Halcyon St. Hill, Edd, MS

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Halcyon St. Hill, EdD, MS Phlebotomy Medical Laboratory Scientist I. The health care system and services A. Identify components of the health care delivery system and the services each provides (Level 1) 1. Inpatient facilities a) Hospitals b) Long term care facilities c) Birthing centers 2. Outpatient care facilities a) Managed Care Systems including Health Maintenance Organizations (HMO) b) Solo practices--physicians’ offices c) Prenatal care facilities d) Respite care facilities e) Hospice f) Home health care g) Chronic care facilities 3. Blood donor collection centers B. Name and describe various departments and services within the health care setting in which interactions with patients, departments, and services occur because of duties related to phlebotomy (Level 1) 1. Emergency facilities—emergency room (ER) or emergency department (ED) and trauma center 2. Cardiac care units 3. Electrocardiography 4. Encephalography 5. Geriatrics 6. Intensive care units 7. Nuclear medicine 8. Nursery 9. Occupational therapy 10. Pediatrics

MLS Phleb 2 11. Pharmacy 12. Physical therapy 13. Radiation therapy 14. Radiology and diagnostic imaging services 15. Psychiatric units 16. Respiratory therapy 17. Surgical units 18. Outpatient laboratory 19. General medicine units C. Identify each specialty area within the laboratory, including the reference laboratory, and list tests most frequently performed in each area (Level 1) 1. Clinical chemistry 2. Clinical microbiology 3. Coagulation 4. Cytogenetics 5. Hematology 6. Immunohematology—blood bank 7. Immunology 8. Molecular Diagnostics 9. Toxicology 10. Urinalysis 11. Anatomic pathology 12. Other areas as applicable D. Identify medical specialty areas within the health care system such as obstetrics, gynecology, oncology, etc. (Level 1) E. Identify the health professionals most often encountered in daily phlebotomy and related technical patient care services and discuss the roles and qualifications of each professional (Level 1) 1. Medical laboratory scientists 2. Medical laboratory technicians 3. Cytotechnologists 4. Electrocardiogram (EKG) technicians 5. Histologists 6. Histotechnicians 7. Patient care technicians 8. Phlebotomists 9. Nurses 10. Nurse practitioners

MLS Phleb 3 11. Occupational therapist 12. Pathologist 13. Physical therapist 14. Physicians 15. Physicians assistants 16. Electrocardiogram (EKG) technicians 17. Radiologists 18. Respiratory therapist 19. Others as applicable F. Demonstrate a knowledge and proficiency in the use of computers as related to job duties and responsibilities (Level 2) G. Define (Level 1) and utilize (Level 2) health professions/medical terminology that is pertinent to phlebotomy, laboratory testing, and patient care II. Patient and laboratory safety A. Identify (Level 1) and discuss (Level 2) precautions, practices and procedures to assure patient safety 1. Correct identification of patients 2. Communication and its applications to patient safety 3. Use of proper equipment and procedures for specimen/sample collection 4. Identification and avoidance of safety risks including but limited to nerve damage. 5. Preventing errors in specimen/sample collection 6. Preventing errors in point-of-care testing 7. Relevance of specimen/sample collection to preventing errors in testing procedures 8. Identification of improper specimens/samples and the impact on testing, e.g., hemolysis, insufficient blood collected in tubes with anti-coagulant, improper draws, etc. B. Identify (Level 1) and/or perform (Level 2) emergency procedures necessary for survival of patients/clients in the health care setting limited to scope of training and practice 1. Cardiopulmonary resuscitation (CPR) 2. First aid techniques to prevent bleeding 3. Managing adverse reactions C. Demonstrate an understanding of safety hazards and precautions and identify symbols (Level 1) 1. Biological hazard

