Identifier Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Identifier and links to relevant pages within the course.
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Patient safety when performing a capillary blood collection includes positive patient identification prior to performing the procedure. The accepted policy in most healthcare facilities is to use two forms of identification, including a unique number if possible, such as a hospital number or medical record number.Ideally, the patient (or the parent/guardian if the patient is a small child) should be asked to spell his/her name and state his/her date of birth. This may not always be possible, but it will aid in positive patient identification whenever it can be done.The phlebotomist should LOOK at the patient's paperwork while they LISTEN to the patient's response. For inpatients, the patient identification bracelet, which must be attached to the patient's wrist or ankle, should be used to verify patient identity. A hospital number recorded on the bracelet may be used as a second identifier in the case of an inpatient.Paying close attention to these details and correcting any discrepancy discovered will greatly reduce the risk of misidentifying a patient. Always follow the policy of your facility for identification and never shortcut the patient identification procedure.
Procedural Step Comment Caution Greet and positively identify patient Always use at least two patient identifiers to ensure positive patient identification. Never rely on name placards that are placed on or near the patient's bed or crib to identify the patient. If there is a discrepancy in identification, do not proceed until the discrepancy is resolved. Explain the procedure If the patient is a small child, be at eye level when explaining the procedure. Also explain the procedure to the parent(s). If the patient is aware of what will be happening there is less chance of the patient suddenly jerking away his/her hand when the puncture occurs. Position patient appropriately An outpatient who is a small child should sit on the parent's lap. If necessary, seek assistance for finger puncture if the patient is a small child. Cleanse hands and put on gloves Use soap and water or alcohol-based gel to cleanse hands. Cleanse hands before donning gloves and after removing gloves. Warm puncture site if needed Use the method that is approved by the laboratory for prewarming the puncture site. Never use a moist cloth that has been heated in a microwave as this may cause injury to the patient. Gather appropriate equipment Only have needed equipment at hand. Keep track of ALL equipment to prevent patient injury. Cleanse the puncture site Use 70% isopropanol unless the patient is sensitive to alcohol. Allow the site to air dry. Performing the puncture before the alcohol has dried may hemolyze the blood specimen. Securely grasp and puncture finger Puncture the side edge of the fleshy pad of fingertip. Avoid extreme side and tip of finger. Discard puncture device into appropriate container Puncture device should be discarded into a sharps container that is puncture-proof, has rigid sides, and has a lid Do not discard puncture devices into regular trash or biohazard bags. Injury to personnel who handle these bags may occur. Wipe away the first drop of blood Use slight pressure to facilitate blood flow. The first drop of blood contains tissure fluid that may contaminate or dilute the blood specimen and affect test results. Collect blood into container Allow blood to flow freely into the collection device. Tap the container gently on a hard surface to move blood further down into the tube if necessary. Do not "milk" the finger or scrape the collection device across the finger to obtain specimen; both actions may cause the specimen to hemolyze. Mix specimen immediately upon completion of the collection. Apply pressure to the puncture site to stop the bleeding. Use gauze to apply pressure to the puncture site. It is not advisable to apply an adhesive bandage over the skin puncture site if the child is less than two years old as the child may place the bandage in his/her mouth. Label specimen Specimen must be labeled in the presence of the patient. Unlabeled specimens will be rejected by the laboratory.
The heel of the foot is the preferred site for dermal puncture and capillary blood collection for infants less than 12 months old. CAUTION: In premature infants, the bone may be as close as 2.0 mm under the skin of the plantar surface of the heel. The bone may be even closer--maybe half this distance-- on the back curve of the heel. Any puncture more than 2.0 mm may risk a puncture of the bone causing severe consequences to the infant. Only use approved preemie puncture devices on small infants. Procedural Step Comment Caution Positively identify patient Always use at least two patient identifiers to ensure positive patient identification. Never rely on name placards that are placed on or near the infant's crib to identify the patient. If there is a discrepancy in identification, do not proceed until the discrepancy is resolved. Position patient appropriately Position the infant so that the heel can be easily accessed. If necessary, seek assistance to stabilize baby's foot during the blood collection. Cleanse hands and put on gloves and any other required PPE. Use soap and water or alcohol-based gel to cleanse hands. Cleanse hands before donning gloves and after removing gloves. Choose puncture site Use the area of heel that is not striped (the white area) in the image on the left. Do not use the center portion of the heel, the arch of the foot, or toes as any of these sites may cause injury to nerves, tendons, and cartilage. Warm puncture site if needed Use only approved warming device. Never use a moist cloth that has been heated in a microwave as this may cause injury to the patient. Gather appropriate equipment Only have needed equipment at hand. Keep track of ALL equipment to prevent patient injury. Cleanse the puncture site Use 70% isopropanol. Allow the site to air dry. Performing the puncture before the alcohol has dried may hemolyze the blood specimen. Securely grasp and puncture the heel. Choose either side of the fleshy part of heel. Avoid center of heel and arch of the foot. Discard puncture device into appropriate container Puncture device should be discarded into a sharps container that is puncture-proof, has rigid sides, and has a lid Do not discard puncture devices into regular trash or biohazard bags. Injury to personnel who handle these bags may occur. Wipe away the first drop of blood Use slight pressure to facilitate blood flow. The first drop of blood contains tissue fluid that may contaminate or dilute the blood specimen and affect test results. Collect blood into container Allow blood to flow freely into the collection device. Tap the container gently on a hard surface to move blood further down into the tube if necessary. Do not "milk" or squeeze the heel excessively. Do not scrape the collection device across the heel to obtain specimen; these actions may cause the specimen to hemolyze. Mix specimen immediately upon completion of the collection to prevent clots. Apply pressure to the puncture site to stop the bleeding. Use gauze to apply pressure to the puncture site. Use a bandage only if this is an acceptable procedure in your facility. Label specimen Specimen must belabeled in the presence of the patient. Unlabeled specimens will be rejected by the laboratory.
