ongoing.
The Sender Encodes the Idea in a Message
To encode the idea means to put the idea into some form that can be communicated. The
sender puts the idea into spoken or written words, or perhaps into hand gestures, body movements,
or facial expressions. A good communicator always understands the importance of using words,
symbols, or gestures that the receiver will understand.
Example: A phlebotomist tells verbally to the patient, that the patient must relax and keep still
while the procedure is ongoing.
The Message Travels over a Channel
There is always a particular means, or medium, by which the sender sends the message. This
is the channel. The sender can choose to use a telephone, speak face-to-face, write on paper or
electronic tablet, send a fax or an email, draw a picture, use body language, make facial expressions,
or use hand gestures. Sometimes the channel can be disrupted by noise. The effective communicator
however, will always try to lessen the disruptions. Healthcare professionals must accommodate all
patients including those with impairments.
Example: A phlebotomist tells verbally to the patient face-to-face, that the patient must relax
and keep still while the procedure is ongoing with a warm smile.
The Receiver Decodes the Message
The receiver must then make some sense of the message. To do this, the receiver must
decode the message, that is, translate the original message from its encoded form into a form that
the receiver understands. This step in the Communication process can be complicated be many
factors, all of which are also types of noise such as cultural differences. Perhaps the receiver does
not have the education necessary to understand the content of the message. Finally, the receiver
may have poor listening—and, therefore, poor communication—skills. There might be physical
conditions that prevent the receiver from decoding the message. These can sometimes be actual
noises, such as the noise from a nearby construction site or a car honk, a telephone ringing, or a
family member interrupting. However, despite the noise present, if the receiver is capable, the
message will be decoded properly.
Example: A phlebotomist tells verbally to the patient face-to-face, that the patient must relax
and keep still while the procedure is ongoing with a warm smile, and the patient followed
diligently despite being afraid of the procedure.
The Receiver Understands the Message and Sends Feedback to the Sender
The receiver understands the message and provides the sender with feedback, something
that says “I have received your message, and I understand it.” This can be verbal or nonverbal—that
is, the receiver can say something or make some gesture with their body or hands.
NOISE
 Anything that inhibits effective communication can be labeled noise. Although the term can at
times refer to actual sound, noise does not have to literally prevent one or both parties from
audibly hearing the other. Ultimately, anything that disrupts the communication process is
noise. Noise can come in many different forms:
 The receiver of the message may have some sort of physical pain or discomfort that
prevents them from effectively “listening.”
 The receiver may be distracted by fear or anxiety about themselves or a family
member or friend and cannot effectively concentrate on the message.
 There may be a language barrier or cultural differences that prevent the receiver from
understanding the message.
 The receiver may not be interested in what the sender of the message has to say,
either through a simple lack of interest or because of other concerns that have a higher
priority for the receiver.
 The receiver of the message may be hearing or sight impaired.
 The channel by which the sender transmits the message may be faulty or may even
break down as, for instance, when a phone connection has fuzzy static.
Communication Components
Active Listening
True communication is not just about speaking. Effective communication requires that the
listener participate while the speaker delivers the message. It is always a two-way process. Active
listening means taking positive steps through feedback to ensure that the listener is interpreting what
the speaker is saying exactly as the speaker intended. Listening is the foundation of good inter-
personal communication. The phlebotomist will find that listening carefully to what is being said is
particularly valuable in building rapport with patients.
Verbal Communication
Verbal communication is associated with spoken words and is vitally important in the
healthcare context. Members of the multi-disciplinary healthcare team communicate verbally with one
another and with patients as well as family members.
Good verbal skills ensure that the information passed
along to patients and their families is clear, accurate
and honest and use the appropriate language
depending on the patient’s culture, age group and
even their level of understanding. It assists in the
smooth operation of healthcare operations as many of
them want to be addressed in a respectful manner. It
is evident because some love to be addressed by their
first names whereas others by their surnames.
The effectiveness of the verbal communication depends on the tone of the speaker, clarity of
speech, volume, speed, body language and the quality of words used in the conversation. In the case
of the verbal communication, the feedback is immediate since there are a simultaneous transmission
and receipt of the message by the sender and receiver respectively.
The sender must keep his speech tone high and clearly audible to all and must design the
subject matter keeping the target audience in mind. The sender should always cross check with the
receiver to ensure that the message is understood in absolutely the same way as it was intended. At
most, refrain from using medical jargons when communicating with the patient.
Nonverbal Communication
More often, people interpret our non-verbal

