Understanding Phlebotomy

Venesection

Latin words vena, “vein,” and section, “cutting” – was the most common method of general bloodletting.

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another word for Phlebotomy, which comes from the Greek words phlebos, “vein” and tome, “incision.”

Difference between short Robe surgeon and a long Robe surgeon

Long Robe surgeon, barber –surgeons placed a striped pole, from which a bleeding bowl was suspended, outside their doors.

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Short Robe surgeons were forbidden by law to do any surgery except bloodletting, wound surgery, cupping, leeching, shaving, tooth extraction, and
enema administration.

During the 17th and early 18th centuries, what was considered a major therapeutic process? And what was the tool used to draw 10 mL blood?

Phlebotomy and lancet was the tool

Art of Cupping

a great deal of practice to maintain the high degree of 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 “——,” to the skin to draw the blood to the surface.

Lancet

Also called as “fleam”, the capillaries in that area were severed by making a series of parallel incisions

Fleam

This medical instrument was a wide double-edge blade at right angles to the handle. Eventually, multiple of these were attached and folded into a brass case for easy carrying.

The use of fleam in phlebotomy

open an artery or, more commonly, a vein to remove a large amounts of blood.

European medical leech used with Fleams

Hirudo medicinalis

Why was leeching a widely practiced in Europe in the mid-18th century?

the components of the worm’s saliva, which contains a local vasodilator (substance that increase the diameter of blood vessels), a local anesthetic, and hirudin, an anticoagulant (a substance that prevents clotting.

List all of the incorrect definition of phlebotomy:


1. Obtain blood for diagnostic purposes and to monitor prescribed treatment
2. Venipuncture, which involves collecting blood by penetrating a vein with a needle and syringe or other collection apparatus.
3. Remove blood for transfusions at a donor center.
4. Capillary puncture, which involves collecting blood after puncturing the skin with a lancet.
5. Remove blood for therapeutic purposes, such as treatment for polycythemia, a disorder involving the overproduction of red blood cells
6. Obtain blood for diagnostic purposes only and to not monitor prescribed treatment
7. Venipuncture, which involves collecting blood by penetrating a vein with a needle and syringe or other collection apparatus.
8. Blood insertion by transfusions at a donor center.
9. Capillary puncture, which involves collecting blood after puncturing the skin with a lancet.
10. Remove blood for therapeutic purposes, such as treatment for polycythemia, a disorder involving the overproduction of red blood cells
11. The same role of the phlebotomist in the emerging healthcare environment

11, 6, 8

List all the uncommon duties and responsibilities associated with the role of phlebotomist:


1. Prepare patients for collection procedures associated with laboratory samples.
2. Comply with all procedures instituted in the procedure manual. •
3. Promote good relations with patients only and not with hospital personnel. •
4. Collect routine skin puncture and venous specimens for testing as required. •
5. Perform quality-control checks while carrying out clerical, clinical, and technical duties. •
6. Prepare specimens for transport to ensure stability of sample. •
7. Maintain patient confidentiality is not important.
8. Transport specimens to the laboratory. •
9. Assist in collecting and documenting monthly workload and recording data. •
10. Perform skin tests. •
11. Maintain safe working conditions. •
12. Perform appropriate laboratory computer operations. •
13. Prepare and process specimens. •
14. Collect urine drug screen specimens. •
15. Perform electrocardiography. •
16. Participate in continuing education programs is not compulsory. •
17. Collect and perform point-of-care testing (POCT). •
18. Perform on lab experiment only and not on front-office duties, current procedural terminology coding, and paperwork. •
19. Perform quality-control checks on POCT instruments.

3, 7, 16, 18

Certification

a voluntary process by which an agency grants recognition to an individual who has met certain prerequisites in a particular technical area. This is confirmed by the awarding of a title or designation.

Licensure

an official document or permit granted by a state agency that gives legal permission for a person to work in a particular health profession. As a demonstration of continued competency, require periodic license renewal, by either reexamination or proof of continuing education.

Continuing Education

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.

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ASCP, ASCLS, AMT are organizations that awards CEUs by sponsoring programs.

International Association for Continuing Education and Training (IACET)

The most widely accepted CEU standard that is 10 contact hours equal one CEU

PATIENT CLIENT INTERACTION

The phlebotomist is often the only real contact the patient has with the laboratory. In many cases, patients equate this encounter with the caliber of care they receive while in the hospital.

RECOGNIZING DIVERSITY

Culturally aware healthcare providers enhance the potential for more rewarding interpersonal experiences. This can lead to increased job satisfaction for them and increased patient satisfaction with the healthcare services they provide.

PROFESSIONALISM

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. From attire to characteristics and behaviors.

