Chapter 1: Phlebotomy pratice and Quality Assessment

what is patient care in phlebotomy

blood collection and ethical responsibility to ensure patient comfort and safety throughout the process

what do professional competencies and phlebotomy include?

accurate specimen, collection, effective communication, and adherence to ethical standards

what does quality improvement in healthcare involve?

Systemic efforts to enhance patient care and outcomes. In phlebotomy, this include includes implementing strategies to reduce error, improve, specimen, handling, and ensure compliance with safety protocols.

what are clinical decisions based on?

Standards of practice

Diagnostic testing (lab test, x-rays)

Patient history

Observation of signs and symptoms

what is the definition of phlebotomy?

Derived from the Greek words, phlebo (veins) and tomy ( cutting)

what words are synonymous with phlebotomy?

venesection or venesection

what are the most common phlebotomy techniques?

Venipuncture

Blood sample from a vein (not an artery) using a needle attached to a collection device

Skin (dermal) or capillary puncture

Superficial skin puncture (finger) to withdraw small amounts of capillary blood

T/F venipuncture involves drawing blood from a vein, typically for larger volumes?

True

T/F skin punctures are used for collecting smaller blood samples

True

which puncture is used for glucose checks ?

skin puncture

how are lab test result used in clinical decisions?

monitoring- is the treatment or therapy effective?

When is venipuncture not practical ?

when used on newborns

what does diagnostic and screening test help identify?

Health concerns

what does the therapeutic monitoring help?

Guide treatment decisions such as adjusting medication doses

What task can a phlebotomist perform?

Clinical, technical, or clerical functions

what environment do phlebotomist practice in?

Labs to hospital, clinics, point of care, home healthcare, ambulance, remote places

what happens in clinical pathology?

Blood and other types of bodily fluid and tissue analyzed

ex: blood, urine, cerebrospinal fluid, CSF, sputum, gastric secretion, synovial fluid

what happens in anatomic pathology?

Autopsies are performed

Historic and cytologic procedures are performed on tissues and fluid specimens

fine needle aspirates in surgical biopsies are analyzed

what are the three stages of laboratory testing?

pre-examination

Examination

post examination

T/F as a phlebotomist your primary responsibility lies in the pre-examination phase

True

what does the pre-examination (pre analytical) include

Patient identification

Specimen collection

Label and handling

Transport to laboratory

what does the examination phase (analytical phase) include

Sample preparation

Instrument analysis

Quality control

what does the post examination (post analytical) phase include

Results are reported to the provider

Result validation

Report generation

Provider notification

receiving an emergency lab test occur during what phase

pre examination (pre- analytical)

agencies that oversee clinical laboratories

Food and Drug Administration (FDA)

Centers for Medicare & Medicaid Services (CMS)

Clinical Laboratory Improvement Amendments (CLIA)

Occupational Safety and Health Administration (OSHA)

Department of Transportation (DOT)

American Society for Clinical Pathologists (ASCP)

College of American Pathologists (CAP)

International Association of Blood Banks (AABB)

The Joint commission

(JCAHO)

which law sets federal oversight standards

CLIA

At the federal level the FDA does what?

regulates lab equipment, test and reagents

what does the center for Medicare and Medicaid services oversee?

Laboratory operation

what does CLIA establish?

National standards for laboratory testing

OSHA protects healthcare workers from?

workplace hazards

what does the department of transportation do?

regulate the packaging and transport of hazardous materials including certain lab specimens

which agencies help maintain laboratory quality and professional standards

American Society for Clinical Pathologists (ASCP)

College of American Pathologists (CAP)

International Association of Blood Banks (AABB)

The Joint commission

(JCAHO)

What does the administrative office handle

scheduling, patient records, billing, and coordination

what does supervisory and management personnel do?

oversee day-to-day operations, making sure staff follow procedures and quality standards

physicians and scientist supervise what kind of areas?