communication more than our spoken words. Unlike verbal
communication, formed from words that are one-dimensional,
nonverbal communication is multidimensional and involves the
following elements:
Kinesics
This includes characteristics of body motion and

language such as facial expression, gestures, and eye
contact.
Body language, which most often is conveyed unintentionally, plays a major role in
communication because it is continuous and more reliable than verbal communication. In fact,
if the verbal and nonverbal messages do not match, it is called a kinesic slip. When this
happens, people tend to trust what they see rather than what they hear.
As health professionals, phlebotomists can learn much about patients’ feelings by

observing nonverbal communication, which seldom lies. The patient’s face often tells the
health professional what the patient will not reveal verbally. For instance, when a patient is
anxious, nonverbal signs may include tight eyebrows, an intense frown, narrowed eyes, or a
downcast mouth.
Proxemics
This is the study of an individual’s concept and use of space.

This subtle but powerful part of nonverbal communication plays a
major role in patient relations. Every individual is surrounded by an
invisible “bubble” of personal territory in which he or she feels most
comfortable. The size of the bubble or territorial “zone of comfort”
depends on the individual’s needs at the time. Four categories of
naturally occurring territorial zones and the radius are as follows:
Territorial zone Radius

Intimate 1 to 8 inches
Personal 1 ½ to 4 feet
Social 4 to 12 feet
Public More than 12 feet
Respecting the territorial zones during patient encounters

is very important especially when entering personal or intimate
zones such as in phlebotomy procedures. If this is not carefully
handled, the patient may feel threatened, insecure, or out of
control.
Appearance
The impression the phlebotomist makes as he or she

approaches the patient sets the stage for future interaction. The right image portrays a
trustworthy professional. A phlebotomist’s physical appearance should communicate
cleanliness and confidence.
Some guidelines are:

✓ Lab coats should completely cover the clothing underneath and should be clean and
pressed.
✓ Shoes should be conservative and polished.
✓ Close attention should be paid to personal hygiene.
✓ Bathing and deodorant use should be a daily routine.
✓ Strong perfumes or colognes should be avoided.
✓ Hair and nails should be clean and natural-looking.
✓ Long hair must be pulled back and fingernails kept short for safety’s sake.
✓ According to current CDC hand hygiene guidelines, healthcare workers with direct
patient contact cannot wear artificial nails or extenders.
Touch
Touching can take a variety of forms and convey many

