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Chapter 7
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Chapter 7
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Objectives
Upon completion of this chapter, you should be able to:




Describe certification for phlebotomists.
Identify the need for phlebotomy continuing
education.
Define quality assurance (QA) as it pertains to
phlebotomy.
Define quality control (QC) as it pertains to
phlebotomy.
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Objectives Cont’d

List at least three factors that affect laboratory
values.

Identify reasons for specimen rejection.

Define risk management.

Describe risk management issues of liability and
safety as they relate to phlebotomy.
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Certification and
Continuing
Education
Certification
and
Accreditation
Certification
Accreditation
Process that ensures
successful completion of
academic and training
requirements
Process that evaluates the
quality of the training
programs
Purpose of certification is
to protect the public by
setting standards for
individuals working at
various levels of
responsibility
The National Accrediting
Agency for Clinical Laboratory
Sciences (NAACLS) ensures
that the competencies taught
are adequate to provide
accurate laboratory results
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Agencies Responsible for
Agencies Responsible for Phlebotomy Certification
Phlebotomy
Certification
• American Certification Agency (ACA)
•
•
•
•
•
•
American Society of Clinical Pathologists (ASCP)
National Certification Agency for Medical Laboratory Personnel (NCA)
American Society of Phlebotomy Technicians (ASPT)
National Healthcareer Association (NHA)
National Center for Competency Testing (NCCT)
American Medical Technologists (AMT)
Certification
Examination
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Phlebotomy Continuing Education
Required in order to maintain
certification
Methods of obtaining continuing education:
Internet
Seminars
Workshops
Development Programs
A lifelong process necessary
to stay current in your field!
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Apply Your
Knowledge
Which process evaluates the
quality of phlebotomy training
programs?
BRAVO!
ANSWER: Accreditation
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Total Quality Management
An institution-wide concept that involves all members of the
health care team in creating quality processes to improve
customer satisfaction is total quality management (TQM).
• This satisfaction is achieved as a result of both the health
care encounter and the accuracy of the results.
• Health care team members must do more than just the
bare minimum in order to achieve customer satisfaction.
• Some health facilities ask patients to complete surveys
or other rating systems to ascertain their level of
satisfaction with the care they received.
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Total Quality Management Part
Patients requiring phlebotomy services rate the care
2 not just on lab results but also on the
they receive
following:
• How long they had to wait for
the procedure
• Presence or absence of bruising
to the site
• Number of needlesticks or
attempts required
• Their perception of the
phlebotomist (e.g., dress,
communication skills)
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Quality Assurance in
Phlebotomy
• System for evaluating
performance, as in
the delivery of
services to consumers
• Set forth to guarantee
quality patient care
• Uses specific
indicators to track
outcomes of patient
care
• Performance improvement
addresses the
performance of all
workers, not just clinical
personnel
• Quality performance starts
with the physician’s order
and continues until the
laboratory results are
given
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Clinical Indicators and
Outcome Evaluation
• Indicators are
designed to assess
areas of care that
tend to cause
negative outcomes.
• Help to ensure that
the test results are as
accurate and reliable
as possible
Average
Poor
Indicator
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Clinical Indcts. and Outcome
Eval. Part 2
Indicators measure the following:
• Quality
• Accuracy
• Timeliness
Evaluation is to show not only
outcome, but also process, so
that events can be retraced to
improve quality
• Customer satisfaction
An unwanted outcome or negative outcome is called a variance.
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Apply Your Knowledge
The core of total quality management is:
A. Increased team member participation
B. Increased customer satisfaction
C. Decreased liability claims
Answer: B. The core of TQM is customer satisfaction.
Good Job!
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Phlebotomy
Quality
Control
Quality control is the process in which each procedural step
is evaluated to guarantee quality patient outcomes.
• In order to evaluate a process adequately, parameters or
limits must be established.
• Laboratory tests require preparation of both the equipment
and the patient in order to ensure quality outcomes.
• Laboratory user manuals describe procedures and special
preparations that must be followed.
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Phlebotomy Quality Control
PartQuality
2 Control Activities
• Checking supplies to be sure they are not outdated
• Checking for damaged equipment and/or supplies
• Calibrating equipment
• Performing function checks
• Validating results
• Documention of testing
Prior to using any equipment, it is important to ensure that it
is functioning properly.
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Equipment used for point-of-care testing must undergo
system checks.
• The system may have both a high and a low control
• If the system check yields a value outside the established
parameter, it may warrant:
- Repair
- Calibration
- Replacement of the equipment
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Phlebotomy Quality Control
Part 4
Equipment must be accurate and
capable of duplicating results.
If a blood specimen were to be
drawn on a patient at 0700, and
