Term
| Define Quality Assurance (QA), quality control (QC), total quality management (TQM) and continuous qulaity improvement, and discuss their differences and roles in quality phlebotomy |
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Definition
Quality Assurance (QA) the larger set of methods used to guarantee quality patient care, including the methods used for patient preparation and collection and transportation protocols. Both technical and nontechnical
Quality Control (QC) refers to the quantitative methods used to monitor the quality of procedures such as regular inspection and and calibration of equipment to ensure accurate test results.
Total quality Management (TQM) the entire set of approaches used by the institution to provide patient satisfaction. Both quality control (QC) and Quality Assistance (QA) are included in total qualtiy management (TQM)
Total Quality management focuses on gradual continual improvements in the quality of services provided by the lab. It sees the potential for improvement in every area, no matter how high the current performance area level, to improve services provided to customers.
The phlebotomist is the member of the lab team with the most direct patient contact and therefore most responsible for customer service satisfaction in this area (TQM) |
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Term
| Describe the contents of the procedural manual, and explain how the phlebotomist can use it |
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Definition
the procedure manual is located in the lab at all times It contains protocols and other information about the test performed in the lab, including the principle behind the test, the purpose of performing it, the specimen type
the test requires, the collection method, and the equipment and supplies needed.
(QA) quality assurance procedures relevant to the procedure manual include updating the standards and protocols to comply with advances in the field, training for lab members in the proper performance of procedures, scheduling testing of standard samples, and monitoring of results |
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Term
| Explain the role of the directory of services, and describe the information it contains |
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Definition
The role of the directory of service is to monitor the number of incomplete or duplicate requisitions received, collecting statistics on the number of missed or delayed collections, and recording the time between a test request and a result report.
The directory of services may be available in hard copy or online at the laboratory web site. It includes laboratory schedules, early morning collection schedules, and written notification of any changes, plus information on patient preparation, specimen type and handling, and normal values |
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Term
| List three types of analytic variables |
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Definition
Preanalytic variables- occur before the specimen and occur in each area of the phlebotomists duties beginning with test ordering and requisition handling. Requisition must be accurately and completely filled out with the patient number, test ordered and priority. variables to be controlled include duplicate or missing requisitions, test left off the requisition, missing patient number, missing doctor name, or priority not indicated.
Analytic values those that occur during specimen analysis, they can be affected by preanalytic variables, such as collection time or transport conditions.
Examples of analytic variables are making sure tubes not expired, choosing correct site location without scars, burns, using proper equipment
Postanalytic variables- which occur after specimen collection which include delays in reporting results or improper entry of results in the data bank also may be part of phlebotomists duties. Examples can include; using wrong tube , wrong additive, not transferred on time, hemolyzed |
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Term
| Describe at least five errors that may occur as a result of improper requisition handling, and explain QA position for monitoring them. |
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Definition
Five errors that may occur due to requisition handling include, duplication or missing requisition, test left off of requisition, missing patient number, missing doctor name, or priority not indicated.
If insurance information is omitted or is inaccurate, there is a delay in the reporting results, introducing a postanalytic variable.
QA procedures for these variables include recording and counting the number of each type of requisition error |
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Term
| Describe the procedures that should be followed for (QC) Quality control of phlebotomy equipment? |
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Definition
Phlebotomy equipment is designed and manufactured to be free of defects and minimized variability. nonetheless, errors do occur and it is up to the phlebotomist to identify and eliminate them before they interfere with patient care.
Tubes should be checked for lot number and expiration date. Never use an expired tube
Stoppers should be checked for cracks or improper seating. Reject any tubes with defective stoppers
Tubes may lose vacuum without any visible sign of defect. When filling a tube, be aware of incomplete filling because of loss of vacuum. CLSI guidelines indicate that the volume should be +/- 10% of the stated draw.
Needles should always be inspected for defects, including blunt points or burrs. Never use a defective needle or one from a package with a broken seal.
