Chapter 16

A phlebotomist collects a patients specimen for potassium using a syringe because the patient's veins were too small and fragile to allow collection with evacuated tubes. After the collection is complete, the phlebotomist realizes that he or she is behind schedule to collect some timed specimens in another unit. To save time, he/she forces the blood out of the syringe rapidly into each specimen tube Which of the following test results is most likely to be influenced by this action?

Potassium

A phlebotomist collects a patients specimen for potassium using a syringe because the patient's veins were too small and fragile to allow collection with evacuated tubes. It was a difficult draw, involving much needle probing and pulling on the syringe handle. Which of the following test results is most likely to be influenced by this collection method?

Potassium

A failure to properly fill a light blue top tube for coagulation tests may introduce which type of variable to the test system?

Pre-examination

Assume that a patient has been identified properly. An error in the patient's preparation for a fasting glucose (so that the patient was collected in a nonfasting state) will affect which phase of the testing process?

Pre-examination

Phlebotomists are mainly involved in which of the following phases of the testing process?

Pre-examination and post-examination phases

Errors in prioritizing specimens appropriately (routine versus stat) for processing are classified as:

Pre-examination variables

An error in identifying a patient properly will affect which phases of the testing process?

Pre-examination, examination and post-examination

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's information management?

Provisions for procedures used by the department.

Quality assessment (QA) differs from quality control (QC) because:

QA refers to the overall process of guaranteeing quality patient care

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's process control?

Quality control results and statistics

Describe the purpose of quality indicators. Give one example of how they would be used in phlebotomy.

Quality indicators are specific areas that are developed in a quality management system (QMS) to monitor each phase of laboratory testing. Answers will vary for examples....

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's testing equipment?

Records of ongoing preventive maintenance

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's documents and records?

Records of the periodic review of all process and procedure documents

Within an institution, a quality management system (QMS) is designed to coordinate activities in achieving which of the following goals?

Reduction of medical errors. Staff competence and efficiency and Ensure quality results

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's occurrence management or nonconforming event management?

Remedial actions taken by each department.

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of the examination of a laboratory's facilities and safety?

Required safety precautions practiced and availability of equipment.

The Lean System utilizes a tool called "6S" that includes the words:

Sort, straighten, scrub, safety, standardize and sustain.

An institution's quality management system (QMS) will incorporate which of the following requirements?

The Joint Commission (TJC), College of American Pathologists (CAP), International Organization for Standardization (ISO), Lean, Root cause analysis and Six Sigma.

The Lean System originated in which industry?

The automobile manufacturing industry in Japan

An effective means of documenting improper patient identification is:

an incident report

Application of the tourniquet on the patient's arm for longer than 1 minute may cause:

an increase in concentration of large molecules

Pre-examination variables occur:

before testing has taken place

All of the following may be effective strategies to reduce the number of contaminated blood cultures EXCEPT:

begin using another type of collection tube media immediately

Six Sigma methodology:

Is a statistical modification of the original plan-do-check-act (PDCA) process.

The phlebotomy department is a central part of the laboratory quality assessment (QA) program because of:

Its close contact with patients and other hospital personnel

A phlebotomist works in a small laboratory that uses manual requisitions forms to order tests. The use of these manual requisitions forms requires the phlebotomist to check the proper box to indicate if the test is routine, STAT or ASAP. If the phlebotomist checks 'routine' instead of 'STAT' for a specimen, which type of variable is introduced into the test system?

Post-examination

In a laboratory test, variables:

can occur in all phases of testing

Post examination variables occur:

during the reporting of the test results

Examination variables occur:

during the testing of the specimens

Accidental punctures with contaminated sharps can reduce productivity and lower morale among the phlebotomy staff and may delay collection and testing of other specimens. Strategies for reducing these incidents include:

provision of ample sharps containers immediate reports to the supervisor and documentation with incident reports & regular and ongoing training in the use of safety features and phlebotomy practices

The acronym QA in a laboratory's QA plan refers to:

quality assessment

Errors in site selection or patient identification affect all of the following EXCEPT:

quality control specimen results

Specimens should remain covered during processing and storage before actual testing to:

reduce the chances of splashing, contamination and evaporation

The use of pneumatic tube systems to deliver patient specimens to the laboratory:

require monitoring to check for hemolyzed or broken specimens.

