LESSON 2 INTRO TO PHLEB Flashcards by arabella erivera

(t or f) Phlebotomists may be scheduled to work at one
of these areas or patients from these areas may
be referred to the laboratory for sample
collection.

TRUE

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May range in size (in terms of bed capacity)

50 to more than 300 beds.

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Classification of Hospitals (based on DOH)
According to Ownership

o Public hospitals
o Created by law
o May be under: National Government,
LGU, DOH, State Universities and
Colleges (PGH)

GOVERNMENT

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Classification of Hospitals (based on DOH)
According to Ownership

Owned, established, and operated with
funds from donation, principal,
investment, or other means by any
individual, corporation, association, or
organization
o Business in healthcare

private

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equipped with the service capabilities
supporting board certified/ eligible medical
specialists in, but not limited to the following:
o Clinical Services (family medicine,
pediatrics, specialty clinics)
o Emergency Services
o Outpatient Services (check-up patients)
o Ancillary and Support Services
(laboratory tests, x-rays, physical
therapy sessions)

general

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May be devoted to the treatment of
the following:
o Particular illness/condition requiring a
range of treatment.
o Patients suffering from diseases of a
particular organ/group of organs
o Patients belonging to a group such as
children, women, elderly or others

Specialty

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According to Functional Capacity: General Hospitals
➢ Clinical Services for in-patients

▪ Consulting specialists in:
Medicine, Pediatrics, OB-GYNE,
Surgery
▪ Emergency and Out-Patient
Services
▪ Isolation Facilities
▪ Surgical/Maternity Services
▪ Dental Clinic

Level 1

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According to Functional Capacity: General Hospitals
➢ Clinical Services for in-patients

▪ Departmentalized Clinical
Services
▪ Respiratory Unit
▪ General ICU
▪ High Risk Pregnancy
▪ NICU

LEVEL 2

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According to Functional Capacity: General Hospitals
➢ Clinical Services for in-patients

▪ Teaching/ Training with
accredited residency training in
all 4 major clinical services
▪ Physical Medicine with
Rehabilitation Unit
▪ Ambulatory Surgical Clinic
▪ Dialysis

level 3

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➢ Ancillary Services

▪ Secondary Clinical Laboratory
▪ Blood Station
▪ 1st Level X-ray
▪ Pharmacy

LEVEL 1

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Ancillary Services

▪ Tertiary Clinical Laboratory
▪ Blood Station
▪ 2nd Level X-Ray with mobile unit

level 2

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Ancillary Services

▪ Tertiary Lab with Histopathology
▪ Blood Bank
▪ Level X-ray

level 3

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Four Traditional Hospital Services

Nursing Services
support services
Fiscal services
professional services

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Deals directly with
patient care

Nursing Services

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Ex: communications
systems, food, housekeeping

Support Services

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Business Aspect
(Accounting, Admitting, Data Collection
and Health Information Management)

Fiscal Services

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Assist the
physician in the diagnosis and treatment
of disease

Professional Services

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o Radiology and Diagnostic Imaging
o Radiation Therapy
o Respiratory Therapy
o Nuclear Medicine
o Occupational Therapy
o Pharmacy
o Physical Therapy
o Cardiovascular Testing
o Clinical Laboratory

Professional Service Departments

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Provides data to
the healthcare team to aid in
determining the diagnosis, treatment,
and prognosis of a patient; 80% of
patients’ diagnosis comes from the
clinical laboratory

Clinical Laboratory

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Consist of several primary care physicians or may
specialize in a particular medical specialty such
as pediatrics or cardiology.
Made up of a combination of family practice
physicians and specialists.
Stand alone clinics with laboratories

PHYSICIAN OFFICE LABORATORIES

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Managed care group practice centers that
provide a large variety of services. Physicians’
offices, a clinical laboratory, radiology, physical therapy, and outpatient surgery are often
available at one location.
Members are charged a prepaid fee for all
services performed during a designated time
period. (Usually tied with insurance company.
Ex. Philhealth)
Phlebotomists are employed as part of the
clinical laboratory staff

HEALTH MAINTENANCE ORGANIZATIONS (HMO)

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Large, independent reference laboratories
contract with health health-care providers and
institutions to perform both routine and highly
specialized tests.
Phlebotomists are hired to collect samples from
patients referred to the reference laboratory.
Stand-alone lab that perform specific tests
Offer test to specific diseases

REFERENCE LABORATORIES

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Independent laboratories that are in contact
with healthcare provider
They perform both routine and highly specialized
tests
Stand-alone laboratories that perform specific
tests for specific diseases
Based on the mandate of department order 393
(2000)
They also offer trainings

National Reference Laboratories (NRL) in the
Philippines:

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Reference Laboratories
for hematology and blood-banking

National Kidney Transplant Institute (NKTI)

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Reference Laboratories – for emerging diseases and microbiology

Research Institute for Tropical Medicine (RITM)

Reference Laboratories for clinical chemistry (proteins, glucose, etc.)