MLS Phleb 4 2. Electrical safety 3. Chemical safety 4. Radiation safety 5. Fire safety 6. Mechanical safety D. Identify and discuss the Occupational Safety and Health Administration (OSHA) Standards and compliance with OSHA in phlebotomy and clinical laboratory practice (Level 1) E. Discuss institutional safety procedures and practices (Level 1) 1. Biological and physical safety of oneself and others in the workplace 2. Proper labeling of biohazardous specimens/samples 3. Handling biological specimens/samples routinely 4. Handling biological specimens/samples collection in cases of bioterrorism and other emergency response situations 5. Hazardous materials 6. Natural disasters including weather emergencies 7. Fire and electrical safety 8. Cleaning protocols including cleaning phlebotomy trays and equipment, cleaning up of specimen/sample spills, and other biohazardous spills 9. Waste disposal F. Comply with federal and state mandates and regulations as well as organizational requirements regarding safety practices (Level 3) G. Evaluate (Level 3) and develop (Level 2) safety protocols for H. phlebotomy and related laboratory services I. Evaluate (Level 3) and select (Level 2) safety equipment for use in phlebotomy and related services III. Infection prevention A. Identify the principles of infection prevention including sources of infection, modes of disease transmission, hosts, susceptibility to infection, and healthcare-associated infections (HAI) (Level 1) B. Identify the elements of the chain of infection and mechanisms to break the chain of infection (Level 1) C. Discuss and demonstrate sterile techniques related to scope of practice (Level 1) D. Discuss standard precautions, workplace practices, and engineering controls and the application to phlebotomy and related services (Level 1)

MLS Phleb 5 1. Use of isolation procedures 2. Handwashing and hand antisepsis 3. Use of personal protective equipment--gloves, gowns, masks, and face shields 4. Sterile technique 5. Environmental controls including use of approved surface disinfectants 6. Needle and other sharps disposal 7. Other E. Discuss the isolation procedures and personal protective equipment requirements in accordance with standard precautions and identify example disease conditions associated with each isolation procedure (Level 1) 1. Airborne or droplet precaution (respiratory isolation) 2. Contact precautions 3. Protective precautions 4. Body substance isolation F. Relate the types of isolation often associated with specific inpatient or clinical treatment units (Level 1) 1. Burn unit 2. Dialysis 3. Intensive care unit 4. Nursery G. Discuss (Level 1) and evaluate (Level 3) protocols for exposure to blood and other body fluids including accidental sticks with contaminated needles H. Discuss (Level 1) and demonstrate (Level 2) proper hand washing procedure and hand asepsis I. Evaluate (Level 3) and develop (Level 2) a system including protocols for ensuring proper infection control in phlebotomy and related services IV. Human anatomy and physiology A. Describe terminology related to direction, anatomic positions, body planes, and body cavities (Level 1) B. Identify body systems by discussing (Level 1) 1. Major organs 2. Components and structures 3. Primary functions 4. Common disorders and clinical laboratory tests/results

MLS Phleb 6 C. Identify specimen/sample requirements and laboratory tests commonly performed to determine the health status for each body system (Level 1) D. Identify (Level 1) and discuss (Level 2) the circulatory system 1. Characteristics of blood and its components--cellular and non-cellular 2. Blood vessels and sites used for arterial puncture and venipuncture 3. Properties of arterial blood, capillary blood, and venous blood, and differences related to collection, handling and appropriate use for laboratory testing 4. Process of coagulation and fibrinolysis as it related to phlebotomy E. Discuss the proximity of nerves to arteries and veins and the impact on phlebotomy (Level 1) F. Discuss the vascular system in the skin and how it applies to phlebotomy and phlebotomy practices (Level 1) 1. Sites for skin puncture for capillary blood collection in infants, children, and adults 2. Limitations and precautions related to skin puncture and capillary blood collection V. Specimens/samples A. Define the term specimen/sample (Level 1) B. Identify the types of specimens/samples tested within the clinical laboratory and discuss requirements that ensure the integrity of each specimen/sample type (Level 1) C. Discuss specimen/sample collection including order of draw, preservation, processing, and analysis of the integrity of each specimen/sample type (Level 1) D. Identify the components of blood (Level 1) E. Discuss the differences between serum and plasma (Level 1) F. Identify and discuss pre-analytic factors that affect basal state of specimens/samples 1. Age 2. Altitude 3. Dehydration 4. Diet 5. Diurnal variation 6. Hemoconcentration

