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Chapter Summary
Learning Outcome Key Concepts/Examples
Related
NAACLS
Competency
. Differentiate
among waived tests,
moderate complexity
tests, and high
complexity tests.
. Identify methods
of performing
an erythrocyte
sedimentation rate.
. Describe the
waived procedure to
test for fecal occult
blood.
. Explain the
procedure for
performing a
microhematocrit and the
reasons why this test is
performed.
. Describe the
general procedure
for performing a strep
screening test.
. List the types of
waived tests that are
commonly performed on
urine specimens.
. Explain the
purpose of point-of-care
testing.
• The Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88)
identified the following levels of complexity for medical laboratory
tests: waived tests, moderate complexity tests, provider-performed
microscopy procedures, and high complexity tests.
• A Certificate of Waiver is needed for facilities wishing to perform waived
testing.
The erythrocyte sedimentation rate (ESR) is the rate at which RBCs
settle in whole blood. Several methods are used, including Wintrobe,
Westergren, and Modified Westergren. Factors that may affect ESR results
include time from collection to testing, testing time, temperature, tilting,
and vibrations.
The waived tests for testing stool for occult blood involve the use of
guaiac, a chemical that turns blue when blood is present. Several samples
from the stool specimen are applied in a thin layer to the front of a card
impregnated with guaiac. Hydrogen peroxide is added to the back of the
card. If the guaiac paper turns blue, blood is present in the stool.
A microhematocrit screens for anemia by measuring the packed cell
volume of RBCs, or the percentage of RBCs in whole blood. Two capillary
tubes are filled with blood from a dermal (capillary) puncture or with blood
from a microcollection container or evacuated tube. The tubes are then
centrifuged, and the percentage of RBCs is read on a microhematocritreading device.
In most waived strep test kits, a swab containing a specimen from the
patient’s throat is placed in a testing vial that contains an extraction
reagent to remove the bacteria from the swab. The vial is then placed on a
testing device treated with antibodies and color developers. The patient’s
specimen is run along with a control that verifies the test has been
performed correctly. Results are read according to the manufacturer’s
instructions.
Urine is routinely tested to determine whether a woman is pregnant, as
well as to evaluate substances found in the urine. Urine tests can help
determine wellness. The chemical screening portion of a urinalysis can be
performed using waived testing methods such as the dipstick test.
Point-of-care testing reduces the turnaround time for test results. In most
cases, the specimen is tested immediately after collection with easyto-use testing devices. Examples of POCT blood tests include glucose,
hemoglobin, sodium, potassium, chloride, bicarbonate, ionized calcium,
cholesterol, blood ketones, blood gases, and coagulation studies.
N/A
4.2, 4.5, 5.00,
5.4, 7.0 0
4.2, 5.00, 5.1,
5.4, 7.0 0 , 7.2
4.5, 5.00, 5.4,
7.00
5.00
4.2, 4.5, 7.00
4.2, 4.5, 7.00, 7.2
Chapter Waived Testing
Copyright © 2019 by McGraw-Hill Education
Chapter Review
A: Labeling
Label the areas on the hematocrit test shown in the following image.
1. [LO 15.4]
2. [LO 15.4]
3. [LO 15.4]
4. [LO 15.4]
5. [LO 15.4]
B: Matching
Match each description with the level of laboratory testing. The levels may be
used more than once. [LO 15.1]
6. grouped with moderate
complexity tests
7. easy to perform and interpret
8. have a few procedural steps
9. have numerous steps
a. high complexity tests
b. moderate complexity tests
c. provider-performed
microscopy procedures
d. waived tests
1
2
3
4
5
10. incorrect procedures cause no
reasonable risk of harm
11. include running automated
instruments
12. little manipulation of specimens
or reagents
13. may be used for at-home testing
14. performed by healthcare providers
on their own patients
15. performed by personnel with
specialized training
16. require close attention to detail
C: Fill in the Blank
Write in the word(s) to complete the statement.
17. [LO 15.3] A strep test is used to screen for Group Streptococcus.
18. [LO 15.6] A(n) is a plastic strip containing pads that are impregnated
with reagents.
