Section 3: Role of a Phlebotomist

Professionalism

Professionalism is defined as the conduct and qualities that characterize a professional person. Working in the healthcare industry as a phlebotomist requires one to be professional at all times. Professionalism will lead to success in the workplace. Some of the characteristics that demonstrate professionalism are:

Honesty
Integrity and Accountability
Dependability and Reliability
Respectfulness and Consideration
Empathy
Compassion
Professional appearance and dress
Clear communication
Humility
Expertise

Bedside Manner, care, and attitude

The phlebotomy world has myriad different kinds of patients. You will probably meet all types of personalities with differing backgrounds, health histories, and needs. More often than not, the patients you draw will be ill in some way or another. It is important to be sensitive to all patients and their circumstances. Strive to make them feel comfortable, both physically (with the actual blood draw) and emotionally (by the way you talk to them). You may be drawing blood in a number of different scenarios. Regardless of where and why, treat the patient kindly and respectfully. A very important skill to develop as a phlebotomist is engaging in conversation, even if it's "small talk." Many patients are fearful and uncomfortable with getting poked. Find ways to quickly connect with your patient. Ask questions that get them talking or distract them from the needle. Don't be obnoxious or ask invasive questions. Pay attention to their body language. Don't be offended if they don't feel like talking back, but be sure that if they are not responding, you are also watching for signs of syncopal episodes (fainting). Some of these signs include the patient becoming dazed or eyes rolling back, excessive sweating, pale face, salivating, and the body going limp.

Be professional at all times and be sure to tell the patient what you are doing as you do it. Some patients like you to warn them before you poke, others prefer you not to say when. Ask their preference prior to starting. Remember, their comfort will often affect the outcome of your success with the draw. The more fearful a person is, the harder it can be to draw them. Instill confidence in them that you are qualified and capable of your job. Call them by their name as you speak to them. You will be their favorite person when you do well enough at distractions that they don't even realize you have finished!

It may seem obvious, but one of the most important steps in being professional is having a good bedside manner. Additionally, to perform proper care legally, it is necessary to positively identify your patient at the very beginning of your encounter with them. It would be a critical mistake with potentially severe consequences to perform a medical procedure on the wrong person. Be sure to verify their identity with at least first and last name, date of birth and their gender. Ensure their ID bands, paperwork, room numbers, lab orders, and any other identifiers match. Each facility will have different protocols for how to properly perform this. Be sure to learn those protocols. Other "person-specific" identifiers, beside name, birthday, and requisition sheet, include the patient's telephone number, assigned ID numbers, social security number, address, photograph, and driver's license.

If you are ever wondering what you should do or say to show good bedside manner, care, and attitude, just remember this question: "How would I want to be treated?" Go above and beyond for your patients. Offer them water if they feel dizzy, recline them if they are fearful, answer their questions professionally and honestly. Be sure when you answer questions to answer to the level of your position. For example, do not diagnose the patient or explain their results, this is not your job. If they ask you what their results mean, tell them that you'd love to help them but that their provider will have to be the one to explain the results. Be sympathetic and polite. You will go a long way in earning trust by simply being kind and treating your patients with respect.

Legal and Ethical Behavior, Patient consent, and HIPAA

Ethical behavior in the healthcare setting is maintaining a set of standards to protect the patient and avoid harming them in any way. It means to be professional and moral in your treatment of others, especially your patients. All employees are expected to maintain the same code of ethics in the workplace. Legally speaking, improper treatment of your patient is considered malpractice and can lead to lawsuits. We live in a litigious society ("sue happy" society). It is important to be ethical, and aware of the laws. Examples of illegal and unethical behavior include negligence, assault, battery, slander, libel, duty of care, and breach of duty malpractice. Battery is the unlawful use of physical force or contact toward another individual, and assault is the unlawful act of threatening or causing a person to experience fear. Negligence is failure to exercise due care or perform duties according to the standards of the profession. If a medical procedure, such as phlebotomy, results in injury, a claim of negligence can be made by the injured party.

All patients in a healthcare setting have rights and should be informed of these rights when care is initiated. The first priority of all healthcare professionals, including phlebotomists, is to provide high quality patient care in a clean and safe environment, while also maintaining the patient’s personal rights and dignity by being sensitive to differences in culture, race, religion, gender, and age. Patients have the right to respectful care given by competent workers. They have the right to know the names and the jobs of their caregivers, the right to another doctor’s opinion, and the right to make informed decisions regarding their care. These are just a few examples of many. One of the most important patient rights for you to learn is Patient Consent.

Patient Consent is permission from the patient to perform a procedure (like a blood draw) on them. ALL PATIENTS HAVE THE RIGHT TO REFUSE CARE. If a patient tells you they do not want the blood drawn, you CANNOT draw them. There are several ways to receive patient consent.