Syringe plunger must move freely in the barrel. Reject a syringe with a sticky plunger. |
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Term
| Explain why expired tubes should not be used. |
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Definition
| You may not be able to get a full draw (the full amount needed to perform test) and may not be able to mix additives with specimen properly |
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Term
| describe delta check and explain its use in (QA) Quality assurance |
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Definition
| A delta check is a QA procedure that helps spot identification errors. This check compares previous patient results with current results. If the difference "delta" between the two sets of results is outside the limit of expected variation, it alerts the lab personnel to the possibility of error. Improper identification can lead to injury or death. |
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Term
| List nine patient activities that may affect laboratory results, and give at least one example of a test affected by each |
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Definition
The Phlebotomist has no control over most of these variables but may note their presence to aid in the interpretation of the test results.
1. Posture. A sample collected from an errect patient has higher concentration of large molecules such as enzymes and albumin as well as WBCs and RBCs.
2.Short term exercise. Exercise increases muscle enzymes such as creatine kinase, as well as WBC, creatinine, and fatty acids
3. Long term exercise. A prolonged exercise regimen increases sex hormones, as well as many other values increased by short term exercise.
4. Medications and medical treatments. Certain medications affect test results directly. Aspirin is the most common one, prolonging bleeding times. Other treatments to be aware of include the administration of radiographic dyes, blood transfusions, or IV fluids. Anticoagulants (warfarin and heparin) cause prolonged bleeding after puncture. It is important to know this since it requires extra time after the puncture to apply pressure at the site and thus avoid compartment syndrome.
5. Alcohol consumption-moderate amounts of alcohol do not affect the test results (except of course for alcohol test), glucose is slightly elevated, and chronic consumption can lead to increased values on liver function test, as well as interfering with platelet aggregation studies.
6. Smoking-Smoking increases catecholamines, cortisol, WBCs, mean corpuscular volume, and hemoglobin, and it decreases eosinophils. Smoking also affects arterial blood gases (ABGs).
7. Stress-Anxiety, crying, or hyperventilating may affect test results, including the stress hormones produced by the adrenal cortex. Prolonged crying or hyperventilating alters ABGs, and crying can increase WBCs.
8. Diurnal variation-Certain specimens must be collected at specific times of the day because of significant changes throughout the day.Such specimens include cortisol (2 times higher am) and iron (lower in am).
9. Fasting-8-12 hours without having food or drink. Caffeinated beverages should also be avoided as they cause a transient rise in blood sugar. A patient not in the in the fasting state may produce a sample that is lipemic which is serum and plasma makes the sample appear turbid. Turbidity is caused by an increase of blood triglycerides, interfers with many test that rely on photometry, or the passage of light through a sample.High-speed centrifugation may be used to pretreat lipemic specimens to overcome interference, but in cases of gross lipemia the sample may have to be recollected. cloudy-did not fast, very cloudy-just ate
10. Age-Many lab values vary with age. For instance, because organ function declines with advancing age, values affected by kidney or liver function are different for the elderly than for young patients. Cholesterol and tryglycerides values increase with age, where as the sex hormones may rise then fall. Both RBC and WBC values are higher in infants than adults. For this reason it is important that the patients date of birth be documented on the requisition form.
11. Altitude-Patients living at higher altitudes have less oxygen available to breathe, so the body compensates by producing a higher RBC mass. Therefore patients living in the mountains have higher counts of RBCs, hemoglobin, and hematocrits.
12. Dehydration-Prolonged diarrhea or vomiting causes loss of fluid from the intravascular circulation. This results in hemoconcentration because of loss of water from plasma. Hemoconcentration produces a false increase in many analytes, including RBCs, enzymes,calcium and sodium.
13. Sex-The normal range of some analytes differ for males and females. males have higher hemoglobin, hematocrit and RBC counts than females do.