different meanings. This special type of nonverbal
communication is very important to the well-being of human
beings and even more so to those suffering from disease.
Touching is granted to and expected of healthcare workers
under certain circumstances. Because touch is a necessary
part of the phlebotomy procedure, it is important for the
phlebotomist to realize that, patients are often much more
aware of your touch than you are of theirs. Generally speaking,
patients respond favorably when touch conveys a thoughtful
expression of caring.
Task: Try practicing some sign language that you can use with patients whose way of communication
is vising language.
Communication in the
Healthcare Setting
Communication is one of the most important processes that takes place in the healthcare
system. A phlebotomist who lacks a good bedside manner (the ability to communicate empathically
with the patient) increases the chances of patient distrust and misunderstanding. Favorable
impressions result when healthcare workers respond properly to patient needs, and this occurs when
there is good communication between the healthcare provider and the patient. Communication
creates the bridge of connection of trust especially when letting the patient know they will have a safe
experience with the phlebotomy procedure. However, communication is not as easy as saying the
correct words to the receiver of the message. It demands more of how the words will be delivered
verbally and non-verbally.
Elements in Healthcare Communication
Empathy
Defined as identifying with the feelings or thoughts of another person, empathy is an essential
factor in interpersonal relations. It involves putting yourself in the place of another and attempting to
feel like that person. A health professional who recognizes the needs of the patient and allows the
patient to express his or her emotions helps to validate the patient’s feelings and gives the patient a
very necessary sense of control.
Control
Feeling in control is essential to an individual’s sense of well-being. People like to think that
they can influence the way things happen in their lives. An important element relating to
communication in the healthcare setting is recognizing fear in patients, which stems from a perceived
lack of control. A hospital is one of the few places where individuals give up control over most of the
personal tasks they normally perform. Many patients perceive themselves as unable to cope
physically or mentally with events in a hospital because they feel fearful and powerless owing to this
loss of control. Consequently, the typical response of the patient is to act angry, which characterizes
him or her as a “bad patient,” or to act extremely dependent and agreeable, which characterizes him
or her as a “good patient.” If a patient refuses to have blood drawn, the phlebotomist should allow
that statement of control to be expressed and even agree with the patient. Sharing control with the
patient may be difficult and often time-consuming, but awareness of the patient’s need is important.
Respect and Confirmation
Respect is shown in both a positive feeling for a person and in specific action demonstrating
that positive feeling. It is an attitude that conveys an understanding of the importance of that person
as an individual. Believing that all people are worthy of respect at some level is extremely important
in healthcare communication. The effect of honoring and respecting the person as a unique individual
is confirmation of the patient’s presence and needs.
Too often, busy healthcare workers resort to labeling patients when communicating with
coworkers and even with patients themselves. They may say, for example, “Oh, you’re the one with
no veins” or “You’re the bleeder, right?” Such communication is dehumanizing and is a subtle way of
“disconfirming” patients.
Trust
Trust, as defined in the healthcare setting, is the unquestioning belief by the patient that health
professionals are performing their job responsibilities as well as they possibly can. As is true with
most professionals, healthcare providers tend to emphasize their technical expertise while sometimes
completely ignoring the elements of interpersonal communication that are essential in a trusting
relationship with the patient. Having blood drawn is just one of the situations in which the consumer
must trust the health professional. Developing trust takes time, and phlebotomists spend very little
time with each patient. Consequently, during this limited interaction, the phlebotomist must do
everything possible to win the patient’s confidence by consistently appearing knowledgeable, honest,
and sincere.
Communication as Applied to
Phlebotomy
Phlebotomy is both a technical and a people-oriented profession. Communication is an
important tool utilized in all steps of phlebotomy.
Good Standard of Care
▪ Introduce yourself with your first and last name, along with what department you are with.
▪ Eye contact is important when gaining a person’s trust. It will make your job much easier if
you have the patient’s cooperation.
▪ Smile when greeting patients. Regardless of what your day brings, you are not the one being
stuck with the needle or needing medical treatment. So be kind and courteous.
▪ Knock before entering patient’s room. They deserve privacy and respect.
▪ Explain to the patient the procedure that is about to take place. Talk to patient as a person,
don’t expect them to know or understand medical terminology. Use appropriate language,
don’t lie and claim this will not hurt. Trust means everything to patients.
During phlebotomy procedures, a phlebotomist must be able to carry out the message of
assurance and trust. A constant combination of active listening, verbal and non-verbal
communication must be present.
Age-specific communication during phlebotomy

Blood collections on young and elderly patients is technically and emotionally challenging for
the phlebotomist. The young patient poses problems due to size and because they are less
emotionally and psychologically prepared to cope with pain. The elderly or geriatric patient will
present with physical and emotional problems that can be challenging.
Preparing the pediatric patient begins the moment your eyes meet. Children can detect
compassion or indifference in your face and body language just as you can read anxiety or
complacency in theirs. How well you interpret and react to the patient’s state of mind plays an
important role in being able to successfully manage the child’s experience. The phlebotomist
performing a child’s first venipuncture is in a powerful position to affect how the child views every
subsequent venipuncture for life.
I. Communicating to the Elderly:
A. Communicating to elderly with visual impairment

› Identify yourself
› Speak normally, don't shout
› Speak directly to the person
› Explain any procedure being done
B. Communicating to elderly with hearing impairment
› Speak at your normal rate - not too rapidly
› Face the person
› Never speak directly into the person's ear
› Include the person in all discussions about him/her
II. Communicating to Children:
Communicating to children depends a lot on many factors such as language,

developmental stage, emotional preparedness, environmental conditions and basic needs.
The following must be considered when taking blood from children:
With
0-6 6-12 1-3 3-5 6-12 13-17
Special
months months years years years years
Needs
Introduce Introduce Introduce Introduce Introduce Introduce Use strategies