MLS Phleb 7 7. Hemolysis 8. Exercise 9. Intravenous therapy 10. Lipemia 11. Obesity 12. Posture 13. Smoking 14. Stress 15. Tourniquet applications 16. Use of improper collection devices G. Describe procedures and discuss the rationale for using each procedure for collecting, preserving, transporting, handling, and processing urine specimens/samples (Level 1) H. Identify factors that affect the integrity of specimens/samples as related to the accuracy of clinical laboratory testing (Level 1) 1. The significance of time as related to specimen/sample collection, transport, and testing 2. Order of draw during specimen/sample collection 3. The effects of environmental factors such as light and temperature on specimens/samples as related to specific laboratory tests, e.g., the protection of specimens/samples from light when tests for bilirubin are required 4. The effects of medication or drugs on specimen/sample integrity and test results accuracy with reference to common examples 5. Physiological factors associated with the patient I. Evaluate specimens/samples and determine the integrity and appropriateness for specific tests requested (Level 3) J. Identify the types of additives (preservatives, anticoagulants, etc.) used for blood collection in phlebotomy (Level 1) 1. Citrate, potassium and disodium forms of ethylenediaminetetraacetic acid (EDTA), heparin, sodium fluoride, oxalates etc. 2. Antiglycolytic agents 3. Clot activators 4. Thixotropic gel, polymer gel 5. Preservatives K. Discuss the modes of action and appropriate use of each additive used for blood collection (Level 1)

MLS Phleb 8 L. Match the blood collection tube stopper colors with the additive routinely associated with each colored stopper (e.g., tubes with lavender colored stoppers contain EDTA) (Level 1) M. Identify (Level 1), evaluate (Level 3), and select (Level 2) appropriate equipment and supplies to be used for skin puncture and venipuncture for a variety of patient types N. Identify specimens/samples used for commonly ordered clinical tests and indicate the laboratory section in which these tests are generally performed (Level 1) VI. Equipment and supplies A. Identify (Level 1), evaluate (Level 3), and select (Level 2) equipment and supplies used for phlebotomy and discuss (Level 1) proper use of each 1. Winged and non-winged infusion sets 2. Evacuated tube system 3. Syringe system 4. Micro collection containers 5. Skin puncture devices 6. Arterial blood collection equipment 7. Blood culture collection equipment 8. Micro pipette dilution systems 9. Tourniquets 10. Antiseptics 11. Disinfectants 12. Puncture resistant containers 13. Phlebotomy trays and carts 14. General supplies, i.e., gauze, bandages, etc. 15. Point of care testing equipment and supplies 16. Newborn screening equipment and supplies B. Identify (Level 1), evaluate (Level 3), and select (Level 2) the appropriate protective wear to be used during blood collection, transport, and handling C. Use equipment and supplies appropriately such that specimens/samples of quality and high integrity are obtained and efficient services of high quality are realized (Level 2) D. Appropriately store equipment and supplies (Level 2) E. Appropriately dispose of used or contaminated equipment and supplies (Level 2) VII. Specimen/sample collection

MLS Phleb 9 A. Instruct the patient on specimen/sample collection (Level 2) B. Evaluate patient readiness for quality specimen/sample collection including adherence to diet, medication, etc. by interviewing/communicating with patients C. Prepare and organize equipment and supplies on the phlebotomy tray and cart (Level 2) D. Prepare and organize equipment and supplies prior to performing phlebotomy and related services (Level 2) E. Identify (Level 1) and select (Level 2) the appropriate collection sites for arterial puncture, skin puncture, and venipuncture after considering factors that affect site selection 1. Intravenous (IV) fluid lines 2. Transfusion 3. Presence of burns 4. Broken skin 5. Scars 6. Mastectomy 7. Other F. Collect blood via the appropriate collection site and standard venipuncture techniques on various patient types, e.g., healthy patients/clients, outpatients, hospitalized adults, elderly adults, and children 1. Syringe system 2. Winged and non-winged infusion set systems 3. Evacuated tube system using correct order of draw G. Collect blood via the appropriate collection site using standard skin puncture techniques on adults, infants, and children (Level 2) H. Assure specimen/sample integrity by proper patient preparation for tests ordered, e.g., fasting, etc. (Level 2) 1. Accurate patient identification 2. Use of proper site of collection, collection supplies, devices, and procedures including order of draw 3. Accurate labeling, transport and handling of specimens/samples collected I. Discuss (Level 1) and appropriately use (Level 2) special precautions when collecting blood specimens/samples 1. Precautions for decontaminating the skin for routine specimen/sample collections 2. Aseptic technique for collecting blood cultures