Lung Center of the Philippines

Reference Laboratories for toxicology (drug testing)

east Avenue Medical Center

Reference Laboratories for sexually transmitted infections

STD-AIDS Cooperative Central Laboratory (SACCL)

o “…Without any discrimination and within the limits of the resources…” o “…Human dignity, convictions, integrity, individual needs and culture shall be respected…” o “…If any person cannot immediately be given treatment that is medically necessary he shall, either be directed to wait for care, or be referred …elsewhere, where the appropriate care can be provided…”

Right to Appropriate Medical Care and Humane Treatment

o “Clear, truthful and substantial explanation, in a manner and language understandable to the patient, of all proposed procedures, whether diagnostic, preventive, curative, rehabilitative or therapeutic…” o “…Person who will perform the said procedure shall provide his name and credentials to the patient…”

Right to Informed Consent

o “…The patient has the right to demand that all information, communication, and records pertaining to his care be treated as confidential…“ o Exemptions: ▪ If disclosing the information will be a public health concern (elected officials and trials in court) ▪ The information is disclosed to the parents or guardian only if the patient is a minor ▪ Not of sound mine

Right to Privacy and Confidentiality

o “…Right to be informed of the result of the evaluation of the nature and extent of his/her disease…”

Right to Information

o “…The patient has the right to discuss his condition with a consultant specialist, at the patient’s request and expense…” o “…He also has the right to seek for a second opinion… from another health care provider…”

The Right to Choose Health Care Provider and Facility

o “…The patient has the right to avail himself/herself of any recommended diagnostic and treatment procedures o “...Any person of legal age and of sound mind may make an advance written directive for physicians to administer terminal care when he/she suffers… terminal illness…”

Right to Self-Determination

o “…The patient has the right to refuse medical treatment or procedures which may be contrary to his religious beliefs… Provided, that such a right shall not be imposed by parents upon their children who have not reached the legal age in a life-threatening situation as determined by the attending physician or the medical director of the facility…”

Right to Religious Belief

o “…Provided, That, an institutional review board or ethical review board in accordance with the guidelines set in the Declaration of Helsinki be established for research involving human experimentation…”

Right to Refuse Participation in Medical Research.

A wrongful act committed by one person against another that causes harm to the person or his or her property

Tort Law

Intentional Tort

Assault, Battery, Defamation

– threat to touch another person without his or her consent and with the intention of causing fear of harm.

Assault

actual harmful touching of a person without his or her consent.

Battery

– spoken or written words that can injure a person’s reputation. Ex. Releasing or are overheard saying any confidential information

Defamation

types of defamation

libel and slander

2 types of Unintentional Tort

Negligence and Medical Malpractice

false defamatory writing that is published

libel

false and malicious spoken word

slander

– as failure to give reasonable care by the health care provider, must be proven in a malpractice suit • Duty • Breach of Duty • Causation • Damages

Negligence

misconduct or lack of skill by a health care professional that results in injury to the patient

Medical Malpractice

is the violation of the patient’s right to be left alone and the right to be free from unwanted exposure to public view. Ex. Unwanted releasing of confidential information and entering a patient’s room without asking permission

Invasion of Privacy

➢ Cytology Section ➢ Histopathology/Histology Section ➢ Cytogenetics

Anatomical Area

process and examine tissue and body fluids for the presence of abnormal cells, such as cancer cells. o The Papanicolaou (Pap) smear – common test performed for women

Cytology Section

process and stain tissue from biopsies, surgery, autopsies, and frozen sections o A pathologist then examines the tissue

Histopathology/Histology Section

o Chromosome studies are performed to detect genetic disorders

Cytogenetics

➢ Hematology ➢ Coagulation ➢ Clinical Chemistry ➢ Blood Bank (Immunohematology)

Clinical Area

o Cellular elements, red blood cells (RBCs), white blood cells WBCs), and platelets Plts) are enumerated and classified in all body fluids and in the bone marrow.