|Which of these methods should be used to verify the identification of an infant in the nursery prior to collecting a blood specimen?||View Page|
|Capillary Blood Collection for Metabolic Testing|
The collection of these specimens requires the same attention to detail as with any phlebotomy procedure. Gather all necessary equipment Be certain to choose a device that punctures the heel to a depth appropriate to the size of the infant. Only use the filter cards provided by your state to collect the specimen. These cards are calibrated to the exact specifications needed for testing of metabolic disorders. An alternate or homemade card must not be used. Put on all necessary personal protective equipment Gloves are always required. Gowns and eye protection may also be required. Positively identify the patient Use two identifiers. The infant who is in the nursery should have an identification band attached to the ankle or wrist. In special care nurseries an alternate form of identification may be used. However, a crib card should never be used as a form of identification. Follow the practice for your facility. Position the infant Be certain that the heel can be easily accessed. Follow all nursery requirements that apply to safe handling of newborns. Warm the heel using an approved warming device Clean the site with alcohol or the approved disinfectant. Allow the site to air dry before proceeding with collection of the specimen. Grasp the heel firmly but not tightly, activate the puncture device, wipe away the first drop of blood, and begin collection of the specimen.Allow the blood to wick onto the card. Completely saturate the circle with one continuous drop of blood. Avoid touching the card to the skin. Apply the blood only to one side of the card. Do not layer the blood by applying a second drop on top of the first. Repeat the procedure to completely fill each circle on the card. Each circle should be completely and uniformly saturated as shown in the bottom image on the right. Follow the policy of your institution or state to determine how many circles must be completely filled. Apply pressure to the puncture site using a sterile gauze Gently raising the infant's leg above the level of the heart will also aid in clotting the puncture site. Bandage according to site-specific policy.
In some institutions, the phlebotomist is responsible for collecting specimens that will be directly tested to yield results for hematology studies.Blood Smear FilmsIf it is the practice of the institution, the phlebotomist may make a blood film slide directly from the blood flowing at a dermal puncture site. In this case, a drop of blood is allowed to fall directly onto the glass slide. The image below illustrates the approximate size of the drop that should be used.Using a second glass slide, the phlebotomist should spread the blood by first aligning the edge of the spreader slide in front of the drop of blood, pulling back into the drop so that it is evenly distributed behind the spreader slide as shown in the image below. Then spread the blood forward, maintaining an angle of approximately 20° between the slides. The finished slide should be at least 2.5 cm in length, there should be a gradual transition in thickness from thick to thin, ending in a feather edge. The blood smear should be made at the beginning of the dermal puncture procedure to avoid formation of microclots. Remember that the glass slides used to make the blood smear are considered sharps and can cause accidental puncture injury to both the patient and the phlebotomist. Dispose of the spreader slide in a sharps container. Also, until the smear is stained or fixed, the blood film is considered potentially infectious so bloodborne pathogen precautions must be followed.Microhematocrit collectionIn some institutions, capillary blood specimens are collected directly into heparinized capillary tubes, which are then analyzed to determine packed cell volume. These results can be used to indicate the presence of anemia. At least two capillary tubes should be filled for microhematocrit testing. The capillary tubes should be filled with blood to about two- thirds the length of the tube. One end of each tube should then be sealed to prevent blood from escaping. The sealant may be sealing clay or commercially-provided covers that are made specifically for the microhematocrit system that is in use. Capillary tubes should be plastic or mylar-wrapped glass tubes. Plain glass capillary tubes should not be used to prevent the possible transmission of bloodborne pathogens if the tube broke and punctured through the glove and skin of the phlebotomist.It is imperative that the specimens are labeled appropriately with patient information. This can be accomplished by inserting the capillary tubes into a second larger blood collection tube that is labeled with the patient name and second identifier, such as hospital or medical record number and capping the large tube. Taping the capillary tubes individually to a paper requisition with the patient information is an alternate method.
