Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Booth, Wallace, and Fitzgerald PowerPoint Presentation to Accompany PowerPoint ® Presentation to Accompany Chapter 1

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 12 Introduction to Phlebotomy

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 13 Learning Outcomes Upon Completion of this chapter, you should be able to: Describe the evolution of phlebotomy. Describe the roles and responsibilities of the phlebotomist. Discuss professionalism, public image, and customer service as they relate to the phlebotomist

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 14 Learning Outcomes (cont’d) Identify the various settings where phlebotomists are employed. List the regulating agencies for phlebotomy. Identify safety and infection control practices related to phlebotomy. Describe HIPAA, law, and ethics related to phlebotomy.

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 15 Phlebotomy means to cut into a vein. This procedure of cutting or puncturing a vein is performed by a phlebotomist. The primary role of a phlebotomist is to obtain blood specimens for testing. Other roles include packaging urine specimens, accepting incoming specimens, and routing specimens to other departments. Introduction

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 16 History of Phlebotomy History of Phlebotomy PhlebotomyPhlebotomy leeches Removing blood from veins dates back to about 1400 B.C. when leeches were applied to the skin of sick people. In the early 1800’s, medicinal leeches were used for the procedure known as bloodletting. Bloodletting was typically performed by barbers or anyone claiming medical training.

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 17 Bloodletting Performed by a cut into a vein with a sharp instrument to drain blood The lancet was the most popularly used instrument Aseptic practices were not known, so the lancet was reused for several patients Then Now Profession emerged as a result of technology and expansions in laboratory function Performed by trained professionals Standards of practice set by the Clinical and Laboratory Standards Institute (CLSI)

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 18 Apply your Knowledge What is the primary role of the phlebotomist? ANSWER ANSWER: To obtain blood specimens for testing BRAVO!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 19 Apply Your Knowledge The standards for the practice of phlebotomy are set by which organization? ANSWER: ANSWER: Clinical and Laboratory Standards Institute Good Job!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 110 Roles and Responsibilities of the Phlebotomist PATIENT IDENTIFICATION Check armband or ID label in acute care settings Check driver’s license or picture ID in outpatient settings Proper Identification Is a Three-Step Process ASK  COMPARE  VALIDATE 

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 111 Roles and Responsibilities (cont’d) Specimen Collection and Handling Physician orders indicate type of specimen and time of collection Most Commonly Used Methods Venipuncture Insertion of a needle into a vein to remove blood Dermal Puncture Use of puncture device to obtain capillary blood by pricking the skin

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 112 Roles and Responsibilities (cont’d) Professionalism Be professional Apply good interpersonal skills Dress professionally Many institutions require that phlebotomists wear a lab jacket and specified shoes to meet OSHA guidelines.

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 113 Roles and Responsibilities (cont’d) The phlebotomist must be able to communicate using nonmedical terms. Verbal and nonverbal communication should be appropriate, such as: Avoiding the use of slang Speaking in a calm, clear voice Avoiding inappropriate terms Maintaining eye contact Neat, well-groomed appearance Respecting personal space

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 114 Roles and Responsibilities (cont’d) When providing customer service: Be empathetic Observe the patient’s behavior Listen to the patient’s concerns Address any situation promptly Be flexible

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 115 Apply Your Knowledge What are the two most commonly used methods of blood specimen collection? ANSWER: Venipuncture and dermal puncture Great!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 116 Apply Your Knowledge True or False: The phlebotomist must be able to communicate using nonmedical terminology. ANSWER: True. The use of nonmedical terminology is important for patient understanding of the procedure. Bravo!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 117 Where Do Phlebotomists Work (Inpatient) Medical Center Inpatient Facilities Phlebotomists employed at inpatient facilities work directly with several members of the health care team. Hospitals Nursing Homes Rehabilitation Centers

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 118 Where Do Phlebotomists Work (Outpatient) Outpatient Facilities Physician’s Offices Home Health Care Agencies Ambulatory Care Centers Reference Laboratories Blood Banks Ambulatory care centers are the fastest- growing outpatient facilities.

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 119 Apply Your Knowledge Give three examples of inpatient care facilities where phlebotomists may work. ANSWER: Hospitals, nursing homes, and rehabilitation facilities Good Job!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 120 Regulatory Agencies Clinical Laboratory Improvement Amendment (CLIA) Established in 1988 to ensure that all laboratories receiving federal funds, regardless of size, would meet the same standards As of 1992, this legislation became the main regulatory body for all laboratories Establishes qualifications for phlebotomists

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 121 Regulatory Agencies (cont’d) Centers for Disease Control (CDC) Occupational Safety and Health Administration (OSHA) Clinical and Laboratory Standards Institute (CLSI) Healthcare Finance Administration (HCFA) Department of Health and Human Services (DHHS)

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 122 Regulatory Agencies (cont’d) The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the College of American Pathologists (CAP) help ensure a high standard of care for patients. JCAHO is the main accrediting agency for hospitals. Laboratory classifications are based on the complexity of testing. Waived Moderately Complex Highly Complex

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 123 Apply Your Knowledge Which amendment established qualifications for phlebotomists? ANSWER: Clinical Laboratory Improvement Amendment (CLIA) GREAT!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 124 Contact transmission of infectious agents can be caused by either direct or indirect contact. Direct Contact Requires transfer of pathogens from reservoir to a susceptible host (person to person) Indirect Contact Contaminated item is handled prior to contact with a susceptible host (person to contaminated item to person) Safety and Infection Control

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 125 Safety and Infection Control (cont’d) Prevention of Nosocomial Infections Breaking the Chain of Infection The Six Links Breaking the chain of infection at any of these links will prevent an infection from developing.