Hematology

o Overall process of hemostasis is evaluated this includes platelets, blood vessels, coagulation factors (bleeding and clotting time), fibrinolysis, inhibitors, and anticoagulant therapy (heparin and Coumadin)

Coagulation

o Most automated area in the laboratory o May perform electrophoresis (uses gel media for analytes), therapeutic drug monitoring (antibiotics) and enzyme immunoassays to measure substances such as proteins, carbohydrates, enzymes and hormones and toxicology.

Clinical Chemistry

o Where blood may be collected, stored, and prepared for transfusion. o Testing procedures involve RBC antigens (Ag) and antibodies (Ab). o Blood from patients and donors is tested for its blood group (ABO) and Rh type. Also tests compatibility (crossmatch) between patient and donor o Detect and identification of abnormal antibodies

Blood Bank (Immunohematology)

o Performs tests to evaluate the body’s immune response; that is, the production of antibodies (immunoglobulins) and cellular activation

Serology (Immunology)

o Responsible for the identification of pathogenic microorganisms and for hospital infection control In large laboratories, the section may be divided into bacteriology, mycology, parasitology, and virology o Common Tests include Culture and Sensitivity and Gram Staining

Microbiology

may be a separate laboratory section or a part of the hematology or chemistry sections o Routine screening procedure to detect disorders and infections of the kidney and to detect metabolic disorders o Consists of physical, chemical, and microscopic examination of the urine

Urinalysis

specialist in the study of disease and works in both clinical pathology and anatomical pathology. o Acts as a consultant to physicians o Has direct responsibility all areas of the laboratory o Responsibilities include working with the laboratory administrator to establish laboratory policies, interpret test results, perform bone marrow biopsies and autopsies, and diagnose disease from tissue specimens or cell preparations

Laboratory Director (Pathologist)

o Responsible for overall technical and administrative management of the laboratory o Usually a medical laboratory scientist (MLS) with a master’s degree and 5 or more years of laboratory experience.

Laboratory Manager (Administrator) or Chief Medical Technologist

MLS with experience and expertise related to the particular laboratory section or sections often have specialty certifications on each section o Responsibilities of the technical supervisor include: ▪ Reviewing all laboratory test results ▪ Consulting with the pathologist on abnormal test results ▪ Scheduling personnel ▪ Maintaining automated instruments ▪ Preparing budget ▪ Maintaining reagents and supplies ▪ Orienting, evaluating, and teaching personnel ▪ Providing protocols for new test procedures.

Technical Supervisor or Section Head

o Has a bachelor’s degree in medical technology and 1 year of training in an accredited medical technology / clinical laboratory science program. o Performs laboratory procedures that require independent judgment and responsibility with minimal technical supervision o Maintains equipment and records performs quality assurance and preventive maintenance activities related to test performance setting

Medical Laboratory Scientist

o Performs routine laboratory procedures according to established protocol under the supervision of a technologist, supervisor, or laboratory director o Duties ▪ Collecting and processing biological samples ▪ Performing routine analytic tests, ▪ Recognizing factors that affect test results ▪ Recognizing and reporting abnormal results ▪ Recognizing and reporting equipment malfunctions ▪ Demonstrating skills to new employees and students

Medical Laboratory Technician

o Collects blood from patients for laboratory analysis. o Usually has completed a structured phlebotomy training program. o Trained to identify the patient properly, obtain the correct amount of blood by venipuncture or microtechnique

Phlebotomist

to cut a vein” - Greek “Phelb” (vein) and “tomia” (to cut

Phlebotomy

t or f The earliest forms of phlebotomy can be traced all the way back to the ancient Egyptian, ancient Greek and Roman cultures

TRUE

Phlebotomy was called

“Bloodletting”

t or f Draining blood, in ancient times, was considered one way to effectively cure the body of most ills (often described as “bad spirits”) and was often performed using a lancet tool

true

prohibited clergyman from performing these bloodlettings

1163 – Pope Alexander III

• Speak loudly and clearly Look directly at patient to facilitate lip-reading • Communicate in writing

Hearing Impairment

Speak calmly and slowly • Do not appear rushed or disinterested

Patient Emotions

• Avoid medical jargon, you are collecting a blood sample rather than performing a phlebotomy • Use age-appropriate phrases

Age and Education Levels

• Locate a hospital-based interpreter • Use hand signals, show equipment, etc. • Remain calm, smiling, and reassuring

Non-English- speaking