|Case Study: De-identified Health Information. You work in a laboratory microbiology department that provides a local nursing home with information about the effectiveness of various antibiotics it uses to treat infections. You print the requested information, including patient first and last names, birthdates, and medical record numbers, bacterial organisms identified, and the organisms' sensitivities to various antibiotics. What information should you provide to the nursing home?||View Page|
|Joint Commission Patient Safety Goals Joint Commission adopted national patient safety goals for healthcare organizations, including specific goals for laboratories. 2009 Laboratory Services National Patient Safety Goals These goals are directly quoted.||View Page|
|Proper Patient Identification|
In order to prevent errors that affect specimen quality, the phlebotomist must pay close attention to detail during the entire venipuncture process. All steps of the phlebotomy procedure must be included for every venipuncture. This will help to maintain specimen integrity during the collection, transport, and handling of blood specimensProperly identify the patient every timeThe phlebotomist is responsible for correctly identifying the patient using two unique patient identifiers that include the patient's complete first and last name, medical record or hospital number, and/or date of birth. The patient location or room number, bed tag and chart are not reliable forms of identification and should not be used for patient identification. Every patient must verbalize his/her name to the phlebotomist, if able to do so. It is unacceptable for the phlebotomist to ask the patient to confirm his/her name that was verbalized by the phlebotomist. For example, the phlebotomist should say, "Would you please tell me (or spell) your name and birthdate. " The phlebotomist should NOT say, "Are you Sally Brown, and is your birthdate June 1, 1925?" If this is a hospital inpatient, check the information on the patient's wristband and confirm that the name and hospital number or medical record number matches the patient information on the test order. Never rely on identification attached to a bed, chart or door. NEVER draw a patient whose identity is not established or is in conflict. If there is a discrepancy, the phlebotomist must STOP and seek assistance to have the discrepancy resolved before proceeding with the venipuncture. If this is an outpatient that does not have a wristband, ask the patient (or guardian/caregiver) to state the patient's date of birth. A picture ID, such as a driver's license, can also be used for positive patient identification.
|What is a Hidden Error?|
Hidden errors are those that cannot be detected or corrected by the laboratory analyst prior to testing. Most often these errors can be prevented by the phlebotomist following correct venipuncture procedure for every procedure, every time.Hidden errors include hemoconcentration, incorrect order of draw, and (the most serious of all errors) misidentification of patient or specimens. Because these errors often are unknown, the analyst may inadvertently report erroneous patient results which could be harmful to the safety and well-being of the patient. Condition What is it? How does it happen? What is the Result? Hemoconcentration Blood pools at site of venipuncture Tourniquet is applied for a prolonged period of time Test results may be inaccurate because blood components move between blood and tissues Pouring Blood between tubes Mixing contents of two or more tubes Removing top of tube to combine contents of one tube with another Inaccurate test results due to over or under dilution or incorrect anticoagulant Clots form due to lack of mixing Patient may have to be redrawn Incorrect patient identification and incorrect specimen labeling Using the wrong name to label a specimen Failure to positively identify EVERY patient using 2 unique identifiers BEFORE beginning venipuncture Failure to label EVERY specimen in the presence of the patient Failure to concentrate fully on the task Results reported to caregiver for wrong patient Compromises patient care; may be life-threatening
|Pre-analytic and hidden errors can greatly affect a laboratory result.Match the error listed below with the cause from the drop-down box.||View Page|
|Venipuncture Procedure At a Glance|
Required Step Description Step #1 Wash your hands. Clean your hands with soap and water or gel cleanser. Step #2 Positively identify patient using unique identifiers. Ask the patient to state his/her first and last name; if the patient is unable to give you this information, ask the patient's caregiver to confirm the patient's name. A second unique identifier must also be used. Step #3 Special test requirements Determine if the test to be obtained has any special requirements. For example, should the patient be fasting? Is this a timed test? If any requirements are not met, consult with the caregiver to determine a course of action. Step #4 Prepare the patient Explain the procedure to the patient and obtain cooperation. Usually the patient will extend an arm. (This is a form of implied consent.) Position the arm for venipuncture; support the arm on a firm surface; the arm should be in a downward position. Step #5 Site determination The patient can make a fist, but should not pump the hand open and closed. Apply tourniquet Palpate the vein. Release the tourniquet and assemble appropriate equipment. Step #6 Aseptic technique Wear gloves that have not been altered in any way. Cleanse site with approved disinfectant. Allow the disinfectant to air-dry to avoid hemolysis of the specimen and discomfort to the patient. Step #7 Specimen collection Re-apply tourniquet about 3-4 inches above puncture site, insert needle, bevel-side up, at about a 30° angle, and collect specimens. Remove needle and immediately activate the safety device. Mix specimens by gentle inversion 5-10 times. Step #8 Patient care Apply direct pressure to stop bleeding at puncture site; do not have patient bend arm as this may cause a hematoma to form. After about 2 minutes, check the puncture site to verify that bleeding has stopped. Apply bandage if appropriate. Thank the patient for his/her cooperation. Step #9 Specimen labeling Label specimen(s) in the presence of the patient including all the information that is required by your facility. Check the labeled tubes a second time against the patient's wristband to verify labeling accuracy. A professional phlebotomist follows the procedure in the same way for every venipuncture. This ensures that none of the vital steps are omitted. The phlebotomist who is consistent in performance and who concentrates fully to obtain a quality specimen is an indispensable part of the healthcare team.
|Which of the following methods could Julie have used to positively identify the patient?||View Page|