Phlebotomy

Parental consent for minors

A parent or legal guardian must permit procedures given to underage patients, depending on the state this can range from 18-21 years old. Patients under the custody of parents or law enforcement cant refuse care as that falls to the custodian of the individual.

Give 2 examples of implied consent

A patient going to the ER and a patient handing you their arm during a blood draw.

Certification of phlebotomy

A voluntary process, the state does not mandate certification. Most certifying agencies are multi-discipline, or they certify many different types of providers. Certification granting agencies use written and/or practical skill evaluations to determine if individuals have met the minimum requisites in specific technical areas that would allow for certification.

Environmental hazards- fire or explosive

Bunsen burners, oxygen, and chemicals can cause burns or dismemberment.

What does PHI require?

PHI is any individually identifiable health information that is transmitted or stored electronically. As healthcare professionals, we safeguard this information.

Expressed consent

Permission is given by the patient verbally or in writing for a procedure

T/F- it is against OSHA to refuse PPE

True

HIV testing consent

special permission is needed to administer a test that detects HIV

What is used for patient identification for outpatient care?

state issued ID containing DOB

T/F- whether or not you think the blood or bodily fluid is infected with bloodborne pathogens, treat it as if it is.

True

T/F- for patient identification, the ID can't be on the bed rail, headboard, or in the patients pocket.

True- the ID band MUST be on the patient.

The portal of entry allows the infectious agent access to the susceptible host. At this point, what do we do?

Try to break the chain of transmission.

Environmental hazards- biologic

Viral, bacteria, parasites, fungal.

What is the easiest and most effective way to break the chain of transmission?

Wash your hands!

Environmental hazards- physical

Wet floors and heavy lifting can cause falls, sprains, and strains

Should you remove PPE before leaving the work area?

YES

What is the proper PPE for vector borne transmission

bunny suit

What is the order of removal of PPE?

gloves, goggles, gown, mask

Agents are infectious microorganisms classified into four groups:

viruses, bacteria, fungi, parasites.

Your rights- although your employer must offer the vaccine to you,.....

you do not have to accept it. You can opt to decline the vaccination series. If you refuse the initial offer, you may still choose to receive the vaccine series at any time during your employment.

What does HIPAA stand for and when was it established?

1996- Health Insurance Portability and Accountability Act (HIPAA)

Informed consent

A competent person gives voluntary permission for a medical procedure after receiving adequate information about the risk of the procedures methods and consequences.

Licensure of phlebotomy

A licensure is granted by the state or local government body giving the licensure holder legal permission to practice in a particular health profession.

Facts about Hepatitis B (HBV)

- Hepatitis B virus is exceptionally durable and can survive in dried blood for 7 days. - HBV is the most common occurring nosocomial infection for lab employees. - in the US, 300,000 people are infected with HBV annually, but of these a small percentage are fatal. - HBV affects the liver, causes inflammation. -HBV is transmitted from blood to blood. - There are different types of HBV, getting one type won't stop someone from getting another type. - There is no cure, but there is treatment. -Although some ppl show no symptom for some time, an infected person may experience mild flu like symptoms. -It takes 1-9 months after exposure for symptoms. -Within 1-3 months, a sense of fatigue, possible stomach pain, loss of appetite, and even nausea may occur. -As the disease progresses, jaundice and darkened urine occur.

If you are an employee who is routinely exposed to blood borne pathogens (doctors, nurses, first aid responders, etc), you should be offered the hepatitis B vaccine series. This costs _____ dollars.

0

Employers can opt to receive the vaccine unless....

1. They have previously received it. 2. Antibody testing revealed they are immune (titer testing). 3. They are contraindicated for medical reasons. 4. Something (symptom or condition) makes a treatment or procedure inadvisable.

What should a sharps injury log contain at minimum?

1. Type and brand of device involved in incident. 2. Department or work area where the exposure incident occurred. 3. Explanation of how the incident occurred.

Starting with January 1. Give an example schedule of the hepatitis B vaccine.

1/1, 2/1, 7/1 (the second is given a month after the first. The second is six months from the first).

Part of employer responsibility and OSHA is that healthcare personal who will potentially be exposed to bodily fluids receive the vaccination series again Hepatitis B within _____ days of employment or sign a declination form.

10

Many procedures require the patient to read and sign an ____

Affidavit stating that they have been informed of their rights. That form is a permanent part of their medical record at every visit.

What is an incident report?

An incident report form records and tracks internal issues. The report will identify everyone involved, the problems, and the actions taken to correct the issues. The incident report can be annotated to include Human Resources actions if the incident reaches that level of interaction from the company. Most likely, incident reports are handled by the office manager in a smaller organization or office setting.

What is the technique to destroy pathogenic organisms?

Aseptic technique

One type of biohazard is bloodborne pathogens. What is this and name 2 examples.

