Hospital Lab Technician 1

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of time

Key Responsibilities

Task A: Phlebotomy/Specimen Collections 

Phlebotomy requires the use of evacuated tubes and/or syringe and needle for obtaining blood specimens by venipuncture, the ability to obtain blood specimens by skin puncture (especially on infants), and the ability to make smears or peripheral blood on microscope slides when indicated.

Standards:

1. Washes hands or uses alcohol-based hand sanitizer prior to contact with patients. 
2. Properly identifies patient by following established department or medical center protocol, to assure proper match of patient with test request on electronic screen or on the paper laboratory requisition.
3. Thoroughly checks requisition-based information and is knowledgeable about volume requirements, container type, and proper specimen labeling.
4. Uses the Clinical Laboratory Online Lab Manual as a resource whenever additional information is required.
5. Consistently utilizes established blood draw technique including site identification and preparation. Skillfully uses appropriate equipment and employs post-venipuncture care.
6. Uses skill to find the correct veins in pediatric patients and utilizes the proper needle to obtain blood by venipuncture. Knows when to perform skin puncture and applies the correct device in the designated area of the foot or hand. Is familiar with the minimum amounts required for testing. Communicates with the ordering physician is unable to obtain the exact amount to establish test priority with the quantity obtained.
7. Administers glucose drink for tolerance tests, Determines collection time(s) and properly collects and labels timed sequential blood draws for glucose tolerance. Other requests for timed blood draws are promptly attended to (e.g., d-xylose tests).
8. All specimens for the Blood Bank must be dated and legibly signed by the person who obtained the specimen.
9. Collects appropriate specimens for blood culture including AFB, fungal, or viral analysis. Carefully selects sites, cleans area, and ensures precautions are taken when transferring blood to culture containers, as this requires changing needles.
10. Adheres to Hospital Infection Control policy in regard to proper health and safety requirements such as wearing gloves and safety goggles, hand washing, and isolation procedures when required.
11. Ensures proper specimen transport by proper racking and/or bagging specimens, proper clocking and routing of STAT specimens.
12. Stocks all blood draw supplies in assigned work area and maintains a clean work area.
13. Takes responsibility for writing phlebotomy code and VPO on the outpatient requisition. Initialing and filing the patient draw record in the designated filing area.

Task B:            Patient Greeting/ Reception

Patients should be greeted in a friendly, cheerful manner. The phlebotomist will:

1. Acknowledge the Patient with a greeting
2. Introduce themself
3. Explain the expected Duration of the test to be performed
4. Explain test or procedure (blood draw, urine collection, etc.)
5. Thank the patient – if outpatient, thank them for choosing UCSF and allowing us to provide service to you today – if in-patient, also say “thank you” and for both patients, ask if there is anything else you can do for them

Task C:             Processing Orders in the hospital (APeX) system and Lab (Sunquest) system

Patient orders must be validated before collecting specimens. 

For In-Patients, orders should be displayed in the handheld PDA devices. The phlebotomist should check with the nurse before drawing blood to ensure orders are correct and verify if Lab to collect versus Nurse to collect. Collection labels are generated from the handheld devices after properly identifying the patient. For orders not displayed in the PDA devices, the nurse should provide an APeX requisition and APeX labels for the specimen collection. Specimens should be transported to the Clinical Laboratory following established protocols.

For OutPatients, orders data should be validated in the hospital APeX and released to generate labels for specimen collection, following established protocols. Outpatients may not always have an electronic order for testing. If the patient presents a paper requisition to the laboratory, follow established protocol for entering the order into the computer system.

 Standards:

1. For In-Patients, use the handheld PDAs or paper requisition/ labels after checking with nurse.
2. For In-Patients, process the work in the following order:
3. STATs
4. Timed orders
5. Routine orders
6. For outpatient collection areas, place specimens in routine blood racks within 30 minutes. Processes STATs, urine, and body fluids within 20 minutes.
7. Processes work in the following order:
8. STAT’s
9. Process Immediately
10. Body Fluids
11. Routine racks
12. Urine
13. Research/”Specimen in lab”
14. Routes back to a supervisor any problem that takes more than 1 – 2 minutes to resolve, or sets it aside until the remaining work is processed. Resolves all problems within 2 hours. Clears up all problems by the end of the work shift.
15. Minimizes the number of computer errors by carefully checking the computer entry on CRT screen before “verifying” input.

Task D: STAT or Routine Processing

STAT specimens should be processed first and sent to the Clinical Laboratory for processing.

In Out-Patient and Processing areas, specimens are sorted for delivery to the appropriate department: Blood Bank, Chemistry, Hematology, etc.. STAT specimens may be grouped together in a single container. As needed, receive specimens in the Laboratory Information System.

Label specimens with the appropriate computer-generated labels. Be aware of the risk of incorrectly labeling a sample when specimens collected at multiple times or from several sites are submitted together; prepare pour-off vials for aliquoting.

Provide clear written instructions to the analytical sections and Specimen Processing when specimens must be shared (e.g., between Chemistry and Hematology). 