Informed Consent- When a competent person gives voluntary permission for a medical procedure after receiving all the adequate information about the risks, methods and consequences.
Expressed Consent- The patient gives permission VERBALLY or IN WRITING (a consent form).
Implied Consent- The patient's actions or situation permit the procedure WITHOUT verbal or written consent. (Example: Emergency room situations, or giving you their arm without verbally saying "You have my permission to poke me." It is implied they give you permission when they give you their arm for the draw.)
Parental Consent for Minors- A parent or legal guardian must give permission for procedures to be performed on patients considered underage. Depending on the state this can range from 18-21 years old.

Another patient right to learn well and never forget is the right to privacy. In 1996, a federal law called the Health Insurance Portability and Accountability Act (HIPAA) was passed and required all healthcare providers to obtain a patient’s consent in writing before disclosing medical information such as a patient’s test results, treatment, or condition to any unauthorized person. This is to protect patient privacy. Any HIPAA violations can result in civil penalties of $100 per violation up to $25,000 per person per year. Knowingly disclosing personal health information (PHI) can result in a fine up to $50,000 and one year in prison. Selling or intending to sell PHI for personal gain or malicious intent can result in fines up to $250,000 and 10 years in prison.

Quality Assurance and Quality Control

Quality is the degree of excellence of something. Quality Assurance (QA) is the process used to create standardization for quality service or products, and the prevention of problems. Quality Assurance in healthcare includes all the activities and programs put in place to guarantee the excellence of patient care. QA indicators are used to monitor all aspects of patient care. All medical offices are held to a quality standard. The U.S. Department of Health and Human Services (HHS) is a government agency that works to "enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services" (Assistant Secretary for Public Affairs (ASPA), 2021). There are several other organizations like HHS that have specific regulations and standards that must be met in health care settings. The Centers For Disease Control And Prevention (CDC) "detect and respond to new and emerging health threats, promotes healthy and safe behaviors in communities and in the environment, and attempts to put science and advanced technology into action to prevent disease" (Mission, Role and Pledge 2019). Clinical Laboratory Improvement Amendments (CLIA) is a program that "ensures quality laboratory testing" (Clinical Laboratory Improvement amendments (CLIA) 2021). Under the Department of Labor is an agency called The Occupational Safety and Health Administration (OSHA). OSHA was created "to ensure safe and healthful working conditions for workers by setting and enforcing standards and by providing training, outreach, education and assistance." We'll talk more about OSHA in the next module. These agencies mentioned are just a few that oversee the quality and safety of medical facilities. Other organizations are The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), The College of American Pathologists (CAP), and The National Committee for Clinical Laboratory Standards (NCCLS). Employee training and orientation at a new job will have a section that reviews these agencies and what you will need to know about them. It is important to be aware of the laws as an employee to ensure compliance. This will reflect the quality of the whole facility.

Working as a phlebotomist falls under the "laboratory" category. It is important to maintain Good Laboratory Practices as it will improve quality and patient safety.

GOOD LABORATORY PRACTICES:

Keeping the manufacturer's current product insert for the current product
Follow manufacturer's instructions for specimen collection and handling
Properly identifying the patient
Label the patient's specimen for testing with an identifier unique to each patient
Inform the patient of any test preparation (example: Fasting, clean-catch urine specimens, etc.)
Read product insert prior to performing the test
Follow storage requirements
Do not mix components with other kits
Record patient results in the proper place (example: patient chart, lab test logs. NOT on post-it notes or scrap paper that can be misplaced)
Perform instrument maintenance as directed by the manufacturer

Quality Control (QC) is the specific activities and techniques that are performed to fulfill the requirements for a quality service or product. It identifies weaknesses or errors in the processes at the practice level that could cause poor patient service or test results. It eliminates sources of errors in specific activities or practices to ensure requirements are continually met. QC is performed only by the facility or person performing the activity or procedure under review. Quality control is recognized by using checklists and logs, monitoring performance, and determining causes of error by inspections and reviews. In other words, quality control is finding and fixing problems to prevent repetition.

In phlebotomy, it is the responsibility of the person who supervises the phlebotomist to oversee Quality Assurance (QA) and ensure that checks are being done and standards are being met. It is the responsibility of the phlebotomist to meet those standards at all times. Consistently following national standards for phlebotomy procedures is a means of controlling the quality of the results. QA indicators are measurements or values that provide information on the effectiveness or quality of processes. QA indicators are designed to look at all areas of care.

What is the difference between Quality Assurance (QA) and Quality Control (QC)? Both are essential. Put simply, QA is preventative and QC is corrective. Quality Assurance is used as a managerial tool by supervisors, improves the necessary work processes, is performed by the entire team/staff, and can be identified with written standards, process checklists and project audits. QA is the daily "to-do's." Quality Control catches and stops problems from repeating, is performed by the person assigned and responsible for monitoring the activity or procedure, and is recorded on checklists, logs and error reports.

RETURN TO THE GOOGLE CLASSROOM AND DO THE PRACTICE WORKSHEET.

For more information and references on the reading material found in Section 3: Role of a Phlebotomist, click the link below. Test questions will be based on the reading in the sections and not from more information found in external references and website links.

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