Bloodborne pathogens are microorganisms such as viruses or bacteria that are carried by the blood and can cause disease. Ex: hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

If you find a discrepency with the ID band, you......

CANNOT proceed

Official recognition of phlebotomy involves _______ and ________.

Certification and licensure

Types of OSHA Inspections- Programmed inspection

Conducted on randomly chosen workplaces determined to be engaged in particularly hazardous work types according to their standard industry classification (SIC) codes.

The most important thing about mistakes is....

DONT hide them, they happen.

Penalties regarding HIPAA or PHI can result in...

Disciplinary actions, hefty fines, and possible jail time.

Ethical definition

Ethical behavior entails conforming to a standard of right and wrong to avoid harming the patient. This code of ethics provides personal and professional performance and moral behavior rules that all phlebotomists are expected to follow.

Patients rights

Federal law guarantees the right to privacy of medical records and the ability to obtain a copy of them. Many says will take this protection even further, and most care facilities will protect this information above and beyond the most protective laws.

What is the proper PPE for direct contact transmission?

Gown and gloves

What is the proper PPE for indirect contact transmission?

Gown and gloves

What is the proper PPE for droplet transmission?

Gown, gloves, mask, and face shield.

What is the proper PPE for airborne transmission?

Gown, gloves, n95 mask, goggles.

What is the proper PPE for vehicle transmission?

Gown, gloves, n95 mask, goggles.

Environmental hazards- electric

High voltage equipment can cause burns or electrical shock

Types of OSHA Inspections- Complaint inspection

Occurs after an employee files a formal complaint with OSHA. Most common.

Types of OSHA Inspections- Imminent danger inspection

Occurs when OSHA receives a report that a condition of imminent danger exists at a workplace. Least common.

What should you ask yourself if you want to know how you are doing ethically?

Is what you are doing when no one is watching the same thing you would do if somebody was watching.

Environmental hazards- allergic reaction

Latex sensitivity can cause allergic reactions ranging from superficial dermatitis to anaphylaxis. Use nitrile gloves if there is a latex allergy.

What are commonly used PPE? (6)

Masks, goggles, face shields, respirators, gloves, gowns.

Environmental hazards- sharps

Needles, lancets, and broken glass can puncture, cut, and cause blood borne pathogen exposure.

Under the patients bill of rights, they can always know what tests are being performed and decline medical treatment. However, as your role of a phlebotomist, what is one thing you cant do?

Never give patients results or explain what the tests check for as you are not medically qualified.

What does OSHA do?

OSHA is the federal agency responsible for overseeing the Occupational safety and health act. Be careful to not confuse the agency and the act. OSHA mandates safety regulations across every workplace, from office furniture to bloodwork. OSHA works to prevent safety issues by investigating hazardous workplaces or on the job injuries. OSHA identifies various hazards in the workplace and creates rules and regulations to minimize the exposure to such risks.

What does OSHA stand for?

Occupational Safety and Health Administration

Types of OSHA Inspections- Fatality or accidents inspection

Occurs after OSHA receives notice from the employer of a fatality or accident resulting in 3 or more employee hospitalizations. OSHA also notes media reports and frequent investigations that do not result in death or hospitalizations.

Your bedside manner, care, and attitude should be ________ because most people will be performing venipuncture on patients who are sick.

Pleasant. Introduce yourself and explain the procedure to be performed in easy to understand terms. Positively identify the patient by asking them to state and spell their full name and date of birth. Address the patient professionally until invited to use their first name. Let them know what you are doing at all times. "pleasant with the patient, professional with the poke"

Environmental hazards- chemical

Preservatives and chemicals used in the lab can create possible exposure to toxic, carcinogenic, or caustic substances.

What does PHI stand for?

Protected Health Information

For refusal of care, what should providers do?

Providers can request the patient sign a refusal form to cover the provider and clinic future litigation revolving around failure to provide care. Ex: Discharge against medical advice (AMA).

How to properly remove gloves?

Remove the first glove by pulling it inside out, use that glove to remove the second glove.

What should you do if you make a mistake?

Report the incident to your supervisor so that corrective action can be taken to fix the mistake and help the patient.

What does HIPAA require?

Requires providers to get written permission before disclosing healthcare information to anyone outside the provider team.

Needlestick Safety and Prevention Act (NSPA 2000)

Revised the blood borne pathogens standard to include safer medical devices to avoid accidental sharp injuries. Employers must establish a sharps injury log for percutaneous (through the skin) injury form to protect the confidentiality of the injured employee.

All patients have _______!

Rights

Implied consent

The patients actions permit the procedure without verbal or written consent.

In addition to privacy rights, the patient has total control over their healthcare. This means....

They can give and remove consent for all or part of the patient care procedures. Even if phlebotomy process has begun, the patient can still choose to terminate the procedure. Failure to stop or heed the patients wishes could result in assault or battery charges.

Safeguard information includes

Treatments , test results, medications, procedures, appointment times, appointment dates.