Phlebotomy and the Health-Care Delivery System Chapter 1

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.

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.

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

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

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

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

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

Changes in Phlebotomy Changes in health-care delivery Efficiency and cost effectiveness Patient-focused care Cross-training Decentralization of phlebotomy services

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)

Professional and Personal Characteristics for Phlebotomists Service-oriented industry Phlebotomists are the “face of the laboratory”

Professional and Personal Characteristics for Phlebotomists Dependable Cooperative Committed Compassionate Courteous Respectful Honest Integrity Competence Organized Responsible Flexible

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)

Communication Skills for the Phlebotomist Verbal skills Listening skills Nonverbal skills Body language

Verbal Skills Verbal barriers Hearing impairment Emotional level Patient education level Age Language barriers Medications Health status

Verbal Communication Barriers

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

Nonverbal Communication Positive body language Smiling Eye contact Display confidence Negative body language Shuffling No eye contact Acting distracted

Zone of Comfort

Cultural diversity Customs Beliefs Religion Values

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.

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

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)

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

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

Phlebotomy Education and Certification Certification requirements Certification examinations Computer adaptive testing Professional organization membership Continuing education Required for licensure Maintain certification

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)

Phlebotomist Certification

Continuing Education Required for licensure Maintain certification Licensure in only two states Louisiana California Maintain certification ASCP-Certified Maintenance (CM) Requires nine Certified Maintenance Points per 36-month cycle

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

Hospital Patient Care Areas

Hospital Organization

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

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

Support Services Food service Grounds care Housekeeping Human Resources Laundry Maintenance Purchasing Security

Fiscal Services Accounting Admitting Business office Credit and collection Data processing Medical records

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

Professional Services Physical therapy (PT) Treatments Respiratory therapy Breathing disorders Cardiovascular testing ECGs Stress Tests Imaging Clinical laboratory Diagnostic testing

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