Phlebotomy Health Care Delivery System PDF

Week 1: Phlebotomy Health Care Delivery System  Learning Objectives: 1. State the traditional and expanding duties of the phlebotomist. 2. Describe the professional characteristics that are important for a phlebotomist. 3. Discuss the importance of communication and interpersonal ski...

Week 1: Phlebotomy Health Care Delivery System  Learning Objectives: 1. State the traditional and expanding duties of the phlebotomist. 2. Describe the professional characteristics that are important for a phlebotomist. 3. Discuss the importance of communication and interpersonal skills for the phlebotomist within the laboratory, with patients, and with personnel in other departments of the hospital. 4. State and describe the three components of communication. 5. List the barriers to communication and methods to overcome them. 6. Describe a phlebotomist using correct listening and body language skills Learning Objectives: 6. Define cultural diversity and discuss the actions needed by a phlebotomist when encountering cultural diversity. 7. State the competencies expected of a certified phlebotomist. 8. Describe the functions of the nursing, support, fiscal, and professional hospital service areas and the functions of the departments contained in these services. 9. Describe the different types of health-care settings in which a phlebotomist may be employed. Historical Perspective: 460-377B.C 1400 B.C Hippocrates application of a leech to a stated that disease was the result of excess patient evidences substance-such as blood, phlegm, black bile, and yellow bile-within the body. bloodletting in Egypt in about 1400 B.C. 17th to 18th century Middle Ages phlebotomy was considered a major in the Middle Ages, barber–surgeons flourished. By therapeutic (treatment) process 1210, the Guild of Barber–Surgeons had been formed; The lancet, a tool used for cutting the vein Long Robe and Surgeons of the Short Robe. during venesection Short Robe surgeons were forbidden by law to do amount of blood withdrawn was any surgery except bloodletting, wound surgery, approximately 10 mL, but excessive cupping, leeching, shaving, tooth extraction, and phlebotomy was common. enema administration. Long Robe surgeon, barber–surgeons placed a striped pole, from which a bleeding bowl was suspended, outside their doors. They are in charge of “cutting the hair” up to “amputating limbs”  Types of Blood Letting techniques (Venesection) Cupping Leeching Arteriotomy Scarification Cupping involved the Leeches were used. It was potentially a very Scarificators contained application of a heated This procedure involved enticing dangerous method. from 1 to 20 blades, and suction apparatus, called the Hirudo medicinalis, a It was usually performed were similar in the “cup,” to the skin to European medicinal leech, to on the superficial appearance to the lancet. draw the blood the spot needing bloodletting temporal artery or one of Cupping devices were They readily transmitted a its branches. made of glass, a gourd, with a drop of milk or blood on host of blood-borne artery was partially cut or an animal’s horn. the patient’s skin infections from patient to through a single incision. patient. the components of the worm’s saliva, local vasodilator (substance that increases the diameter of blood vessels). local anesthetic. hirudin, an anticoagulant (a substance that prevents clotting). Phlebotomy Today phlebotomy is performed to: 1. Obtain blood for diagnostic purposes and to monitor prescribed treatment 2. Remove blood for transfusions at a donor center 3. Remove blood for therapeutic purposes, such as treatment for polycythemia, a disorder involving the overproduction of red blood cells Phlebotomy is primarily accomplished by one of two procedures: 1. Venipuncture, which involves collecting blood by penetrating a vein with a needle and syringe or other collection apparatus 2. Capillary puncture, which involves collecting blood after puncturing the skin with a lancet. the term phlebotomist is applied to any individual who has been trained in the various techniques used to obtain blood for laboratory testing or blood donations. A competent clinical phlebotomist must have good manual dexterity, special communication skills, good organizational skills, and a thorough knowledge of laboratory specimen requirements and departmental policies.  Official Recognition Certification Licensure Continuing Education a voluntary process by which an Licensure is the act of granting a Continuing education is designed agency grants recognition to an license. to update the knowledge or skills individual who has met certain of participants and is generally prerequisites in a particular License in healthcare is an geared to a learning activity or technical area official document or permit course of study for a specific granted by a state agency that group of health professionals, indicates the completion of gives legal permission for a such as phlebotomists defined academic and training person to work in a particular requirements and the attainment health profession. of a satisfactory score on an examination. must meet specific education and experience requirements and I.e. Certification programs pass an examination before the 1. Basic Phlebotomy procedure by license is granted I.e. ASCPi, PAMET, PASMETH, PNRC PCQACL, PSMLS. 2. Blood Donation Procedure I.e. PRC license (MLT, RMT) PATIENT–CLIENT INTERACTION Positive “customer relations” involves promoting goodwill and a harmonious relationship with fellow employees, visitors, and especially patients. A competent phlebotomist with a professional manner and a neat appearance helps to put the patient at ease and establish a positive relationship. 