Phlebo

• Patient Consent


  Patients must give consent prior to any procedure and the type of consent depends on the type of procedure to be performed
• Different types of patient consent in health care


  • Informed consent
  • Expressed consent
  • Minor consent
  • Implied consent
  • HIV consent
• Informed Consent


  Requires that the health-care professional explain what the medical procedure is; how it is to be performed, including possible risks; and the expected results. The procedure must be explained in a manner that the patient will understand. Vital to consent is the patient's belief that the health-care professional is competent to perform the procedure
• Health-care professionals may be legally liable for failing to offer information to patients and for not obtaining informed consent. Consent may be expressed or implied
• Expressed Consent


  Primarily required for invasive procedures but can include phlebotomy. The health-care worker explains the procedure as discussed under informed consent. The patient then gives consent in writing or verbally. The most commonly used and safest method for obtaining expressed consent is in writing. Verbal consent must be documented in the patient's chart
• Implied Consent

  Very common in blood collection. The phlebotomist must explain the procedure that will be used to collect the blood sample, stressing that the patient's health-care provider ordered the test. The patient expects that the phlebotomist is competent in blood collection procedures and gives consent to collect the blood samples by extending the arm or rolling up the sleeve. Implied consent also exists when emergency procedures must be performed to save a person's life or prevent permanent impairment to the patient. The law implies consent for treatment for these patients without consent from the responsible party. Implied consent is a state statute, and the limitations vary from state to state
• Consent for Minors and Incapacitated Patients


  Blood collection in minors requires consent of their parents or legal guardians. A legally responsible person must give consent for patients who cannot communicate, persons who are mentally incompetent, patients in shock or trauma, demented patients, or those under the influence of drugs or alcohol. A legal guardian who can give consent may have to be appointed by the courts
• Consent for Testing for Human Immunodeficiency Virus


  State legislation may require informed consent be obtained before HIV testing is performed. The laws dictate what type of information must be provided to the patient. The patient may have to receive an explanation of the test and its purpose, possible uses of the test, the limitations of the test, and the meaning of the test results. In 2006 the Centers for Disease Control and Prevention (CDC) issued a new screening recommendation for HIV testing on all persons between the ages of 13 and 64 receiving treatment at health-care facilities. The procedure is called opt-out screening or opt-out testing. This means that the patient is told that the HIV screening test is part of their routine care and covered by their general consent for treatment. Patients have the right to ask questions about the procedure and the right to decline (opt-out of) the procedure. This differs from opt-in testing where the health-care provider recommends that the patient have the test and the patient must give written consent. Based on state laws the procedure of opt-out screening may vary or not be an option for the facility to use. In some states an accidental needlestick is considered a significant exposure to the health-care worker, and HIV testing can be ordered by a health-care provider without patient consent. In this situation, the HIV results are not entered into the patient's chart
• Respondeat Superior


  The Latin phrase respondeat superior, "let the master answer," establishes that employers are responsible for their own acts of negligence as well as their employees' acts. Institutions are responsible for ensuring that their employees perform only those tasks that are within the scope of their knowledge and training. However, this does not diminish the responsibility of the employee. Both the institution and the employee can be found liable if injury occurs to the patient because of the employee's actions. Professional liability should be a concern for all health-care workers
• Malpractice Insurance


  Most institutions have policies covering all workers, and the phlebotomist should confirm this coverage at the time of employment. Phlebotomists who work independently for insurance companies or home health-care agencies may need to be covered by personal malpractice insurance. Liability insurance can be purchased at a reduced rate through professional organizations
• By consistently practicing good patient care standards, the phlebotomist can avoid the trauma of a lawsuit
• Risk Management

  The potential for injury exists in the health-care profession, and the phlebotomist should be aware of these risks and the precautions necessary to minimize them. Risk is inherent with every venipuncture. Risk management departments develop policies to protect patients and employees from preventable injuries and the employer from financial loss. Risk management programs must identify the risk; determine policies and procedures to prevent the risk; educate employees, patients, and visitors; and evaluate changes that may be necessary for improvement. Various tools are available to identify risks and determine methods for reducing risk and the financial loss incurred by paying for the occurrences after they have happened. One commonly used tool in the phlebotomy department is the incident report
• Patient Consent


  Patients must give consent prior to any procedure and the type of consent depends on the type of procedure to be performed
• Different types of patient consent in health care

  • Informed consent
  • Expressed consent
  • Minor consent
  • Implied consent
  • HIV consent
• Informed Consent

  Requires that the health-care professional explain what the medical procedure is; how it is to be performed, including possible risks; and the expected results. The procedure must be explained in a manner that the patient will understand. Vital to consent is the patient's belief that the health-care professional is competent to perform the procedure
• Health-care professionals may be legally liable for failing to offer information to patients and for not obtaining informed consent. Consent may be expressed or implied
• Expressed Consent

  Primarily required for invasive procedures but can include phlebotomy. The health-care worker explains the procedure as discussed under informed consent. The patient then gives consent in writing or verbally. The most commonly used and safest method for obtaining expressed consent is in writing. Verbal consent must be documented in the patient's chart
• Implied Consent

  Very common in blood collection. The phlebotomist must explain the procedure that will be used to collect the blood sample, stressing that the patient's health-care provider ordered the test. The patient expects that the phlebotomist is competent in blood collection procedures and gives consent to collect the blood samples by extending the arm or rolling up the sleeve. Implied consent also exists when emergency procedures must be performed to save a person's life or prevent permanent impairment to the patient. The law implies consent for treatment for these patients without consent from the responsible party. Implied consent is a state statute, and the limitations vary from state to state
• Consent for Minors and Incapacitated Patients

