Introduction to Phlebotomy: Roles, Laboratory Sections, and Tests, Lecture notes of Earth science

Download Introduction to Phlebotomy: Roles, Laboratory Sections, and Tests and more Lecture notes Earth science in PDF only on Docsity! CHAPTER 1: INTRODUCTION TO PHLEBOTOMY KEY TERMS Definition ADVANCE DIRECTIVE ➢ Document stipulating the kind of life-prolonging medical care permitted for a patient CENTRALIZED PHLEBOTOMY SAMPLE ➢ Sample collection where the phlebotomist is part of the laboratory team and is dispatched to hospital units to collect blood samples COMPATIBLE ➢ Substances that can be mixed without reacting with one another DECENTRALIZED PHLEBOTOMY ➢ Sample collection where all members of the health care team share responsibility to collect blood samples. DEMEANOR ➢ The outward behavior of an individual ESOTERIC ➢ All processes that are done to perform the test(s) on the sample to achieve a result. FAILURE ➢ A case when the system does not meet user or customer expectations PATHOLOGY ➢ Study of the nature and cause of disease. PHLEBOTOMY ➢ Act or practice of bloodletting as a therapeutic or diagnostic measure POSTEXAMINATION (POSTANALYTICAL) ➢ Process in which the results of the testing are communicated to the health care provider. PREEXAMINATION (PREANALYTICAL) ➢ All processes that it takes to collect the sample and get to the point in which the testing of the sample can occur. QUALITATIVE ANALYSIS ➢ The chemical analysis designed to identify the components of a substance. The results from this analysis are released as a positive (present) or negative (not present) result. QUALITY ASSURANCE ➢ Program that strives to have the health care facility guarantee that all areas are providing the highest quality and most appropriate level of care QUALITY CONTROL ➢ Methods to monitor processes and confirm that processes are within the preestablished limits ➢ Review and monitoring of outcomes to strive toward continuous improvement in performance QUALITY IMPROVEMENT ➢ Review and monitoring of outcomes to strive toward continuous improvement in performance QUANTITATIVE ANALYSIS ➢ The analysis of a substance to determine the amount or proportions of the substance. Results will be released as an amount, such as grams per liter. ROOT CAUSE ➢ Analysis of an event to determine the actual reason for the incident and corrective action needed to prevent a recurrence SENTINEL EVENT ➢ An unexpected occurrence involving death or serious physical and psychological injury. THRESHOLD ➢ Acceptable level of performance. VENIPUNCTURE ➢ Collection of blood from a vein by penetrating the vein with a needle. PHLEBOTOMY  is the process of collecting blood  "the act of practice of bloodletting as a therapeutic measure” Webster's dictionary twelfth century  bloodletting was practiced by barbers, whose red-and-white barber poles became the symbol of their trade. Hybrid phlebotomy • a blend of centralized and decentralized phlebotomy, has been used in some health care facilities to reduce the error of decentralized phlebotomy. • Typically sends laboratory-based phlebotomist to the nursing units during the early morning collection and then keeps a limited number of phlebotomists available the rest of the day to help patient care technicians with difficult collections. ANCILLARY HOSPITAL AREAS AND THEIR PURPOSE Administration-Keeps the hospital in compliance Electrocardiography (EKG) Monitors patients with cardiovascular disease Electroencephalography (EEG)- Diagnosis of neurophysiological disorders Environmental Services - Maintains a clean facility Food Service (Dietary) - Provides diets to patients Gastrointestinal (GI) Laboratory- Diagnoses gastrointestinal disorders Laboratory- Provides testing of patient samples Medical Records-Maintains patient records Nursing Provides - direct patient care Occupational Therapy-Provides therapy to help maintain living skills Pharmacy-Dispenses drugs and advises on drug usage Physical Therapy-Provides therapy to restore mobility Radiology Uses imaging for diagnosis and treatment Respiratory Therapy Provides therapy to evaluate the lungs Speech Therapy-Provides therapy to restore speech AREAS OF NURSING AND TYPE OF CARE Coronary Care Unit (CCU)-increased care of the patient due to a heart condition Emergency Department-Emergency treatment of patients Geriatric - Elderly patients Home Health Care-Follow-up care of a patient at home Intensive Care Unit (ICU) - Increased care