specific areas of the lab such as microbiology or hematology ensuring test are performed correctly and results are interpreted accurately

technical experts and staff perform what

The test and report results turning the blood or body fluid you collect into actionable data

which organizations offer certification, continuing education, and advocacy

American Society for Clinical Laboratory Science (ASCLS)

American Society for Clinical Pathology (ASCP)

National Phlebotomy Association (NPA)

National Health career Association (NHA)



what are the ethical standards for phlebotomist

Do no harm intentionally

Perform according to sound technical ability and good judgment

Respect patients' rights - Maintain Confidentiality and privacy

Right to know about their treatment & Right to refuse treatment

what are the two main categories of quality?

Scientific/technical

Non-technical or interpersonal

what does scientific quality involve?

accurate testing, properties of equipment, and adherence to protocols

what does non-technical quality involve?

How patients are treated (courtesy, empathy, and respect during procedures)

what does efficacy mean?

Healthcare services provided positive outcome, patient improve, recover or benefit from the care provided

what does appropriateness mean?

selecting the correct test or procedure for the right condition at the right time

what do internal stakeholder include?

Inpatient and outpatient

Blood donors

Patients families

phlebotomist

Laboratory staff

Nurses and physicians

Administrators

Students and volunteers

what do external stakeholders include?

local community

Insurance companies

Employers

Grant agencies

Advocacy groups (AARP)

Federal and state agencies like OSHA & CDC

what is regulatory compliance?

ensures that all practices, meet established, safety, and quality standards

What are the quality initiatives?

Code of ethics

Health care organizations evaluate employees credentials and continued performance

Standards of practice...CLSI- Clinical and Laboratory Standards Institute

Educational programs...NAACLS- National Accrediting Agency for Clinical Laboratory Sciences

Certification and licensure...ASCP, NPA, etc.- American Society for Clinical Pathology

Continuous Quality imporvement

Six Sigma

Define, Measure, Analyze, Improve, and Control (DMAIC)

Continuous Quality Improvement (CQl)

In phlebotomy, CQl involves regularly assessing and refining specimen collection techniques to minimize errors and improve patient outcomes.

what is CLSI’s quality management system?

Policies: indicate intentions (commitment to patient safety or error reduction)

Processes: activities required to implement quality policies (steps in a blood draw or in a labeling specimen)

Procedure documents: instructions for performing steps consistently and correctly

what is CLIA’s individualized quality control plan? (WAQCP)

Risk assessment

Quality assessment

Reliability

Accuracy

Precision

what does the WAQCP allow

allows, laboratories to tailor their quality control systems to their specific risk and workflows

what three components make up IQGPP

risk assessment (identifies where errors may occur)

Quality control plan (outlines steps to reduce or prevent risks)

ongoing quality assessment (evaluate whether the plan remains effective overtime)

IQCPT emphasizes three qualities of laboratory performance

reliability

Accuracy

precision

what is apart of quality improvement?

Health care worker's technique

Patient identification procedures

Waiting times

Complications

Recollection/repeat venipuncture rates

Multiple sticks on the same patient

Duplicate test orders

what’s used to review analytical and non-analytical parts of laboratory

Brainstorming, Flowcharts, Pareto charts

Analytic Processes

Accuracy

Cause-and-Effect (Ishikawa or fish bone diagrams)

Bar charts that show frequency of problematic events

Pareto Principle "80% of the trouble comes from 20% of the problems"

Specimer

Reviewing analytic and nonanalytic parts of the laboratory

Plan-Do-Check-Act Cycle (PDCA)

Line graphs, histograms, and scatter diagrams

Checkpoints and tally sheets

Control charts

future trends in phlebotomy

Standardization and globalization (ISO)

Electronic medical records (EMRs)

Smaller, faster laboratory testing (nanotechnology)

Point-of-care- (POC) testing

Direct access testing (DAT)

Direct to customer (DTC) availability

Robots and drones

Education/ Certification

Which phase of the laboratory workflow pathway involves cleansing the skin before venipuncture?