Pre-examination variables that may be introduced into a test system by a failure to properly calibrate and maintain centrifuges include all of the following EXCEPT:

unacceptable results for quality control specimens

Phlebotomy collection sites that should be avoided because of the possibility of specimen collection include all of the following EXCEPT:

uncomplicated antecubital area of one of the patient's arms

When aliquoting specimens into different tubes, the best means of labeling the pour-off tubes to ensure that specimen numbers are correctly transferred is to:

use extra specimen tube labels generated by the laboratory computer system.

An effective means of increasing the accuracy of patient identification is to:

utilize wrist bands with bar codes to identify patients

Phlebotomists are most involved with the introduction of examination variables into the testing system:

when performing point-of-care (POC) testing

A team of phlebotomists is working the third shift in a laboratory. One of the responsibilities of the third-shift phlebotomists is to monitor the printers that print out routine test results that will be delivered by couriers, beginning during the day shift. Because of the high number of STAT collections requested by the emergency department, no one was able to check on the printers and they ran out of paper. This was not discovered until the first shift was practically ready to begin. Which kind of variable has this series of events introduced into the test system?

Post-examination

State and describe the 12 quality essentials used in a quality management system (QMS).

**See table 26-1

A phlebotomist finishes collecting a specimen for a complete blood count (CBC) from a newborn using a heel puncture collection and microtainer containing ethylenediaminetetraacetic acid (EDTA). Assume the sample is collected exactly according to procedures established by the laboratory. As he/she is leaving the nursery, the child's nurse ask if a calcium draw may be added on - to be done from the same specimen already collected. The phlebotomist does not wish to subject the newborn to another collection, so he/she adds the calcium on to the tests already on the requisition. The action will result in which of the following outcomes?

A decreased calcium result

After collecting several evacuated tubes from a patient, the phlebotomist receives a pager message to go to the intensive care unit (ICU) immediately and draw several STATs. Because of this page, he/she forgets to properly invert the tubes just collected. Which of the following test is most likely to be affected by this action?

Activated partial thromboplastin time (APTT) in a sodium citrate tube.

The Six Sigma System utilizes the acronym DMAIC to describe its principles. In this acronym, A stands for:

Analyze the data for cause-and-effect information.

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's purchasing and inventory?

Availability of adequate reagents, supplies, and service arrangements

Variables that can change or alter the testing system:

Can happen by chance or by human activity

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's personnel?

Continuing Education Records

A primary goal of Six Sigma is to reduce variables and decrease errors to a level of 3.4 defects per 1 million opportunities. Attaining this goal indicates that the laboratory is addressing factors critical to:

Customer Satisfaction and quality care.

A sentinel event report to the Joint Commission (TJC) must include:

a root cause analysis and an action plan

One effective means of detecting improper patient identification is the:

Delta check

Documentation required by the Joint Commission (TJC) includes all of the following EXCEPT:

Detailed procedure manuals on all nursing floors.

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's external and internal assessments?

Development of quality indicators for each phase of testing.

The Lean System focuses on:

Enhancing efficiency and proficiency in the system and in the elimination of waste in a system

A phlebotomist is performing point-of-care (POC) glucose measurements on patients in the outpatient clinic using a glucose meter according to established procedures. He/she notices that one patient's glucose value is very high at 327 mg/dL. The laboratory policy requires that POC glucoses great than 200 mg/dL be verified by a glucose performed in the central laboratory on an instrument. However, the phlebotomist forgets this requirement in his/her haste to phone the results to the patient's physician as soon as possible. This action has introduced which type of variable into the test system?

Examination and Post-examination

Quality system essentials (QSEs) form the basis of a laboratory's quality management system (QMS) and contain the management information needed for a laboratory to perform quality work. Which of the following items might be studied as part of an examination of a laboratory's customer service?

Feedback from customers including patients, patients families, and health-care providers.

The Six Sigma System utilizes the acronym DMAIC to describe its principles. In this acronym, I stands for:

Improve the process using the data collected.

The Six Sigma System utilizes the acronym DMAIC to describe its principles. In this acronym, M stands for:

Measure current processes and collect data.

A properly prepared laboratory procedure manual provides the following types of information about a laboratory test:

Normal values for the test Specimen type and method of collection required & Step-by-step procedure for the test

Quality indicators are part of a quality management system in which of the following ways?

The indicate an opportunity for improvement.