MLS Phleb 10 3. Use of warming devices 4. Collecting appropriate sample size 5. Suitability of site for collection, e.g., site selection as related to intravenous (IV) drips, mastectomy 6. Implementing, monitoring and evaluating quality assurance methods and systems J. Discuss the purpose of performing arterial punctures (Level 1) K. Discuss (Level 1) and demonstrate (Level 2) the modified Allen’s test L. Discuss blood donor screening, donor blood collection procedures, and precautions, blood products, expiration dates, and storage requirements (Level 1) M. Identify and discuss technical complications associated with blood collection and methods of correction for each--include needle insertion and loss of vacuum in evacuated tubes (Level 1) N. Identify and discuss patient factors and physiological complications that affect phlebotomy specimen/sample collection (Level 1) 1. Vein damage 2. Collapsed veins 3. Scar tissue 4. Infections 5. Difficult veins 6. Pain 7. Petechiae 8. Excessive bleeding 9. Syncope 10. Seizures 11. Nausea 12. Vomiting 13. Insulin shock 14. Tattoos O. Discuss methods to prevent or address technical and physiological complications encountered in phlebotomy (Level 1) P. Define hemolysis, hematoma, and hemoconcentration and discuss prevention of each item defined (Level 1) Q. Describe (Level 1) and demonstrate (Level 2) appropriate technique in preparation of acceptable peripheral blood smears R. Prepare peripheral blood smears that are appropriate for testing using standard procedure (Level 2)

MLS Phleb 11 S. Discuss technical complications associated with peripheral blood smear preparation and precautions to be taken to address or alleviate complications (Level 1) T. Label specimens/samples collected with the appropriate information as defined by standard protocol (Level 2) U. Identify (Level 1) and label (Level 2) biohazard specimens/samples V. Prepare specimens/samples for transport or mailing to reference laboratories or other off-site laboratories for testing using appropriate standard protocol (Level 2) W. Describe (Level 1) and demonstrate (Level 2) proper disposal of contaminated equipment, supplies, and discard specimens/samples VIII. Phlebotomy related services A. Identify the phlebotomy and related services provided by medical laboratory scientists (MLS), medical laboratory technicians (MLT), and phlebotomists (Level 1) 1. Scheduling of personnel for specimen/sample collection for routine, STAT, and emergency requests 2. Establishing procedures and standard operation manuals for phlebotomy and related services a) Skin puncture b) Venipuncture c) Bleeding time procedures d) Other procedures related to point of care testing e) Specimen/sample collection, transport, and handling f) Use of equipment and supplies 3. Perform outcomes assessment related to phlebotomy and phlebotomy services (Level 3) 4. Provide information regarding requirements for phlebotomy certification, licensure, and continuing education sessions and education and clinical training in phlebotomy and related services (Level 2) 5. Provide information regarding phlebotomy procedures and related services to other health care professionals (Level 2) IX. Point-of-care testing (POCT) A. Identify tests commonly performed at the patients’ bed side or chair side--point of care (Level 1) B. Identify health practitioners who are qualified to perform POCT and discuss the qualifications needed to perform such tests (Level 1) C. Perform point of care procedures as established using standard

MLS Phleb 12 protocol and predetermined criteria for testing and quality assurance (Level 2) D. Demonstrate knowledge and proficiency in operating equipment and use of supplies in POCT procedures performed (Level 2) E. Demonstrate accurate measurement and proper use of measuring systems in testing and calculating results (Level 2) F. Discuss the purpose, specimen/sample requirements, precautions, limitations, sources of error, reference values, and quality assurance methods associated with each point of care test (Level 1) G. Record and report POCT results appropriately and accurately (Level 2) H. Identify critical values and follow established criteria for reporting such values (Level 2) I. Train other personnel to accurately perform POCT (Level 3) X. Quality assurance A. Define and distinguish among the terms quality control, quality assurance and quality improvement (Level 1) B. Discuss quality assurance in phlebotomy and related services (Level 1) 1. Requisitioning 2. Patient preparation 3. Phlebotomy procedures 4. Aspects of post phlebotomy care 5. Specimen/sample labeling, transport, handling, and procurement 6. POCT C. Develop (Level 1), implement (Level 2), and evaluate (Level 3) a quality assurance system for phlebotomy services D. Identify and discuss methods of improving phlebotomy services and related patient outcomes (Level 1) E. Discuss (Level 1) and demonstrate (Level 2) proper documentation of procedures and quality assurance related to phlebotomy and related services using established standards 1. Specimen/sample logs 2. Tracking using standard manual procedures and computerized procedures and systems F. Evaluate specimens/samples for acceptability for tests requested (Level 3) 1. Labeling discrepancies or absence of labels