pre-examination (pre analytical)

what are some common characteristics of laboratory professionals

Problem-solving, accuracy, communication, pressure, standards

T/F The workflow concept in a clinical laboratory begins with a request for a laboratory test and ends with laboratory examination results, emphasizing the importance of not following standards of practice to avoid harm to patients and medical errors l

F

Centrifugation of a blood specimen is an example of which phase of laboratory testing?

preexamination/preanalytical

Professional certification typically refers to:

passing a national examination and/or completing continuing education

Which of the following medical specialists would only treat elderly patients?

gerontologist

Which of the following would do the most to promote a professional appearance in a patient care setting?

good posture and personal hygiene

The term "right to know" refers to:

the patient's right to information about his procedures and who is performing them

The term phlebotomy is derived from Greek words that mean:

vein, cut

Cleanliness and personal hygiene are important for:

personal and patient safety

Which of the following is an important work-related characteristic that is helpful for phlebotomists?

enjoying work with small objects

Health care for infants and children falls into which medical specialty?

pediatrics

Which of the following is acceptable attire for a phlebotomist?

necklace tucked inside a collar

What are competency statements for health care workers?

skills and abilities required for job performance

In which circumstances is the phlebotomist likely to collaborate with the pharmacy?

when asked to collect specimens for drug monitoring

Six Sigma is an example of a:

quality improvement framework

Which of the following would be an example of ethical behavior?

respect for patient's privacy

Performing a laboratory test on a patient's blood specimen is an example of which phase of laboratory testing?

examination/analytical

The terms venesection/venisection are synonymous with (the same as) which of the following?

phlebotomy

Which of the following is the medical specialty that pertains to the diagnosis and treatment of skin disorders?

dermatology

Licensure typically refers to:

passing a state-required examination and/or continuing education

An emergency care center is an example of which type of health care setting?

ambulatory care (outpatient) setting

The concept of meeting and exceeding customer expectations by resolving immediate problems, and finding opportunities for improvement where no problems are evident, is known as:

continuous quality improvement (CQI)

What is the practice of drawing blood from a vein?

Phlebotomy

What is the process of puncturing a vein to obtain a blood sample?

Venipuncture

What do you call a patient who stays in a hospital for treatment?

Inpatient

What medical services are provided on an outpatient basis?

Ambulatory Care

What is the phase of laboratory testing that occurs from when lab tests are ordered until the specimen is tested?

Preexamination phase

What phase occurs where the blood specimen is tested and results are generated & confirmed?

Examination phase

What is the phase where the final test results are sent to the ordering physician and critical values are entered?

Postexamination phase

What describes the skill, competence, or character expected of an individual in a trained profession?

Professionalism

What is the study and treatment of tumors and cancer called?

Oncology

Who is a medical specialist that focuses on the diagnosis and treatment of skin conditions?

Dermatologist

Which U.S. agency is responsible for regulating food, drugs, and medical devices?

FDA (Food and Drug Administration)

What is the branch of medicine that focuses on the health care of elderly people?

Geriatrics

What are the federal regulations governing laboratory testing on humans?

CLIA

Which organization accredits and certifies healthcare organizations in the U.S.?

The Joint Commission

What is a nonprofit organization that recommends quality standards and guidelines for clinical laboratory procedures?

CLSI

What method is designed to improve process performance by reducing variation, improving quality, enhancing financial performance, and improving customer satisfaction?

Six Sigma

What are functions of everyday practice in clinical laboratories that make the testing process more accurate and precise?

Quality Control

What is a major area of laboratory services where blood and other types of body fluids and tissues are analyzed?

Clinical pathology

What area of laboratory services involves performing autopsies and analyzing cytology procedures and surgical biopsy tissues?

Anatomic pathology

What refers to specialized clothing or equipment designed to protect healthcare workers from workplace hazards?

PPE (Personal Protective Equipment)