Phlebotomy: Chapter 16

Documentation required by TJC includes what 6 things?

1) A detailed procedure manual. 2) Identification of variables associated with the procedures. 3) Policies to control and monitor variables. 4) Reference manuals provided to nursing and other nonlaboratory staff who collect specimens. 5) Competency assessments. 6) Continuing education records.

TJC requires what 2 things?

1) A planned, systematic process for the monitoring and evaluation of the quality and appropriateness of patient-care services. 2) The resolution of identified problems.

A good medical record must be what 3 things?

1) Accurate 2) Complete 3) Concise

Application of a tourniquet for longer than 1 minute increases the concentration of what 4 large molecules?

1) Bilirubin 2) Lipids 3) Protein 4) Enzymes

Records may be used to determine the need for what 3 things?

1) Changes to the reference manual. 2) Continuing education presentations for those ordering tests. 3) Additional phlebotomy staffing or training.

The NCE process must do what 4 things?

1) Document the NCE episode and associated actions. 2) Classify the event type and its seriousness. 3) Initiate remedial action, when possible. 4) Begin an investigation and corrective action plan.

What 2 things are required for accreditation?

1) Documentation of centrifuge calibration and maintenance. 2) Documentation of temperature readings.

It is the responsibility of the phlebotomy supervisor to do what 3 things?

1) Enter all policy and procedural changes into the manual. 2) Notify personnel of changes to the manual. 3) Document an annual review of the entire manual.

What are the 2 most critical variables in patient preparation?

1) Fasting. 2) Abstaining from certain medications.

What are 2 errors in requisitioning?

1) Generation of duplicate requisition forms. 2) The missing of tests.

What 2 things should a phlebotomist do for economical management of phlebotomy supplies?

1) Keep packages of tubes stored in groups by lot number. 2) Place the lots with the shortest expiration dates in the front of the storage area.

What 3 things are included in the laboratory reference manual?

1) Laboratory schedules for inpatient collection of routine specimens. 2) A list of laboratory tests and instructions. 3) Any changes to laboratory policies.

Variables can be divided into what 3 groups?

1) Pre-examination variables. 2) Examination variables 3) Post-examination variables.

What 13 things does the procedure manual provide?

1) Principle and purpose 2) Specimen type and method of collection 3) Equipment and supplies needed 4) Tube and volume requirements 5) Specimen handling and precaution instructions 6) Standards and controls 7) Step-by-step procedure 8) Specific procedure notes 9) Limitations of the method 10) Corrective actions 11) Method validation 12) Normal values 13) References

What 2 things does the QMS focus on?

1) Resolving issues. 2) Preventing issues.

What are the 6 S's of the Lean system?

1) Sort 2) Straighten 3) Scrub 4) Safety 5) Standardize 6) Sustain

Variables in phlebotomy technique affect what 2 things?

1) Specimen quality. 2) Patient safety.

Variables associated with specimen processing include what 5 things?

1) The length of time between collection and processing or testing. 2) Centrifugation time and speed. 3) Contamination. 4) Storage conditions. 5) Labeling.

Variables in the transportation of specimens include what 2 things?

1) The method and timing of delivery to the laboratory. 2) The use of special handling procedures.

Monitoring of specimen ordering can include records of what 4 things?

1) The number of specimens rejected. 2) Errors in requisition forms. 3) The number of missed tests. 4) The turnaround time.

What 4 things do pre-examination variables include?

1) The ordering of specimens 2) The collection of specimens 3) The transportation of specimens 4) The processing of specimens

What are the 4 purposes of a non-conforming event management program?

1) To identify problems with the processes in the laboratory's workflow path. 2) To improve the process quality and safety of patients and employees. 3) To implement procedural changes that support continual improvement. 4) To work to remove the cause of non-conforming events.

QC includes what 2 things?

1) Use of approved standardized procedures. 2) Use of controls and instrument calibrators when performing specimen testing.

The phlebotomist should always document what 4 things when telephoning results?

1) Verbal results with the time of the call. 2) The name and credentials of the receiver. 3) Confirmation of a read back. 4) The identity of the caller.

Lean utilizes a tool called what?

6S.

A missed test causes a routine test to be ordered on what basis?

A STAT basis.

What is a delta check?

A comparison between a patient's previous test results and the current results.

The laboratory must facilitate test ordering by providing what?

A laboratory reference manual.

What is Six Stigma?