Personal behaviors and characteristics mentioned in the book?

Self-confidence, integrity, compassion, self-motivation, dependability, and ethical behavior

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S I C S D E → SIC SED 🤮🌾

Personal behaviors and characteristics: Self-Confidence

The behavior were the ability to trust his or her own personal judgment. “Perception is reality”

Personal behaviors and characteristics: Integrity

The behavior and/or characteristic that 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.

Personal behaviors and characteristics: Compassion

The behavior and/or characteristic that is considered to be one of the greatest of virtues by major religious traditions; sensitive to a person’s needs and willing to offer reassurance in a caring and humane way.

Personal behaviors and characteristics: Self-Motivation

The behavior and/or characteristic that is a direct reflection of a person’s attitude toward life; 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.

Personal behaviors and characteristics: Dependability

The behavior and/or characteristic that takes personal responsibility for his or her actions is extremely refreshing in today’s environment; set of value that makes a person desirable candidate for a new job opportunities.

Personal behaviors and characteristics: Ethical Behavior

The behavior and/or characteristic that there are policies designed to regulate what should or should not be done by those who work in the healthcare setting.

safeguard the patient’s welfare

The primary objective in any healthcare professional’s code of ethics must always be

Hippocratic oath, primum non nocere means

First do not harm

PATIENT’S RIGHTS

A patient has rights and must be informed of these rights when care is initiated. The patient must sign a statement that these rights have been explained, and the signed statement must be made a part of the patient’s health record.

Medicare and Medicaid

Two bills that were formed by the federal government to strengthen consumer confidence in healthcare system

The Patient Care Partnership (AHA latest revision in 2003)

CONFIDENTIALITY

It serves to protect both the patient and the practitioner. The healthcare provider must recognize that all patient information is absolutely private and confidential.

Health Insurance Portability and Accountability (HIPAA) of 1996

Federal law to obtain a patient’s consent in writing before disclosing medical information to any unauthorized person.

Safeguarding the confidentiality of protected health information (PHI)

one of the primary aims of the HIPAA privacy rule.

Define PHI

individually identifiable health information that is transmitted by electronic media; maintained in any medium described in the definition of electronic media or transmitted or maintained in any other form or medium.

* obtain the patient’s written authorization for any use or disclosure of PHI unless the use or disclosure is for treatment, payment, or healthcare operations.


* To avoid litigation in this area, all HCWs and students must sign a confidentiality and nondisclosure agreement affirming that they understand HIPAA and will keep all patients’ information confidential.

What does HIPAA have a say on the healthcare workers (HCWs)

T/F

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Phlebotomy is both a technical and a people-oriented profession.

True

Communication

the means by which information is exchanged or transmitted, communication is one of the most important processes that takes place in the healthcare system. It has three components which are the verbal, nonverbal, and ability to listen.

Communication components: Verbal Communication

Expression through the spoken word is the most obvious form of communication.

taking positive steps through feedback to ensure that the listener is interpreting what the speaker is saying exactly as the speaker intended.

Accurate verbal exchange depends upon feedback, as it is through feedback that the listener or receiver is given the chance to clarify ideas or correct miscommunication, which may be due to preformed biases.

Communication components: Active Listening

taking positive steps through feedback to ensure that the listener is interpreting what the speaker is saying exactly as the speaker intended. The foundation of a good interpersonal communication.

Communication components: Non-Verbal Communication

80% of language is unspoken. Examples are


1. Kinesics: study of nonverbal communication
2. Proxemics: the study of an Individual’s concept and use of space.
3. Appearance
4. Touch

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K PAT \[(O)K PAT(RICK)\]

Kinesics

The study of nonverbal communication. Has a major role in communication.

It includes characteristics of body motion and language such as facial expression, gestures, and eye contact.

Kinesic slip

if the verbal and nonverbal messages do not match, it is called a

Proxemics

the study of an individual’s concept and use of space. Powerful in patient relations.

Match the following to its correct zone radius

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1. Intimate
2. Personal
3. Social
4. Public

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Zone radius

A. 1 and half to 4 feet

B. More than 12 feet

C. 4 to 12 feet

D. 1 to 18 inches

1. D
2. A
3. C
4. B

Appearance

The right image portrays a trustworthy professional. A phlebotomist’s physical appearance should communicate cleanliness and confi dence. Lab coats, when worn, should completely cover the clothing underneath and should be clean and pressed.

Touch

that is therapeutic and is designed to aid in healing has found a new place in medical practice. It is a PRIVILEGE granted under certain circumstances.

ELEMENTS IN HEALTHCARE COMMUNICATION: Empathy

Definition: identifying with the feelings or thoughts of another person, empathy is an essential factor in interpersonal relations.