Standards:

1. Labels and prepares STATs for 20 minute messenger runs.
2. Labels specimens and aliquots correctly.
3. Maintains reasonable speed on a steady basis in order to complete labeling of a rack within 10 minutes of completion of computer order entry (accession).
4. Detects and corrects discrepancies between request forms and computer-generated labels or in making appropriately labeled pour-off tubes.

Task E: Aliquoting of Urine Collections

When assigned to work in the Processing areas of the Clinical Laboratory or one of the Out-Patient Laboratories where urine specimens are processed, Urine labels must be verified against the requisition to detect entry errors and corrections made when needed. Check specimen when a preservative is required and/or urine aliquots treating the specimen as directed by the computer labels.

Aliquot urines into the proper tubes or containers and enclose 24-hour urines in plastic bags. When there are two or more specimens for one 24-hour collection, ensure that they are labeled correctly. Initial requisition in appropriate “Aliquot” box upon completion of task.        

Standards:

1. Aliquots and labels specimens correctly.
2. Assures transfers or orders are made on requisitions of shared Hematology and Chemistry specimens to alleviate confusion by Specimen Handling section.
3. Processes all routine urines received within 45 minutes, all STATs within 20-minute messenger runs. If a specimen has not been received within 2 hours, communicates to the ordering location and sends an appropriate comment on the computer.
4. Notifies Supervisor if unable to complete tasks in a timely manner.

Task F: Responses to Inquiries/Communications

Communicate non-technical information (such as collection instructions and turnaround times, pricing, test results, etc.) obtained from the Laboratory Manual. The in- and out-patient price files, the laboratory computer, and the requisitions. Consult with supervisor and technical staff WHEN INFORMATION IS NOT AVAILABLE in these sources. Communicate accurately and clearly, whether in person or by telephone.

Standards:

Be professional and courteous at all times. Keep in mind that everyone has the common goal of helping the patient.

Task G: Telephone Duty

Answer all telephone extensions in the work area in a timely manner.

Standards:

Adheres to the hospital’s established house and telephone standards. Identifies oneself and the unit and offers “May I help you?”. Attempts to answer phones before the third ring.

Task H: Bone Marrow Collection

When assigned, assist physician on site in the outpatient clinic location by preparing smears of bone marrow aspirate and preserving bone marrow biopsy specimen for further processing by anatomic pathology.

Standards:

1. Correctly prepares appropriate paperwork and specimen labels before beginning procedure to assure proper labeling of specimens and that specimens will be handled according to physician’s orders.
2. Let the doctor know as soon as the bone marrow aspirate specimen is placed into the EDTA tube and examined if the specimen is adequate for smear preparation.
3. Makes “touch prep” smears on the bone marrow biopsy.
4. Follows instructions for unusual requests based on information in the ACC Laboratory Procedure Manual.

Task I: Pneumatic Tube

Check contents of pneumatic tube from Hematology clinic upon arrival in ACC lab. Promptly check and return the tube with any slides, blood products, and any other supplies.

Standards:

1. Empties and returns tubes as soon as possible after arrival.
2. Tubes blood products to the clinic no more than 5 minutes after they arrive by messenger from the Blood Bank.

Task J: Computer Downtime

During a computer downtime, it will be necessary to process specimens according to established downtime protocols. Process specimens correctly without the aid of computer labels and forward them to the proper testing sections. Write patient/test information on all pour-off tubes.

Standards:

1. Is familiar with Computer Downtime plans and is able to follow with minimal supervision. Follows these instructions except when authorized to do otherwise by supervisor.
2. Hand-writes al requisitions and labels legibly.

Task K: Additional Unspecified Duties

            Perform additional duties or projects as assigned in the Clinical Laboratory In-Patient Phlebotomy, Out-Patient Blood Draw or Clinical Laboratories Processing sections.

Standards:

1. Completes the assigned task properly within the agreed upon time.

Errors – Definitions and Significance

Errors in processing laboratory specimens can have a serious negative impact to patients by delaying testing and the availability of test results, or it can result in improper follow-up and treatment for the patient.

1. Incorrect identification of patient before phlebotomy, especially for Blood Bank tests, can result in disciplinary action up to and including dismissal from employment.
2. Errors can potentially misdirect diagnosis or treatment. These include mixing up samples from different patients, mixing up two different specimens from the same patient, using the wrong specimen additive, incorrectly entering (sending) test results in the laboratory computer, and similar mistakes, as well as errors which may require a patient to repeat an invasive diagnostic procedure (e.g., failure to properly preserve or store a CSF, which results in the patient’s having to undergo another spinal tap).
3. Other serious errors may cause some degree of inconvenience to a patient but do not yield an incorrect result and therefore are not likely to lead directly to improper management of the patient. These are primarily errors of omission or of additional unwarranted laboratory testing, failing to enter orders for tests, which were requested or excessive delay in processing resulting in the test missing the scheduled run. Erroneous entry of charges to budget accounts are also serious because they waste the time and resources of personnel inside and outside the laboratory in tracking down and correcting the problem. Such errors often can be corrected without requiring another patient sample.