14. Pregnancy-The changes that occur in pregnancy affect lab values. The presence of the fetus and increased water retention causes a dilution effect that is reflected in falsely lower hemoglobin and RBC counts as well as other analytes. |
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Term
| List at least four blood collection sites that may lead to sample contamination |
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Definition
| Sites that can cause specimen contamination include hematomas or areas with edema and the side of the body that has undergone a mastectomy or is currently receiving IV fluids |
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Term
| six sites that may result in pain or injury to the patient during specimen collection. |
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Definition
| Sites that can cause injury or pain to the patient include burns, scars, previous puncture sites, the arm near a mastectomy, sites near fistulas or shunts, and the back of the heel or other regions close to the bone. |
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Term
| Discuss two errors that may result from improper tourniquet application |
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Definition
| Tourniquets should be left on no longer than 1 minute to reduce hemoconcentration. Hemoconcentration cause the false increase of large molecules such as proteins and cholesterols and the false decrease of chloride and potassium. Tourniquets applied too tightly can cause petechiae. |
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Term
| Explain the risk of failing to cleanse the puncture site carefully, and describe one method to monitor for such errors. |
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Definition
| Proper cleansing reduces the risk of infection. Blood culture collections require special care to prevent contamination of the sample with skin flora. As part of (QA) quality assurance program, the microbiology department keeps records of contaminated samples. Iodine must be removed from skin after collection because it can irritate the skin. Iodine should not be used for dermal puncture, because it is virtually impossible to keep out of sample. Iodine interferes with bilirubin, uric acid, potassium and phosphorus test (BURPP) |
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Term
| Discuss at least 8 precautions that must be taken in collecting and labeling specimens |
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Definition
Specimens must be collected in the right tube for the test ordered and in the right order. The sample volume must be matched to the quantity of additives to the tube, and the tube size should be choosen to provide adequate volume for the requested test. The specimen must be mixed gently and thoroughly by inversion immediately after being drawn.
Incorrect or incomplete labeling makes a specimen useless and requires redrawing the specimen at a later date. label tubes immediately after they are drawn, before leaving the patients room. Be sure that the labeling is complete and note any special patient conditions on the requisition. |
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Term
| Explain the phlebotomist role in ensuring a positive patient perception of the level of care received? |
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Definition
| You should strive to avoid painful probing, unsuccessful punctures, and repeated draws and be scrupulously careful regarding site selection, accidental arterial puncture, and nerve injury. In addition infection control procedures must always be followed. Break the chain of infection by performing hand washing hygiene upon entering the room and after finish procedure and by wearing gloves during the procedure. |
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Term
| Explain the steps to be followed in the case of an accidental needle stick, and describe (QA) quality assurance procedures that may be used |
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Definition
Accidental puncture with a used needle must be reported immediately to a supervisor. Immediate and follow up testing for bloodborne pathogens, plus counseling, is standard protocol for accidental needle sticks
QA procedure includes monitoring the number of accidental punctures and instituting additional training or equipment modifications in the event of frequent accidents. |
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Term
| Discuss the monitoring of variables during sample transport |
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Definition
Samples requiring either cold or warm temperatures must be handled so that the appropriate temperature is maintained throughout the transport process. Stat specimens should be delivered for immediate analysis.
Pneumatic tube systems require special monitoring as specimens that are overly agitated during transport can cause hemolysis. It is the phlebotomist responsibility to ensure proper handling of the specimen. The directory of services contain this type of information they are located on each floor |
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Term
| Explain the effects of sample-processing variables on sample quality (separation times and centrifuge) |
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Definition
No more than 2 hours should elapse between the time a specimen is collected and the time serum or plasma is separated from formed elements.
Even less time should be allowed for determinations of potassium, ammonia, adrenocorticotropic hormone, or cortisol.
The exception is serum separator tubes which are stable once they are spun and a good gel seal is in place. |
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Term
| describe how refrigerators and freezers are monitored |
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Definition
| Fluctuation in cold storage units can degrade sample quality. Temperature of refrigerators and freezers must be monitored daily with the temperature recorded automatically or manually (document and initial) at specific times of the day. Temps of too high or low indicate the unit needs maintenance or replacement. |
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Term
| Explain how multiple aliquots prepared from a single sample should be handled. |
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Definition
| Multiple aliquots prepared from a single specimen allow different departments to share a single sample for multiple test. Each aliquot must be properly labeled as to the source and additives present. Specimens with different additives should never be combined in a single aliquot |
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Term
| Samples should not be left uncovered any longer than necessary during processing it can lead to |
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Definition
| evaporation of liquid, especially from small samples and can affect ABGs, alcohol, and ammonia amoung other test |
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Term
| Contamination may occur while the sample is |
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Definition
| uncovered arising from airborne dust or talc from gloves.Contamination may also occur from incomplete seperation, such as when RBCs are left in the sample after incomplete centrifugation. |
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Term
Centrifuges must be calibrated every 3 months with a tachometer to ensure that they are running at the reported speed.
Variation may indicate the need to replace worn parts. Spinning samples below the required speed may result in incomplete separation of liquid from formed elements, affecting test results |
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Definition
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