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Need: 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.

ELEMENTS IN HEALTHCARE COMMUNICATION: Control

Essential to an individual’s sense of well-being.

* People like to think they can influence the way things happen on the lives.

ELEMENTS IN HEALTHCARE COMMUNICATION: Respect and Confirmation p

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.

ELEMENTS IN HEALTHCARE COMMUNICATION: Trust

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.

ELEMENTS IN HEALTHCARE COMMUNICATION: Telecommunication

Each one should be taught how to answer, put someone on hold, and transfer calls properly. To promote good communication, proper telephone etiquette (see Table 1-3) should be followed

**inpatient** (nonambulatory) and **outpatient** (ambulatory), support all three (primary, secondary, and tertiary) levels of healthcare currently offered in the United States.

What are the two general categories of facilities under healthcare delivery?

AMBULATORY CARE AND HOMEBOUND SERVICES

These services meet the needs of patients who may still require nursing care, lab tests, or other follow-up procedures after discharge from the hospital.

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Ambulatory care is classified into two types

* (a) freestanding medical care settings and hospital- owned clinics and
* (b) outpatient departments and urgent care facilities.

Outpatient demands falls heavily on hospital emergency departments.

Differentiate outpatient from inpatient

PUBLIC HEALTH SERVICE

One of the principal units under the Department of Health and Human Services (HHS) is

Mission of PHS

to promote the protection and advancement of the nation’s physical and mental health by sponsoring and administering programs.

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\-Notes-

Public health departments provide their **services for little or no charge** to the entire population of a region, **with no distinction between rich or poor**, simple or sophisticated, interested or disinterested.

Public health facilities **offer ambulatory care services through clinics**, much like those in hospital outpatient areas, military bases, and Veterans Administration and Indian Health Service facilities. As the country moves into managed care, integration between primary prevention and primary/ambulatory care is necessary.

Healthcare financing

Paying for healthcare services involves multiple payers and numerous mechanisms of payment.

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It consists of

* Third-Party Payers
* Diagnoses and Billing Codes
* Reimbursement

THIRD-PARTY PAYERS

It can be an insurance company, the
federal government, a managed care program, or a self- insured company that pays for healthcare services on behalf of its employees. Some healthcare providers are even beginning to contract directly with the employers to provide healthcare, thus eliminating insurance carriers.

The Center for Medicare and Medicaid Services (CMS) contracted with 3M Health Information Systems to develop the Procedural Coding System (PCS) to replace the list of procedure codes found in ICD-9-CM. It is called what?

International Classification of Diseases–Tenth Revision, Procedural Coding System, or ICD-10-PCS.

In 2013, ICD-10-PCS procedure codes will be available for use in (1) settings and CPT procedure codes will continue to be used for patients seen in (2) settings and for (3)

inpatient, ambulatory, & professional services in inpatient settings.

AHCCCS

Arizona Health Care Cost Containment System

Managed care is a generic term for a payment system that attempts to manage cost, quality, and access to healthcare by:

o Detecting illnesses or risk factors early in the disease process o Putting into practice various financial incentives for providers

o Offering patient education

o Encouraging healthy lifestyles

Case Management

One of the most important concepts in managed care is that of the designated case manager (primary care physician , gatekeeper), whose responsibility it is to coordinate all of a patient’s healthcare.

Network Service Systems

Today’s large managed care organizations (MCOs) evolved from prepaid healthcare plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

Match


1. HMOs
2. PPOs
3. Goal of MCO
4. IDS

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A. a healthcare provider made up of a number of associated medical facilities that furnish coordinated healthcare services from prebirth to death.

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B. independent groups of physicians or hospitals that offer services to employers at discounted rates in exchange for a steady supply of patients.

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C. to reduce the total cost of care while maintaining patient satisfaction, and this can best be done if the patient can get the right care from the right provider at the right time.

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D. group practices reimbursed on a prepaid, negotiated, and discounted basis of admission.

1. D
2. B
3. C
4. A

Medical Specialties

As a manager of a person’s care, he or she is expected to refer to the appropriate specialist as needed.

Actually the term hospital can be applied to any healthcare facility that has these four main characteristics: What are they?

o Permanent inpatient beds
o 24-hour nursing service
o Therapeutic and diagnostic services

o Organized medical staff

Hospitalist

a general physician who assumes the care (admission and ongoing treatment) of inpatients in the place of a primary care physician

Speciality: Anesthesiology

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area of interest & specialist title?

Partial or complete loss of sensation, usually by injection or inhalation

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Anesthesiologist

Speciality: Cardiology

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area of interest & specialist title?