due to the ontical needs of the patient Neonatal Newborn care Nephrology-Patients on dialysis Obstetrics Patients in labor of childbirth Oncology Patients with cancer Orthopedic Patients with broken bones Pediatrics infants and children Recovery - Recovery treatment of patients POINT OF CARE TESTING ➢ This testing that is done at the patient's bedside ➢ The instrument is taken to the patient's room, the patient's blood is collected, the blood is tested in the instrument, and results are determined at the patient's bedside LABORATORY SECTIONS AND THEIR PURPOSE Administrative- Office Responds to telephone calls, handies specimen colection requests, and handies some specimens Phlebotomy- (Sample Collection) Collects samples from patients and processes samples for testing or transport Hematology - Studies the blood in normal and diseased states. Usually limited to the study of cellular components and not the chemistry of blood Examples of Tests: Complete blood cell count (CBC), hemoglobin, hematocrit, platelet count, sedimentation rate, body fluid cell counts Coagulation - Study of blood clotting machanisms as an aid in diagnosis or monitoring of patient therapy Examples of Tests: Prothrombin time (PT): activated partial thromboplastin time (aPTT), D-dimer. factor VIII, fibrinogen sasay, heparin level, von Willebrand factor (ristocetin) Urinalysis-Study of urine to aid in patient diagnosis to follow the course of a disease or the body's metabolism Examples of Tests: Unnalysis, reducing substance, urine pH, urino glucose Chemistry-Performs biochemical analysis of blood and body fluids to determine the status of a patient Examples of Tests: Comprehensive metabolic panel, iron studies, ronal panel, carcinoembryonic antigen (CEA), glucose, alanine aminotransferase (ALT), aspartato aminotransferase (AST), cholesterol Microbiology-Cultures samples to determine if pathogenic organisins are present in a sample and determines the organisms sensitivity to antibiotics (culture and sensitivity) Examples of Tests: Blood cultures, throat cultures, anserobic cultures, urine cultures, parasile identification, stool culture, mycobacteria) (tuberculosis) culture, virus cultures, fungal cultures, genital cultures, mycoplasma cultures, antibiotic susceptibility testing Immunology-Studies antigens and antibodies to determine immunity to disease or presence of disease Examples of Tests: Human immunodeficiency virus (HIV) testing, rubolla, syphilis (rapid plasma reagin (RPR)), hepatitis testing Immunohematology -(Blood Bank)-Determines compatibility of blood and blood products that ara to be administered to patients Examples of Tests: Compatibility testing, antibody screens or ABO, Rh determination Cytogenetics - Study of deficiencies related to genetic diseases Examples of Tests: Chromosomes analysis, prenatal chromosome screening Molecular Diagnostics-Using polymerase chain reaction (PCR) technologies to study the presence of various diseases or infections Examples of Tests: Methicillin-resistant Staphylococcus aureus (MRSA) infections, HIV and other infectious disease Examples of Tests: Methicillin-resistant Staphylococcus aureus (MRSA) infections, HIV and These are groups of tests that have been arranged into panela for general Information about a patient's health. These panels are approved for use by the American Medical Association (AMA). COMPLETE BLOOD CELL COUNT (CBC):  White blood cell (leukocyte) count and differential white count  red blood cell (erythrocyte) count;  hematocrit  hemoglobin, red blood cell indices, which include: the mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC)  platelet (thrombocyte) count ELECTROLYTE PANEL (LYTES)  Sodium  Potassium  Chloride  carbon dioxide (CO₂) HEALTH MAINTENANCE ORGANIZATIONS (HMOS) • were formed to provide health coverage for both hospital and physician services. • Members of the HMO are required to use only certain contracted physicians and hospitals for their care. • To become one of the contracted physicians or hospitals, the physician or hospital would offer to provide services at a discount. PREFERRED PROVIDER ORGANIZATION (PPO) • which also contracts with certain health care facilities but offers more freedom for patients to choose to whom they go. This freedom results in a higher cost to the patient or the employer THE AFFORDABLE HEALTHCARE ACT • has been enacted to help those that could not afford insurance. • his requires all people to have