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 126 STANDARD PRECAUTIONS Combines the good hand hygiene and the use of gloves when workers are exposed to contaminated products ISOLATION PRECAUTIONS Based on how the infectious agent is transmitted: Airborne Droplet Contact Centers for Disease Control (CDC) Levels of Protection for the Prevention of Nosocomial Infections Always follow Standard Precautions with every patient when performing phlebotomy!! Safety and Infection Control (cont’d)

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 127 Safety and Infection Control (cont’d) If performed correctly, will reduce the risk of transmitting infection Steps to Proper Handwashing Remove all rings and jewelry Wet hands thoroughly using warm water Apply antibacterial soap and work up a good lather Interlace fingers using friction to cleanse the hands

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 128 Safety and Infection Control (cont’d) Steps to Proper Handwashing Technique (cont’d) Use an orange stick or handbrush to clean under fingernails Be sure not to lean against the sink area Rinse each hand with fingers pointing downward Keep fingers pointed downward so water and lather will drain toward fingertips Turn water off and dry hands thoroughly with paper towels Turn off water with a clean paper towel if needed Clean area of the sink without recontamination of your hands if needed

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 129 Safety and Infection Control (cont’d) Alcohol-based hand rub Make sure there is no visible dirt or contamination. Apply ½ to 1 teaspoon of alcohol cleanser to one hand. Check the manufacturer’s directions for proper amount. Rub your hands together vigorously, making sure all surfaces are covered. Continue rubbing until your hands are dry.

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 130 Safety and Infection Control (cont’d) OSHA is the federal organization responsible for preventing or minimizing employee exposure to bloodborne pathogens such as hepatitis and HIV. OSHA mandates that health care facilities provide annual training on preventing exposure to bloodborne pathogens. OSHA requires that health care facilities provide the necessary Personal Protective Equipment to prevent exposure. Occupational Safety and Health Administration

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 131 Needlestick Safety and Prevention Act of 2001 Established through the recommendation of the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) Mandated the use of safety devices on needles for the prevention of exposure to bloodborne pathogens All devices for phlebotomy should be equipped with needlestick prevention features Safety and Infection Control (cont’d)

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 132 Apply Your Knowledge Name the two levels of protection developed by the CDC for the prevention of nosocomial infections. ANSWER: Standard and Isolation Precautions GREAT!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 133 Apply Your Knowledge Which agency has the responsibility of minimizing or preventing exposure to bloodborne pathogens? ANSWER: Occupational Safety and Health Administration (OSHA) GOOD JOB!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 134 Health Insurance Portability and Accountability Act (HIPAA) Developed in response to medical information transactions In 2003, established a national standard for electronic health care transactions Protects the privacy and confidentiality of patient information Patient information can be shared only for treatment purposes HIPAA, Ethics, and Law

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 135 HIPAA – Protect Patient Information! Close patients’ room doors when discussing their health Do not talk about patients in public places Log off computers when finished Turn computer screens so passersby cannot see patient information Do not walk away from patient medical records; close them when leaving HIPAA, Ethics, and Law (cont’d)

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 136 HIPAA, Ethics, and Law (cont’d) Code of Ethics Ethics consist of a set of written rules, procedures, or guidelines that aid in determining right from wrong. Remember the Golden Rule!!! Treat others the way you would want to be treated. All Information Concerning a Patient’s Care Must Remain Confidential!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 137 HIPAA, Ethics, and Law (cont’d) A phlebotomist must have clear consent from the patient before performing any blood collection procedure! Patients have the right to: Refuse care Be treated with respect Have all records and information kept confidential Be informed about the purpose and expected results of treatments Have access to their medical records

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 138 Apply Your Knowledge What act was established in 2003 to protect the privacy and confidentiality of patient information? ANSWER: Health Insurance Portability and Accountability Act (HIPAA) BRAVO!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 139 Apply Your Knowledge A patient’s right to refuse care, be treated with respect, have all records kept confidential, and be informed regarding the purpose and outcome of treatment is known as: ANSWER: The Patient’s Bill of Rights GREAT!

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 140 CHAPTER 1 SUMMARY The art of phlebotomy has evolved from the use of leeches to modern-day certified phlebotomists. Phlebotomists are responsible for collecting, processing, and transporting blood specimens. Professionalism involves a positive attitude and appearance, proper communication to the patient, and providing quality customer service. Phlebotomists are employed at hospitals, rehabilitation centers, nursing homes, clinics, physician’s offices, ambulatory care centers, blood banks, and reference labs.

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 141 CHAPTER 1 SUMMARY (cont’d) There are many regulating agencies for phlebotomy including CLSI, JCAHO, HCFA, CDC and OSHA. Infection control and safety practices include hand hygiene and Standard and Isolation Precautions. HIPAA provides protection of health care information. Ethics is used to help determine right from wrong. The law includes following your scope of practice and obtaining consent for procedures.

Copyright © 2010 The McGraw-Hill Companies, Inc. Permission required for reproduction or display END OF CHAPTER 1 Always bear in mind that your own resolution to succeed is more important than any one thing. --Abraham Lincoln