again at 0705, we would expect
the results to be similar.
Results that do not match previous results, expected results,
or the patient’s clinical symptoms require repeating the test.
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The results of tests for potassium and other
blood samples can be affected by:
• Prolonged tourniquet placement
• The dietary state of the patient
• Incorrect volume of blood drawn into the
tube
• The order of draw
• Any special instructions regarding a sample
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Reasons for Rejecting
a Specimen
Specimen
Rejection
• Specimen lacks proper
identification
• Inadequate sample to
perform the test
• Hemolyzed blood samples
• Incorrect time for
specimen collection
• Incorrect tube for the
specimen
• Outdated equipment
• Improper handling of the
specimen
• No date or time on the
specimen
• Contamination of the
specimen
• Label does not match the
requisition
• Clotted specimens in an
anticoagulated tube
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Apply Your Knowledge Part 3
You have just collected a blood glucose specimen and the
result is much higher than all other previous readings. Which
of the following actions would be best?
A. Repeat the test
B. Contact the physician immediately
Great!
C. Record the results immediately
Answer: A. When results do not mirror earlier results and do
not agree with the patient’s symptoms, always repeat the test.
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Risk Management and Reg.
Agencies
Risk Management
departments generate
policies and procedures to
protect from loss or injury.
These departments are designed to protect the
institution from litigation and liability.
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Risk Mangmt. and Reg.
Agencies Part 2
Patient Issues Related to Phlebotomy
• Venipuncture procedures, if improperly performed, can
cause temporary or permanent injury to the extremity.
• Most injuries resulting from phlebotomy procedures are
considered to be either malpractice or negligence.
• The burden of proof always resides with the patient.
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Comn.
Causes
Of
Liability
for
Common Causes of Liability for Phlebotomists
Phlebotomists
• Misidentification of the patient
• Breach of confidentiality
• Improperly labeled specimens
• Performing venipuncture without consent
• Injury to nerves or blood vessels
• Poor sterile technique resulting in patient
infection
• Permanent scarring or disfigurement
• Acting outside the scope of practice
• Starting an IV or performing ABGs
• Mishandling a specimen
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Preventing Liability Suits
• Be aware of standards of care
• Do not perform procedures you are not fully trained to do
• Avoid destructive and unethical criticism of other team
members
• Communicate with tact and professionalism when dealing
with patients
• Always document results and variances immediately
• Do not give false reassurance to patients
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Risk Mangmt. and Reg.
Agencies Part 3
OSHA
Health Care
Personnel Issues
• Exposure to bloodborne
pathogens is a serious
risk to health care
employees
• Phlebotomists must
adhere to CDC and OSHA
guidelines
• Mandated that all
health care facilities
maintain exposure
action plans
• All employees at
greatest risk are to be
given the hepatitis B
vaccination free of
charge
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Risk Mangmt. and Reg.
Agencies Part 4
OSHA Hazardous Communication Standard
• Also called OSHA HazCom
• Governs the identification of potentially harmful chemicals
in the workplace
• All essential information must be labeled for all chemicals.
The information is kept on material safety data sheets
(MSDS).
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Risk Mangmt. and Reg.
Agencies Part 5
MSDS books are available for all health care personnel.
MSDS Sheets:
• Provide emergency information about the chemical product
for immediate treatment in the event contact with it occurs
• Indicate specific data about each substance, such as:
- Whether it is flammable
- What other agents react with it
- How to dispose of it
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Apply Your Knowledge Part 4
The physician has requested that Bob draw ABGs.
Bob indicated that he was not trained fully to do
ABGs, but the physician insisted that someone
perform it STAT, so Bob does it. The patient sustains
temporary paralysis of her arm. Who is liable in this
situation?
A. The physician
B. The patient
C. The phlebotomist
Great!
Answer: C. The phlebotomist should NEVER perform
any skill he or she is not fully trained to perform.
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CHAPTER SUMMARY



Certification ensures successful completion
of an examination by a certifying body and
sets standards for practice.
Phlebotomy continuing education is
necessary to ensure that knowledge and
skills are up to date.
Quality assurance (QA) is a system that
guarantees quality patient care by
evaluating processes.
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CHAPTER SUMMARY



Quality Control (QC) ensures accuracy by setting
standards for procedures, equipment, validating
results, and accurate documentation.
Factors that affect lab values include extended
tourniquet use, dietary intake, volume of blood, order
of draw, and handling of the specimen.
Specimen rejection can occur for many reasons,
including improper ID, hemolysis, incorrect tube
handling, and improper labeling
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CHAPTER SUMMARY



Risk management identifies policies and
procedures to protect patients, employees,
and the employer from loss or injury
Phlebotomist should work within their
scope of practice.
Phlebotomists must follow standard
precautions and utilize MSDS information
when necessary
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END OF CHAPTER 7
Success means having the courage, the
determination, and the will to become the
person you believe you were meant to be.
-- George Sheehan
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