yourself to yourself to yourself to yourself yourself yourself that are
caregiver caregiver caregiver appropriate
and child Talk to child Child may Use adult for the
Explain Talk slowly in simple be interested vocabulary, developmental
procedure to infant Child will terms in health do not talk stage
understand concepts down
Try to simple Allow child "Why" and
make eye commands to touch "How". Explain
contact with and may equipment procedure
infant choose to Explain why thoroughly
cooperate Try using the blood is
familiar needed Ask if he or
Take it slowly, cartoon she would
do not rush characters Involve child like to help
patient with the In the with the
explanation procedure procedure
Allow child
to touch Perhaps use Ask what
supplies toys to might make
demonstrate them more
Ask parent procedure comfortable
to also explain
procedure Child may Allow time
in familiar pretend he for questions
terms or she is or to handle
doctor and supplies
will "help"
with the
procedure
Provide
tokens
for bravery
Word Search
Word Search: Find fifteen (15) words related to NON-VERBAL COMMUNICATION. (15 points)
REFERENCES
› Strasinger, S. and Schaub, M. 2011. The Phlebotomy Textbook. 3rd Edition.
› Ernst, D. 2005. Applied Phlebotomy.
› McCall, R. 2012. Phlebotomy Essentials. 5th Edition.
› Bishop, M. 2013. Clinical Chemistry. 7th Edition.
› Turgeon, M. 2012. Clinical Hematology. 5th Edition.
› WHO guidelines on drawing blood: Best practices in phlebotomy. 2010.
› Clinical and Laboratory Standards Institute: Collection of Diagnostic Venous Blood

Specimens. 2017. 7th Edition.
› Kaplan, A. 1988. Clinical Chemistry: Interpretation and Techniques.
› Burtis, C. and Bruns, D. 2014. Tietz Fundamentals of Clinical Chemistry and Molecular
Diagnostics. 7th Edition.
› McPherson, R. and Pincus, M. 2011. Henry’s Clinical Diagnosis and Management by

Laboratory Methods. 22nd Edition.

MLS 123 MODULE 1 Understanding Phlebotomy

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ALTERNATIVE LEARNING MODULE FOR MLS 123 AND MLS 123L

Department of Medical Laboratory Science

COURSE LEARNING OUTCOMES

Dear future Medical Laboratory Scientists,

MLS 123 and 123L Facilitators

COURSE LEARNING OUTCOMES ............................................................................................... 1

MODULE SELF MONITORING FORM

Schedule Activities Completed

Do Read Quiz Submit

Unit Learning Objectives:

Duties and Responsibilities of a Phlebotomist

Official Recognition of Phlebotomists: How to become a recognized phlebotomist?

Traits Expected of a Phlebotomist as a Professional

The Evolution of Phlebotomy

To distinguish their profession from that of the

Excessive phlebotomy is thought to have contributed to George Washington’s death in

17th – 18th century

Cupping and Leeching

By the mid-18th century, leeching

Phlebotomy is primarily accomplished by one of two procedures:

Full Name: Date of Submission:

Title of the Activity

Unit Learning Objectives:

The Healthcare Setting

The Different Types of Healthcare Settings

Types Services Offered and Description

The Classification of Health Facilities is based on:

Communication is a skill. It is the way by which information is exchanged or transmitted. This

The Elements of the Communication Process

The Sender has an Idea to Communicate

The Sender Encodes the Idea in a Message

The Message Travels over a Channel

The Receiver Decodes the Message

More often, people interpret our non-verbal

This includes characteristics of body motion and

As health professionals, phlebotomists can learn much about patients’ feelings by

This is the study of an individual’s concept and use of space.

Territorial zone Radius

Respecting the territorial zones during patient encounters

The impression the phlebotomist makes as he or she

Some guidelines are:

Touching can take a variety of forms and convey many

Respect and Confirmation

Good Standard of Care

Age-specific communication during phlebotomy

I. Communicating to the Elderly:

A. Communicating to elderly with visual impairment

II. Communicating to Children:

Communicating to children depends a lot on many factors such as language,

Introduce Introduce Introduce Introduce Introduce Introduce Use strategies

› Strasinger, S. and Schaub, M. 2011. The Phlebotomy Textbook. 3rd Edition.

› Ernst, D. 2005. Applied Phlebotomy.

› McCall, R. 2012. Phlebotomy Essentials. 5th Edition.

› Bishop, M. 2013. Clinical Chemistry. 7th Edition.

› Turgeon, M. 2012. Clinical Hematology. 5th Edition.

› WHO guidelines on drawing blood: Best practices in phlebotomy. 2010.

› Clinical and Laboratory Standards Institute: Collection of Diagnostic Venous Blood

› Kaplan, A. 1988. Clinical Chemistry: Interpretation and Techniques.

› McPherson, R. and Pincus, M. 2011. Henry’s Clinical Diagnosis and Management by

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