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Phlebotomy Competency Skills Checklist | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination. | |||||||
| Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below. | |||||||
| Proficiency Scale: |
1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently |
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| Rating Stars (Click) | Preparation | 1 | 2 | 3 | 4 | ||
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Introduces self to patient and explains blood tests have been ordered by physician. | ||||||
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Identifies
the patient with two unique identifiers (armband, ask for name &
DOB). Compare patient ID information with barcode label. |
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Checks testing requirements (ie fasting). | ||||||
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Prepares supplies and tube selection. | ||||||
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Washes hand, dons gloves. | ||||||
| Rating Stars (Click) | Getting Started | 1 | 2 | 3 | 4 | ||
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Positions Patient and applies tourniquet. | ||||||
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Palpates antecubital area to select venipuncture site. | ||||||
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Properly cleanses venipuncture site. | ||||||
| Rating Stars (Click) | Sample Collection | 1 | 2 | 3 | 4 | ||
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Stablizes vein. | ||||||
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Inserts needle, bevel up. | ||||||
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Smoothly pushes tube(s) into holder without changing needle position. | ||||||
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Adjusts needle, if necessary, to obtain flow then stablizes vacutainer. | ||||||
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Releases tourniquet as blood begins to flow. | ||||||
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Changes vacutubes without changing needle position. | ||||||
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Fills vacutubes in correct order. | ||||||
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Mixes anticoagulated vacutubes properly. | ||||||
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Removes last tube from needle before withdrawing needle. | ||||||
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Withdraws needle from arm smoothly. | ||||||
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Applies pressure to site after withdrawing needle. | ||||||
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Disposes of needle properly and safely, Discards tourniquet. | ||||||
| Rating Stars (Click) | Handling & Processing | 1 | 2 | 3 | 4 | ||
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Labels tubes immediately (ie at bedside). | ||||||
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Legibly completes label/requisition with username and date/time of collection. | ||||||
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Observe special handling requirements. | ||||||
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Checks puncture site to ascertain bleeding has stopped. Applies bandage. | ||||||
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Places tubes into biohazard bag. Label(s)/requisiton are placed in sleeve of bag. | ||||||
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Removes gloves and practice hand hygiene. | ||||||
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Transport specimens to lab via porter or pneumatic tube system. STATs are sent immediately. | ||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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Infant (Birth - 1 year) | ||||||
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Preschooler (ages 2-5 years) | ||||||
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Childhood (ages 6-12 years) | ||||||
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Adolescents (ages 13-21 years) | ||||||
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Young Adults (ages 22-39 years) | ||||||
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Adults (ages 40-64 years) | ||||||
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Older Adults (ages 65-79 years) | ||||||
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Elderly (ages 80+ years) | ||||||
| CERTIFICATIONS | Other | Expiry Date : | |||||
| Resource location – Lab Test information Guide. | |||||||
| Blood Ethanol Collection – cleanse site with soap and water. | |||||||
| Blood Culture Collection Review. | |||||||