health insurance. The theory is that if everyone has insurance, there will be fewer people defaulting on health care bills THE LABORATORY STAFF PATHOLOGIST • Physician who reads and interprets the results of laboratory fests or examines tissues under a microscope to diagnosis and monitor disease. Pathologists are experts in diagnosing such diseases as cancer, diabetes, acquired immunodeficiency syndrome (AIDS), hepatitis, and thyroid conditions. • The American Board of Pathology requires 5 years of training following graduation from medical school to be eligible to take examinations leading to board certification as a clinical/anatomic pathologist. MEDICAL LABORATORY SCIENTIST (MLS) or CLINICAL LABORATORY SCIENTIST (CLS) • Holds a minimum of a baccalaureate degree and is responsible for performing a full range of laboratory tests, confirming the accuracy of test results, and reporting laboratory findings to the pathologist and other physicians. Medical technologists work in five major areas of the laboratory: blood banking, chemistry, hematology, immunology, and microbiology. MEDICAL LABORATORY TECHNICIAN (MLT) • Under the supervision of the medical technologist, performs general tests. Medical laboratory technicians have special training in addition to a high school diploma or an associate degree. PHLEBOTOMY TECHNICIAN (PBT) • Collects blood samples to be used in many laboratory tests to detect and monitor treatment. Phlebotomists have training in addition to a high school diploma. CYTOTECHNOLOGIST (CT) • Examines cells under the microscope to detect signs of cancer in the earliest stages, when a cure is most likely, Cytotechnologists must hold baccalaureate degrees and have special training to search out the smallest abnormalities in color, shape, or size of cells. HISTOTECHNOLOGIST (HTL) • Prepares body tissue samples for microscopic examination by the pathologist using sophisticated techniques such as immunohistochemistry. Histotechnologists must hold baccalaureate degrees and have special training to freeze, cut, mount, and stain the tissues, often while the patient is still in surgery, thus playing a major role in the diagnosis of malignancy Three separate categories of California phlebotomy technicians requiring three separate qualification standards: 1. LIMITED PHLEBOTOMY TECHNICIAN • This technician is only able to perform skin punctures. • The technician must perform 25 skin punctures (fingersticks) before meeting the qualifications for this standard. 2. Phlebotomy Technician 1 • This technician performs skin punctures and venipunctures. • The technician must perform 50 venipunctures and 10 skin punctures (fingersticks) and pass an approved national certifying organization's exam 3. Phlebotomy Technician Il • This technician performs skin punctures, venipunctures and arterial punctures. • The technician must perform 20 arterial punctures and meet the requirements of the Certified Phlebotomy Technician 1. To work in the laboratory, nearly all positions require passing certification and/or state licensing exams. Many agencies certify medical laboratory personnel. Some of these agencies, the certification, and title they confer are listed here: Medical Laboratory Scientist (Medical Technologist) • MLS (ASCP): Medical Laboratory Scientist (American Society for Clinical Pathology) • MT (AMT): Medical Technologist (American Medical Technologists) • CLT (HHS). Clinical Laboratory Technologist (Department of Health and Human Services) Medical Technician • MLT (ASCP). Medical Laboratory Technician, Certificate (American Society for Clinical Pathology) • MLT (AMT): Medical Laboratory Technician (American Medical Technologists) Phlebotomist • PBT (ASCP) Phlebotomy Technician (American Society for Clinical Pathology) • RFT (AMT) Registered Phlebotomy Technician (American Medical Technologists) CPT (ASPT): Certified Phlebotomy Technician (American Society of Phlebotomy • Technicians) Phlebotomy Technician (NCCT): (National Center for Competency Testing) • CPT (NPA): Phlebotomy Technician (National Phlebotomy Association) American Society for Clinical Pathology (ASCP). • The agency that is accepted worldwide in laboratories for all certification and registries. • Even though certification has not raised the pay scale for phlebotomists, it has granted recognition to the phlebotomist as an integral part of the laboratory team. Responsibility refers to the tasks or duties assigned to the