  Blood collection in minors requires consent of their parents or legal guardians. A legally responsible person must give consent for patients who cannot communicate, persons who are mentally incompetent, patients in shock or trauma, demented patients, or those under the influence of drugs or alcohol. A legal guardian who can give consent may have to be appointed by the courts
• Consent for Testing for Human Immunodeficiency Virus

  State legislation may require informed consent be obtained before HIV testing is performed. The laws dictate what type of information must be provided to the patient. The patient may have to receive an explanation of the test and its purpose, possible uses of the test, the limitations of the test, and the meaning of the test results. In 2006 the Centers for Disease Control and Prevention (CDC) issued a new screening recommendation for HIV testing on all persons between the ages of 13 and 64 receiving treatment at health-care facilities. The procedure is called opt-out screening or opt-out testing. This means that the patient is told that the HIV screening test is part of their routine care and covered by their general consent for treatment. Patients have the right to ask questions about the procedure and the right to decline (opt-out of) the procedure. This differs from opt-in testing where the health-care provider recommends that the patient have the test and the patient must give written consent. Based on state laws the procedure of opt-out screening may vary or not be an option for the facility to use. In some states an accidental needlestick is considered a significant exposure to the health-care worker, and HIV testing can be ordered by a health-care provider without patient consent. In this situation, the HIV results are not entered into the patient's chart
• Respondeat Superior

  The Latin phrase respondeat superior, "let the master answer," establishes that employers are responsible for their own acts of negligence as well as their employees' acts. Institutions are responsible for ensuring that their employees perform only those tasks that are within the scope of their knowledge and training. However, this does not diminish the responsibility of the employee. Both the institution and the employee can be found liable if injury occurs to the patient because of the employee's actions. Professional liability should be a concern for all health-care workers
• Malpractice Insurance

  Most institutions have policies covering all workers, and the phlebotomist should confirm this coverage at the time of employment. Phlebotomists who work independently for insurance companies or home health-care agencies may need to be covered by personal malpractice insurance. Liability insurance can be purchased at a reduced rate through professional organizations
• By consistently practicing good patient care standards, the phlebotomist can avoid the trauma of a lawsuit
• Risk Management

  The potential for injury exists in the health-care profession, and the phlebotomist should be aware of these risks and the precautions necessary to minimize them. Risk is inherent with every venipuncture. Risk management departments develop policies to protect patients and employees from preventable injuries and the employer from financial loss. Risk management programs must identify the risk; determine policies and procedures to prevent the risk; educate employees, patients, and visitors; and evaluate changes that may be necessary for improvement. Various tools are available to identify risks and determine methods for reducing risk and the financial loss incurred by paying for the occurrences after they have happened. One commonly used tool in the phlebotomy department is the incident report
• Sentinel Events

  A sentinel event is defined as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. A list of sentinel events designated by the JC is shown in Box 3-7. The list is updated periodically as the JC becomes aware of additional events. Sentinel events must be documented for the JC. The report must include a root cause analysis and an action plan. Acceptable root cause analyses identify basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event and focus primarily on systems and processes rather than individual performance
• Types of Reportable Sentinel Events


  • Patient suicide
  • Medication error
  • Procedural complication (patient identification)
  • Hemolytic transfusion reaction (patient identification)
  • Unauthorized absence
  • Wrong site/side surgery
  • Treatment delay
  • Abduction
  • Assault, rape, homicide
  • Fall related
  • Unanticipated full-term infant death
  • Unintended retention of a postsurgery foreign body
• A significant number of sentinel events involve incorrect patient identification. This problem directly affects the phlebotomist and serves to stress again the importance of this first step in any phlebotomy procedure. Remember that the first Patient Safety Goal addresses patient identification. Of equal concern to the phlebotomist should be the improper labeling of samples delivered to the laboratory and in particular the blood bank, because this can be the root cause of a hemolytic transfusion reaction
• Health-care–acquired infection (HAI)


  Infection acquired by a patient as the result of a health-care procedure that may or may not require a hospital stay
• The number of HAIs has been increasing in recent years
• Estimates have raised the number of HAIs to be a significant problem in health care
• Health-care worker immunizations/tests

  • Hepatitis B vaccination
  • Measles, mumps, and rubella (MMR) immunization
  • Varicella (chickenpox) immunization
  • Tetanus immunization within the past 10 years
  • Annual tuberculosis skin test (purified protein derivative [PPD])
• Health-care-associated infection (HAI)


  Infection acquired by a patient as the result of a health-care procedure that may or may not require a hospital stay
• HAI


  • Infection following an outpatient phlebotomy procedure if proper precautions were not followed
• Health-care worker immunizations/tests

  • Hepatitis B vaccination
  • Measles, mumps, and rubella (MMR) immunization
  • Varicella (chickenpox) immunization
  • Tetanus immunization within the past 10 years
  • Annual tuberculosis skin test
• Estimates have raised the number of HAIs from 5 percent to 8 percent of hospital admissions
• The number of HAIs is estimated at 1.7 million per year with 99,000 deaths occurring as a result of the infection
• The Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) monitors and analyzes infection control
• The majority of HAIs are the result of personnel not following infection control practices
• Phlebotomists must report all cases of personal illness to a supervisor and keep immunizations current
• Conditions that can limit phlebotomist-patient contact

  • Chickenpox
  • Conjunctivitis
  • Diarrheal disorders
  • Hepatitis A
  • Herpes zoster/shingles
  • Impetigo
  • Influenza
  • Mumps
  • Pediculosis/lice
  • Pertussis/whooping cough
  • Respiratory synctial virus (RSV)
  • Rubella
  • Scabies
  • Streptococcus group A/strep throat
  • Tuberculosis/active