MLS Phleb 13 2. Hemolysis 3. Specimen/sample collection using the wrong additive--in the wrong tube 4. Use of outdated supplies 5. Improper transport or storage conditions G. Discuss the volume of blood that can be taken from a patient with regard to age and standard practice (Level 1) H. Discuss standard practices related to the number of times a patient can be punctured by the same phlebotomist for a given test request in the same day (Level 1) XI. Human communication theory and application to practice A. Discuss human communication definitions, theories, key components, and the importance of effective communication in phlebotomy and related services (Level 1) B. Discuss the application of communication theories in practice as a means of assuming the role of listener, speaker, and ultimately, effective communicator as a phlebotomist and patient care provider(Level 1) C. Demonstrate effective communication in providing patients with instructions for preparing for phlebotomy procedures such as bleeding time, fasting specimens/samples, and glucose tolerance tests (Level 2) D. Demonstrate proper communication skills in interviewing a patient/client as related to phlebotomy and phlebotomy services (Level 2) E. Demonstrate proper greeting of patients/clients, visitors, peers, and other health care professionals (Level 2) F. Discuss (Level 1) and demonstrate (Level 2) effective communications with the diverse clients encountered including pediatric and geriatric patients G. Describe factors that influence effective communications between the patient/client and phlebotomist, medical laboratory technician (MLT), or medical laboratory scientist (MLS), the health care professional and their colleagues/other health care professionals, the health care professional, and patients’ families and guests (Level 1) 1. Cultural sensitivity 2. Language barriers 3. Technical jargon

MLS Phleb 14 4. Disabilities 5. Age 6. Stress 7. Medication 8. Other XII. Professionalism, legal, and ethical aspects A. Discuss professionalism and behaviors associated with professionals practicing phlebotomy (Level 1) B. Demonstrate professional appearance by proper grooming and wearing professional attire (Level 2) C. Discuss basic theories of ethics and the application to professionals practicing phlebotomy (Level 1) D. Discuss laws that impact upon phlebotomy and related services (Level 1) 1. Clinical Laboratory Improvement Amendments of 1988 (CLIA’88) 2. Occupational Safety and Health Administration (OSHA) regulations 3. Health Insurance Portability & Accountability Act (HIPAA) 4. Patient Self-Determination Act of 1990 5. Affordable Care Act (2010) 6. Other E. Discuss the Patient’s Bill of Rights published by the American Hospital Association and its application to phlebotomy and related services (Level 1) F. Discuss the ethical and legal responsibilities associated with the Patient’s Bill of Rights especially as they relate to phlebotomy and phlebotomy services (Level 1) 1. HIPAA 2. The Patient Self-Determination Act 3. Confidentiality 4. Right to refuse treatment 5. Informed consent 6. Privacy 7. Other G. Discuss (Level 1) the importance of patient confidentiality and demonstrate (Level 2) maintenance of patient confidentiality and how it relates to HIPAA H. Discuss the ethical and legal implications associated with breach of

MLS Phleb 15 patient confidentiality (Level 1) I. Discuss the United States’ legal system as it relates to phlebotomist, Medical Laboratory Technician (MLT), and Medical Laboratory Scientist (MLS) participating in duties related to phlebotomy (Level 1) J. Discuss the importance of standard of care and legal implications associated with standard of care (Level 1) K. Discuss the importance of labeling specimens/samples and the legal ramifications associated with improper specimen/sample labeling (Level 1) L. Discuss the legal ramifications of testing specimens/samples that lack integrity (Level 1) M. Discuss the interrelationship of ethics, morals, professional and personal values, and legal aspects of care in performing phlebotomy and related services (Level 1) N. Discuss stress and the affects of stress on professionals performing phlebotomy and related services (Level 1) O. Identify methods of handling stress or eliminating stress in the work place (Level 1) P. Discuss measures that can be taken to avoid or reduce risks and liability in performing phlebotomy and related duties (Level 1)

MLS Phleb 16