Diseases of the heart and blood vessels and cardiovascular surgery, a subspecialty of internal medicine

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Cardiologist

Speciality: Dermatology

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area of interest & specialist title?

Diseases and injuries of the skin; more recently, concerned with skin cancer prevention

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Dermatologist

Speciality: Endocrinology

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area of interest & specialist title?

Disorders of the endocrine glands, such as, sterility, diabetes,

and thyroid problems

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endocrinologist

Speciality: Family medicine

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area of interest & specialist title?

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Individual and family care by integrating biological, behavioral, and clinical sciences for treatment

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General or family practitioner

Speciality: Gastroenterology

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area of interest & specialist title?

Digestive tract and related structural diseases, a subspecialty of internal medicine

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Gastroenterologist

Speciality: Gerontology

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area of interest & specialist title?

Effects of aging and age-related disorders

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Gerontologist

Speciality: Hematology

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area of interest & specialist title?

Disorders of the blood and blood-forming organs

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Hematologist

Speciality: Infectious Diseases

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area of interest & specialist title?

Contagious and noncontagious infections caused by pathogenic microorganisms

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ID Specialist

Speciality: internal medicine

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area of interest & specialist title?

Diseases of internal organs and general medical conditions; uses nonsurgical therapy

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Internist

Speciality: Nephrology

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area of interest & specialist title?

Diseases related to the structure and function of the kidney

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Nephrologist

Speciality: Neurology

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area of interest & specialist title?

Disorders of the brain, spinal cord, and nerves

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Neurologist

Speciality: Obstetrics and Gynecology

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area of interest & specialist title?

Sees women through pregnancy, childbirth, disorders of the reproductive system, and menopause

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Gynecologist

Speciality: Oncology

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area of interest & specialist title?

Tumors, including benign and malignant conditions

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Oncologist

Speciality: Ophthalmology

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area of interest & specialist title?

Eye examinations, eye diseases, and surgery

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Ophthalmologist

Speciality: Orthopedics

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area of interest & specialist title?

Disorders of the musculoskeletal system, including preventing disorders and restoring function

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Orthopedist

Speciality: Otorhinolaryngology

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area of interest & specialist title?

Disorders of the eye, ear, nose, and throat

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Otorhinolaryngologist

Speciality: Pediatrics

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area of interest & specialist title?

Diseases of children from birth to adolescence, including wellness checks and vaccinations

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Pediatrician

Speciality: Psychiatry

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area of interest & specialist title?

Mental illness, clinical depression, and other behavioral and emotional disorders

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Psychiatrist

Speciality: Pulmonary Medicine

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area of interest & specialist title?

Function of the lungs; treatment of disorders of the respiratory system

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Pulmonologist

Speciality: Rheumatology

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area of interest & specialist title?

Rheumatic diseases (acute and chronic conditions characterized by inflammation and joint disease)

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Rheumatologist

Speciality: Urology

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area of interest & specialist title?

Urinary tract disease and disorders of the male reproductive system

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Urologist

What are departments within area in the service area: patient care services?

Nursing care, emergency services, intensive care units (ICUs), and surgery

What are the departments with the support services area?

Central supply , dietary services , environmental services, and HIS

What are the departments within professional services area?

Cardioagnostics (EKG or ECG), pathology and clinical laboratory, electroneurodiagnostic technology (ENT) or electroencephalography (EEG), Occupational therapy (OT), pharmacy, physical therapy (PT), respiratory therapy (RT), and Diagnostic radiology services.

Nursing care

Direct patient care. Includes careful observation to assess conditions, administering medications and treatments prescribed by a physician, evaluation of patient care, and documentation in the health record that reflects this. Staffed by many types of nursing personnel including registered nurses (RNs), licensed practical nurses (LPs), and certified nursing assistants (CNAs).

Emergency services

Around-the-clock service designed to handle medical emergencies that call for immediate assessment and management of injured or acutely ill patients. Staffed by specialists such as emergency medical technicians (EMTs) and MDs who specialize in emergency medicine.

Intensive care units

(ICUs)

Designed for increased bedside care of patients in fragile condition.

Found in many areas of the hospital and named for the type of patient care they provide (e.g., trauma ICU, pediatric ICU, medical ICU).

Surgery

Concerned with operative procedures to correct deformities and defects, repair injuries, and cure certain diseases. All work is performed by licensed medical practitioners who specialize in surgery.

Central supply

Prepares and dispenses all the necessary supplies required for patient care, including surgical packs for the operating room, intravenous pumps, bandages, syringes, and other inventory controlled by computer for close accounting.

Dietary services

Selects foods and supervises food services to coordinate diet with medical treatment.