position within the organization. Accountability is the obligation to someone higher on the organizational chart. An organizational chart is a multilevel vertical hierarchy that signifies the relationship of one position to another A laboratory organizational chart develops into a pyramid with the number of individuals increasing at the base of the pyramid. The laboratory organizational chart usually contains a smaller, adjacent pyramid that includes the pathologists and their relationship to the rest of the laboratory staff Occupational Safety and Health Administration (OSHA) • Regulations enforced by is committee of inspectors • Establishes and enforces safety standards for employees • Can issue fines if there are violations The Joint Commission Web site offers the patient the opportunity to submit a complaint about any health care organization accredited by The Joint Commission. sentinel event is defined as "an unexpected occurrence involving death or serious physical or psychological injury, or risk thereof. These sentinel events require immediate investigation by the health care organization. The investigation and response would include • Investigation into the root cause of the event • Corrective action and developing a process to prevent the recurrence • Monitoring the new process to determine effectiveness Congress has been involved in the performance standards of the laboratory since it e acted the Clinical Laboratory Improvement Act (CLIA) of 1967. This act mandated com prehensive regulation of laboratories involved in interstate commerce. The laboratories are monitored by the Health Care Financing Administration (HCFA) of the US. Department of Health and Human Services (HHS). They have designated four categories of testing 1. WAIVED TESTS • Tests that are simple, unvarying, and require a minimum of judgment and interpretation. 2. PHYSICIAN • performed microscopy tests. • Tests in which the physician personally looks under the microscope and makes the judgment and interpretation. 3. MODERATE-COMPLEXITY TESTS • Tests that require more complex testing equipment and a moderate amount of judgment and interpretation. Moderate-complexity laboratories must employ personnel with specific levels of education 4. HIGH-COMPLEXITY TESTS • Tests that require the most complex testing equipment and a large amount of judgment and interpretation. Highly complex laboratories must employ personnel with specific levels of education. The Occupational Safety and Health Act of 1970 • regulates the safety and protection of the associate doing testing. The Federal Register Rules and Regulations of December 6, 1991 • established new regulations that employers must follow to protect their associates from blood or other potentially infectious materials. • The enforcement of the act started on July 6, 1992. • This act dictates that the employer is responsible for enforcing the rules and that the Occupational Safety and Health Administration (OSHA) can issue fines of up to $7,000 per infraction. The Joint Commission has outlined 10 steps to a quality assurance plan: 1. Assign responsibility 2. Delineate scope of care 3. Identify important aspects of care. 4. Identify indicators related to these aspects of care. 5. Establish thresholds for evaluation 6. 16. Gather and organize data. 7. Evaluate care when thresholds are reached. 8. Take corrective action 9. Assess the effectiveness of the actions; document improvement. 10. Communicate relevant information. To supplement this plan, the health care facility must also have a total quality management (TQM) and continuous quality improvement (CQI) plan in place. The TQM plan • is a management plan that ensures that the quality expected can be met. • This plan establishes the assurance of adequate supplies and personnel, up- to-date procedures, and acceptable patient outcomes (the patient's health improving). The CQI plan • aims at more than just meeting the minimum standards. • does not accept the status quo, there must be constant efforts to improve what is being done. The phlebotomist must monitor a variety of quality improvement items. Seven examples follow: 1. Phlebotomist response time (for inpatients) 2. Patient waning (for outpatients) 3. Time it takes to perform a phlebotomy procedure 4. Number of redraws due to inappropriate amount of sample 5. Number of incorrect tubes drawn 6. Number of patients requiring a second attempt 7. Number and size of hematomas