A statistical modification of the original PDCA method developed by Deming and adopted by TJC as a guideline for healthcare organizations.

What is root cause analysis?

A tool widely used in the investigation of adverse events in the healthcare setting.

What can a delta check do?

Alert laboratory personnel to the possibility of an error.

A laboratory supervisor frequently generates what as documentation of poor technique affecting patients or specimen quality?

An incident report.

What is a non-conforming event?

An instance that failed to meet a requirement.

What is a sentinel event?

An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.

The procedure manual must be available to who?

Anyone collecting blood specimens at the facility or sending specimens to the laboratory for analysis.

What is a variable defined as?

Anything that can be changed or altered.

What can solve problems with patient identification?

Bar-coded technology.

How is a centrifuge calibrated?

By using a tachometer to confirm rpm at various settings.

The microbiology department maintains records of what?

Contaminated blood cultures.

What does CQI stand for?

Continuous quality improvement.

What does a quality management system do?

Coordinates activities to direct and control an organization with regard to quality and the reduction of medical errors.

The Six Sigma methodology utilizes what acronym?

DMAIC.

What does DMAIC stand for?

Define goals and current processes. Measure current processes and collect data. Analyze data for cause and effect information. Improve the process using data collected. Control the correction of concerns displayed.

What is the most common method for reporting results?

Electronic transmission.

When are centrifuges routinely calibrated?

Every 3 months.

What is the most serious error in phlebotomy?

Failure to identify a patient properly.

What are quality indicators?

Graphic measurements that monitor and track performance of work processes.

Blood culture contamination is a variable associated with what?

Improper cleansing of the puncture site.

Where does RCA have roots?

In the manufacturing industry, like the Lean System.

What does ISO stand for?

International Organization for Standardization.

Who develops quality system essentials?

Management.

QA is an essential part of preventing what?

Medical errors.

Delta checks are detected by who?

Medical laboratory scientists who examine the results.

Should the phlebotomist ever erase an error?

No; they should draw a thin line through it and initial it or correct it online along with a comment indicating the error.

What does NCE stand for?

Non-conforming event.

What must be present on collected specimens?

Phlebotomist identification.

What is part of laboratory and facility QMS?

Phlebotomy QA.

What does PDCA stand for?

Plan-Do-Check-Act.

What may also increase as a result of lengthy tourniquet application?

Potassium levels.

Quality control is a part of the laboratory's overall program of what?

Quality assurance.

What does QMS stand for?

Quality management system.

What does QSE stand for?

Quality system essentials.

What is the telephone used to transmit?

Results of STAT tests and critical values.

What does RCA stand for?

Root cause analysis.

Samples should not be stored in what?

Self-defrosting freezers.

TJC mandates the use of RCA to investigate what?

Sentinel events.

Manufacturers of evacuated tubes must ensure they meet the standards established by who?

The Clinical and Laboratory Standards Institute.

What is TAT defined as?

The amount of time required from the ordering of a test by the healthcare provider to reporting of the results to the healthcare provider.

What does the Lean system focus on?

The elimination of waste to allow a facility to do more with less while simultaneously increasing customer and employee satisfaction.

If the phlebotomist is performing POCT, what phase are they involved in?

The examination phase.

What do QSEs form?

The foundation of a QMS.

What do incident reports describe?

The incident and the problem caused along with the corrective action taken.

What does an RCA begin with?

The investigation and reconstruction of the adverse event to determine how the event occurred.

The 12 QSEs serve as what?

The management infrastructure that supports the workflow of the organization.

What does QA refer to?

The overall process of guaranteeing quality patient care.

Laboratory reports must be present in what?

The patient's record.

It is important for the requisition form or computer label to be properly documented with what?

The phlebotomist's initials along with the date and time of collection.

What does an incident report become a part of?

The phlebotomist's permanent record.

The ordering of laboratory tests is a joint effort between who?

The phlebotomy department and the personnel who generate the requests for tests.

Which variable is the phlebotomist primarily involved with?

The pre-examination variables.

What is a NCE management program based on?

The quality indicators.

How is the phlebotomist involved in the post-examination phase?

The timeliness of collection affects the amount of time required to report the test results.

What is the primary goal of Six Stigma?

To reduce variables and decrease errors to a level of 3.4 defects per 1 million opportunities.

What does TQM stand for?

Total quality management.

Where did the Lean system originate?

Within the automobile manufacturing industry in Japan.