1. Recognizing Diversity 6. Self-Motivation 2. Professionalism 7. Dependability 3. Self-Confidence 8. Ethical Behavior 4. Integrity 9. Confidentiality 5. Compassion COMMUNICATION SKILLS Many different types of people or customers interact with phlebotomists. Often, the customer’s perception of the healthcare facility is based on the employees they deal with on a one-to-one basis bedside manner (the ability to communicate empathically with the patient) Communication with Patient Verbal Communication Expression through the spoken word is the most obvious form of communication. It involves a sender (speaker), a receiver (listener), and, when complete, a process called feedback, creating what is referred to as the communication feedback loop  communication Examples of communication barriers barriers 1. Language limitations 2. cultural diversity Biases or personalized Filters 3. Emotions that become obstructions to hearing and understanding what has been said and are frequent 4. Age causes of miscommunication. 5. physical disabilities such as hearing loss  Nonverbal Communication It has been stated that 80% of language is unspoken. one-dimensional, nonverbal communication is multidimensional and involves the following elements. (1) happy, (2) sad, (3) surprise, (4) fear, (5) anger, (6) disgust. Kinesics study of nonverbal communication is also called kinesics; it includes characteristics of body motion and language such as facial expression, gestures, and eye contact. If the verbal and nonverbal messages do not match, it is called a KINESIC SLIP. When this happens, people tend to trust what they see rather than what they hear. when a patient is anxious, nonverbal signs may include tight eyebrows, an intense frown, narrowed eyes, or a downcast mouth Proxemics Proxemics is the study of an individual’s concept and use of space. Every individual is surrounded by an invisible “bubble” of personal territory in which he or she feels most comfortable It is often necessary, in the healthcare setting, to enter personal or intimate zones not carefully handled, the patient may feel threatened, insecure, or out of control. Appearance phlebotomist’s physical appearance should communicate cleanliness and confidence. Lab coats, when worn, should completely cover the clothing underneath and should be clean and pressed. Shoes should be conservative and polished. Close attention should be paid to personal hygiene. Bathing and deodorant use should be a daily routine. The Healthcare Setting Healthcare facilities are categorized as inpatient that requires the patient to stay at the hospital for at least a night and outpatient in which patients are served and dismissed the same day. Healthcare has 3 levels of service: Primary – refers to the health units in rural areas and sub-units. Secondary – refers to non-departmentalized hospitals that attend to patients during the symptomatic stages of an ailment. Tertiary – larger hospitals and medical centers that has sophisticated services coupled with highly technical facilities that can address serious illnesses. The Different Clinical Analysis Areas of the Laboratory Clinical labs offers test procedures to aid physicians in diagnosis of diseases. It has two major divisions: Anatomical and surgical pathology – related to the tests such as histology, cytology and cytogenetics. Clinical Analysis area – divided in to seven different areas. Examples of Tests and Procedures in Clinical Analysis Area Clinical Area Test Procedures Hematology – blood Hematocrit and blood-forming tissues Hemoglobin Red Blood Cell Count White Blood Cell Count Platelet Count Differential and WBC count RBC Indices (MCV, MCH, MCHC, RDW) Coagulation – part Activated Partial Thromboplastin Time (APTT) of hematology, ability to form and dissolve D-Dimer test clots Fibrin split products Fibrinogen Tests Prothrombin time Clinical Area Test Procedures Clincal Chemistry – Alanine aminotransferase (ALT) Alphafetoprotein (AFP) amounts of certain chemicals in the Alkaline phosphatase (ALP) Ammonia blood sample Amylase Aspartate aminotransferase (AST) Bilirubin tests Arterial Blood Gas (ABG) Blood Urea nitrogen (BUN) B-Natriuretic peptide (BNP) C-Reactive protein (CRP) Carcinoembryonic Antigen (CEA) Blood Calcium Cholesterol Cortisol Creatine Kinase Creatinine Drug Analysis Electrolytes Glucose Gamma glutamyltransferase (GGT) Hemoglobin A1C Lactate Dehydrogenase (LD) Lipase Prostate Specific Antigen (PSA) Total Protein Triglycerides Troponin Uric Acid Vitamin level tests Clinical Area Test Procedures Serology/ Bacterial Studies Immunology - - Antinuclear antibody serum and - Antistreptolysin O autoimmune - Cold Agglutinins reactions to blood - Febrile Agglutination tests - FTA-ABS - Rapid Plasma Reagin - Rheumatoid factor Viral Studies - Anti-HIV - Cytomegalovirus Antibody - Epstein-Barr Virus - Hepatitis B surface antigen (HBsAg) General Studies - CRP - Human Chorionic Gonadotropin Clinical Area Test Procedures Clinical Physical Evaluation Other Body Fluid Analysis Microscopy – test - Color - Stool urine and other body - Clarity - Cerebrospinal Fluid (CSF) fluid specimen - Specific Gravity - Synovial fluid Chemical Evaluation - Amniotic fluid - Blood - Gastric fluid - Bilirubin - Peritoneal fluid - Glucose - Pleural fluid - Ketones - Pericardial fluid - Leukocyte - Semen - pH - Sweat - Protein - Vaginal secretions - Nitrite - Sputum - Urobilinogen Microscopic Evaluation Examples of Tests and Procedures in Clinical Analysis Area Clinical Area Test Procedures Microbiology – Acid Fast Bacilli microorganism in body fluids and Blood Culture tissues Culture and Sensitivity Fungus Culture and Identification Gram staining Ova and Parasites Blood Bank/ Antibody Screen Immunohematology Direct Antihuman Globulin test – transfusion and blood components. ABO and Rh Typing Type and Crossmatching Compatibility testing The STAT Lab and Reference Lab Stat labs Established in the emergency room Reference laboratory Large independent laboratory that receives specimen from many facilities in the area. Provide routine and specialized analysis of the specimen Offer fast turnaround time and reduced cost ASSIGNMENT Provide an example of setting where there is/are a communication challenge/s encountered by phlebotomists during the procedure. Provide at least five specific examples of appropriate behaviors during phone calls in a laboratory setting and their rationale (e.g., how to greet the caller, confirm information, and handle sensitive data).