In today's clinical laboratory, written reports of patient results:

are less common but must be placed in the patient's chart or entered into the computer system carefully.

Phlebotomy collection sites to be avoided to prevent patient injury include:

arteries for routine testing arms with fistulas or shunts & burned and scarred areas

Pre-examination variables associated with specimen processing include all of the following EXCEPT:

availability of electronic test report generation instead of paper reports

Laboratory procedure manuals must be:

available to all employees at all times

When performing point-of-care testing, phlebotomists may contribute most effectively to the production of quality patient results by:

consistently using all available quality controls. Strictly following the procedures and manufacture's instructions and performing all required instrument calibration

The best way to avoid introducing pre-examination variables into specimen testing at the specimen processing stage would be to:

consult the procedure manual or the supervisor when questions arise.

Improper cleansing of the venipuncture site is the most frequently encountered variable associated with:

contaminated blood cultures

A phlebotomist who makes a suggestion that shortens the turnaround time for test ordered by the emergency department is contributing to:

continuous quality improvement

The Six Sigma System utilizes the acronyms DMAIC to describe its principles. In this acronym, D stands for:

define goals and current processes

The first step in a laboratory quality management system (QMS) activity is to:

determine the pathway of workflow through the laboratory.

A desirable time for "sweeps" or large numbers of patient collections is:

early morning hours, when patients are in a basal state.

A phlebotomist is collecting a specimen for potassium by fingerstick on an adult patient. the patient's hands are callused and the phlebotomist experiences difficulty in obtaining enough specimen. One possible effect of this difficulty is:

excessive squeezing and tissue fluid in the sample may affect the potassium result

The most serious errors in phlebotomy are:

failures of patient identification

Errors in the requisitioning of a test may include:

generating duplicate orders

Justification for additional training of phlebotomists who are missing tests or collecting improper specimen may be gained by examination of all of the following EXCEPT:

monitoring the schedules of couriers delivering test results

The reporting of patient results by electronic means:

is more common but still requires permanent records

When corrective actions are necessary in the specimen processing area, the phlebotomist should:

keep a record of the actions following established procedures

The outdate listed on a package of blood collection tubes is the:

last date the manufacturer guarantees the stability of the tubes.

Post-examination viariables:

may involve reporting and interpretation of test results

A Delta check helps to detect potential errors in patient results by comparing:

patient results with previous patient results

The primary goal of Six Sigma is to reduce variables and decrease errors to a level of 3.4

per 1 million opportunities

Patient preparation procedures listed in the phlebotomy procedure manual must be followed for all patient collections since these procedures may affect:

pre-examination variables

A phlebotomist has a question about the proper patient preparation and specimen for a test that is done infrequently, and so he/she has not memorized this information. The best place to access this information is the:

procedure manual

The examination phase of testing refers to:

processes occurring during the testing of a specimen

An unexpected patient death that is not related to the patient's illness is termed a:

sentinel event

The following are valid reasons for performing Delta checks EXCEPT verifying that:

sharps wastes were properly disposed of.

Centrifuge performance is verified using a:

tachometer

Documentation in the specimen processing area must include:

technical processing instructions and procedures. procedures for keeping records of corrective actions and instructions for contacting a designated supervisor

Turnaround time (TAT) for a test generally means:

the amount of time between the ordering of a test and the reporting of the result

A phlebotomy supervisor is interested in studying the quality of the point-of-care (POC) glucose results obtained from the tests performed by all phlebotomists. A valid quality indicator for POC glucose results for a given time period is:

the percentage of POC patient and quality control results properly charted.

A phlebotomy supervisor is interested in studying the quality of the blood culture results obtained from the specimens drawn by all phlebotomists. A valid quality indicator for blood culture results for a given time period is:

the percentage of patient results for 'normal skin flora'.

Which of the following forms of information must be present in the patient's medical record when reporting the results of laboratory tests?

the tests performed, the results and the reference ranges of the tests.

Documentation of the time between the delivery of a requisition form to the laboratory and the arrival of the associated specimen in the laboratory can be accomplished by the use of:

time entries in the computer system

The monitoring of specimen ordering may include examination of all of the following measures EXCEPT:

timeliness of the delivery of patient reports

When a test result has been entered incorrectly, the best way to enter a corrected test result in the patient's medical record is:

to follow the facility's policy for entering corrected reports