Clinical Competencies
Phlebotomy students must successfully perform the following clinical competencies to be eligible to take the certified phlebotomist examination:
Safety and Compliance
- Adhere to regulations regarding workplace safety (e.g., Occupational Safety and Health Administration, National Institute for Occupational Safety and Health).
- Adhere to regulations regarding operational standards (e.g., The joint Commission, Clinical and Laboratory Standards Institute, Center for Disease Control).
- Adhere to HIPAA regulations regarding protected health information.
- Adhere to scope of practice and comply with ethical standards applicable to the practice of phlebotomy.
- Perform quality control for laboratory equipment (e.g., maintain logs for equipment inspection, reporting and troubleshooting equipment issues).
- Perform quality control (e.g., machine calibration, test controls, storage controls) for CLIA-waived tests.
- Identify and dispose of sharps and biohazards according to Bloodborne Pathogens Standard.
- Follow exposure control plans in the event of occupational exposure
- Follow transmission-based precautions (e.g., airborne, droplet, contact).
- Follow standard precautions regarding personal protective equipment (e.g., gloves, gowns, masks, shoe covers, respirators.
- Use aseptic and infection control techniques throughout the phlebotomy process.
- Follow hand hygiene guidelines to prevent the spread of infections
- Initiate first aid and CPR when necessary (e.g., check for DNR bands).
- Comply with documentation and reporting requirements.
Patient Preparation
- Introduce yourself to the patient and provide information such as name, title, and department.
- Positively identify the patient based on specific identifiers while following HIPAA guidelines.
- Receive implied, informed, or expressed consent from the patient
- Review and clarify the requisition form.
- Verify patient compliance with testing requirements (e.g., fasting, medication, basal state) and proceed accordingly.
- Interview patients to identify special considerations that may impact collections (e.g., allergies, medications, recent surgeries, history of fainting) and proceed accordingly.
- Explain to the patient the phlebotomy procedure to be performed.
- Position the patient to maximize comfort and safety and optimize specimen collection.
- Determine site for specimen collection, based on the Clinical and Laboratory Standards Institute standards, to minimize patient risk and optimize outcome.
- Instruct patients on collection of non-blood specimens (e.g., stool, urine, semen, sputum).
Routine Blood Collections
- Select and assemble equipment (e.g., evacuated tube system, syringe, winged collection set) needed for blood collection(s).
- Verify quality of equipment (e.g., sterility, expiration date, manufacturer’s defects).
- Follow standard tourniquet application and removal procedures.
- Select final site through observation and palpation, for specimen collection.
- Apply antiseptic agent to blood collection site.
- Anchor below venipuncture site.
- Insert venipuncture device.
- Follow order of draw when performing venipuncture.
- Ensure patient safety throughout the collection by identifying problematic patient signs and symptoms (e.g., syncope, diaphoresis, nausea, seizure).
- Recognize and respond to potential complications resulting from procedure (e.g., lack of blood flow, hematoma, petechiae, nerve pain).
- Remove venipuncture device.
- Invert evacuated tubes with additives according to procedural guidelines
- Perform dermal puncture for capillary collection based on patient age and condition.
- Follow order of draw when performing capillary collection.
- Label all specimens.
- Perform post-procedural patient care.
Special Collections
- Prepare peripheral blood smears
- Perform blood culture collections
- Assist other health care professionals with specimen collection
- Collect blood samples for inborn errors of metabolism (e.g., PKU, galactosemia).
- Perform phlebotomy for blood donations.
- Calculate volume requirements in patients who are at higher risk (e.g., pediatric, geriatric) to avoid causing iatrogenic anemia.
- Perform non-blood specimen collection (e.g., throat cultures, nasal swab, wound cultures).
- Prepare specimens (e.g., centrifuging, aliquoting, freezing or refrigeration) for testing or transport.
- Maintain integrity of specimens based on handling requirements (e.g., temperature, light, time).
- Adhere to chain of custody guidelines when required (e.g., forensic studies, blood alcohol, drug screen).
- Coordinate communication between non-laboratory personnel for processing and collection.
- Input and retrieve specimen data using available laboratory information system.
- Recognize and report critical values for point of care testing.
- Distribute laboratory results to ordering providers
Clinical Supervision
The Certified Phlebotomists at the clinical affiliates will act as the students' immediate supervisors. Any problems with the clinical schedule should be discussed with the MCHP Healthcare Science Preceptorship course instructor/Clinical Coordinator, or dean overseeing the clinical preceptorship for the students. The MCHP Healthcare Science Preceptorship course instructor/Clinical Coordinator and Dean are available as resources and are available in the event of a problem in the clinical area. The MCHP Healthcare Science Preceptorship course instructor/Clinical Coordinator, or Dean determines the level of supervision required for each student. All tasks and tests results must be approved by the Certified Phlebotomist before the patient leaves the office/lab setting. The AHS or Pre-DMS Phlebotomy student must be under direct supervision by the Certified Phlebotomist as described below. The Clinical Phlebotomist may take over the procedures at any point if they think it is in the best interest of the patient.
Direct supervision: A Certified Phlebotomist must be able to observe the student at all times and assist or intercede immediately if, in their opinion, the procedures being performed are being improperly conducted or the continuation of the procedure(s) will be potentially harmful to the patient or student. The Certified Phlebotomist must:
- Review the procedure in relation to the student's achievement
- Evaluate the condition of the patient in relation to the student's knowledge
- Be physically present during the performance of the procedure, and
- Review and approve the procedure and/or test.