Copyright © 2019 by McGraw-Hill Education
Chapter Waived Testing
19. [LO 15.2] Methods for performing erythrocyte sedimentation rates include ,
, and .
20. [LO 15.3] If occult blood is present in a stool specimen, the guaiac card will turn
when the sample is added and is applied.
D: Sequencing
Place the steps for performing a POCT glucose test in the correct order (from 1 to 11). [LO 15.7]
21. _______ Provide postpuncture patient care.
22. _______ Don appropriate PPE.
23. _______ Wipe away the first drop of blood, if required.
24. _______ Properly identify the patient.
25. _______ Run and/or verify controls on the glucose instrument.
26. _______ Read and record the results.
28. _______ Assemble the equipment.
29. _______ Apply the blood to the test strip.
30. _______ Properly dispose of biohazards.
31. _______ Insert the test strip into the glucose instrument.
E: Case Studies/Critical Thinking
32. [LO 15.3] A specimen is tested for occult blood and found to be positive. A brief history on the patient
revealed that he had recently eaten a meal that included steak with horseradish dressing. What is the
most appropriate course of action?
33. [LO 15.6] When performing urine chemistry screening using reagent strips, you notice that the
urobilinogen pad is already brown when you remove the strip from the container. What is your course
of action? How might this strip have become discolored?
F: Exam Prep
Choose the best answer for each question.
34. [LO 15.2] An erythrocyte sedimentation rate is
a. the distance RBCs settle in a calibrated tube
after 1 hour.
b. the speed at which RBCs move through an
automated analyzer.
c. how far red blood cells settle in the EDTA
tube.
d. the percentage of red blood cells in a
centrifuged capillary tube.
35. [LO 15.4] A microhematocrit is
a. the percentage of red blood cells in a centri-
fuged capillary tube.
b. the amount of hemoglobin in the average red
blood cell.
c. the number of red blood cells seen using a
microscope.
d. none of these.
Chapter Waived Tes ting
Copyright © 2019 by McGraw-Hill Education
36. [LO 15.3] The guaiac card occult blood test is
commonly performed on what type of specimen?
a. Sputum
b. Stool
c. Throat swab
d. Urine
37. [LO 15.3] False-positive results may occur in a
fecal occult blood test if patients have ingested
(Choose all that apply.)
a. alcohol.
b. bananas.
c. milk.
d. horseradish.
41. [LO 15.7] What is POCT?
a. Physician-ordered chemistry test
b. Patient-operated cholesterol test
c. Point-of-care testing
d. Personnel occupational care training
42. [LO 15.7] The blood glucose test is performed by
a. applying blood to a strip inserted into a
specially designed electronic meter.
b. using a urine reagent strip to test for glucose.
c. allowing blood to settle in a calibrated tube
and measuring the distance.
d. applying blood to a guaiac card and adding
hydrogen peroxide.
38. [LO 15.3] A microhematocrit test is used to
screen for
a. anemia.
b. diabetes mellitus.
c. occult blood.
d. strep infection.
39. [LO 15.6] Testing for human chorionic
gonadotropin assesses the status of
a. pregnancy in women.
b. male fertility.
c. Streptococcus infection.
d. none of these.
40. [LO 15.6] Points of concern when using reagent
strips for urine chemical testing include (Choose
all that apply.)
a. the time urine is in contact with reagent pads.
b. the removal of excess urine off the reagent
pads.
c. correct comparison of the color changes of the
reagent pads.
d. the time of day the specimen was collected.
43. [LO 15.1] Levels of laboratory testing complexity
were established by
a. CA P.
b. CLIA.
c. CLSI.
d. COLA.
44. [LO 15.2] For which of the following does an
ESR test screen?
a. High blood pressure
b. Inflammation
c. Anemia
d. Jaundice
Enhance your learning by completing these exercises and more at
connect.mheducation.com.
References
Cox, P., & Wilken, D. (2011). Palko’s medical laboratory procedures (3rd ed.). New York, NY: McGraw-Hill.
Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2006). How to obtain a CLIA Certificate
of Waiver, Brochure #6. Retrieved September 10, 2013, from www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/
Downloads/HowObtainCertificateofWaiver.pdf
Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2013). Clinical Laboratory Improvement
Amendments (CLIA). Retrieved July 30, 2013, from www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/downloads/CLIABrochure.pdf
Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2015). MLN matters. Retrieved
January 11, 2017, from www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/
downloads/MM9416.pdf
Harmening, D. (2007). Laboratory management principles and processes (2nd ed.). St. Petersburg, FL: D. H. Publishing & Consulting.
National Accrediting Agency for Clinical Laboratory Sciences. (2010). NAACLS entry-level phlebotomist competencies. Rosemont, IL:
Author.
Sinatra, M. A., St. John, D. J. B., & Young, G. P. (1999). Interference of plant peroxidases with guaiac-based fecal occult blood tests
Copyright © 2019 by McGraw-Hill Education
is avoidable. Clinical Chemistry, 45, 123–126.
Chapter Waived Testing
NAME: _____________________________________ DATE: _____________________________________
COMPETENCY CHECKLIST: URINE CHEMICAL SCREENING
Practice Performed
Procedure Steps Yes No Master
Preprocedure
. Examines the requisition.
. Matches requisition identification with the specimen identification.
. Labels a report form correctly with the patient’s identification
or opens the correct patient’s electronic laboratory test
reporting form.
. Washes hands and dons appropriate PPE (lab coat, gloves, eye
protection or face shield).
. Assembles appropriate equipment (reagent strips, absorbent
material, biohazard waste container).
Procedure
. Ensures that the specimen is at room temperature.
. Thoroughly mixes the specimen before removing the cap.
. Correctly removes a reagent strip from its bottle (does not
contaminate other strips; replaces cap on the bottle) and ensures
that it has not expired.
. Correctly dips the reagent strip into the urine (submerges
all reagent pads).
. Immediately removes strip, dragging it across the top of the
container and/or touching it gently on absorbent material to
eliminate dripping.
. Begins timing immediately.
. Compares reagent strip pad colors to the chart on the bottle at the
correct time.
. Selects the correct reaction reading for each test pad on the
reagent strip.
. Correctly records results onto the result form or patient chart
(or electronic record) including lot number and expiration date
of the reagent strips.
Postprocedure
. Properly disposes of reagent strip, specimen, and PPE.
COMMENTS: ______________________________________________________________________________
________________________________________________________________________________________
SIGNED
EVALUATOR: ___________________________________________________________________________
STUDENT: ______________________________________________________________________________
Chapter Waived Testing
Copyright © 2019 by McGraw-Hill Education
NAME: _____________________________________ DATE: _____________________________________
COMPETENCY CHECKLIST: POINTOFCARE GLUCOSE TESTING
Practice Performed
Procedure Steps Yes No Master
Preprocedure
. Performs quality control on the glucose meter.
. Records quality control and verifies that the meter is within control limits.
. Examines the requisition.
. Greets the patient; introduces self.
. Identifies the patient verbally using two identifiers, including comparing
the identification band, if available, with the requisition.
. Explains the procedure to the patient.
. Verifies diet restrictions or instructions.
. Puts on gloves.
. Selects the correct equipment and supplies.
. Assembles the equipment and supplies properly.
. Conveniently places the equipment.
. Reassures the patient.
. Selects the appropriate finger.
. Warms the finger, if necessary.
. Selects the dermal (capillary) puncture site.
. Cleanses the puncture site.
. Allows the site to air dry.
Procedure
. Applies the lancet across the fingerprints.
. Uses adequate pressure when activating the lancet.
. Wipes away the first drop of blood if required by the manufacturer of the
machine being used.
. Follows the manufacturer’s procedure for performing glucose analysis.
. Places gauze over the puncture site.
. Records the glucose level correctly.
Postprocedure
. Thanks the patient.
. Disposes of used supplies appropriately.
. Removes gloves and washes hands.
. Documents the results in the computer system (if required).
COMMENTS: ______________________________________________________________________________
________________________________________________________________________________________
SIGNED
EVALUATOR: ___________________________________________________________________________
STUDENT: ______________________________________________________________________________
Design Elements: Communicate & Connect icon (patient and doctor) ©Rocketclips, Inc./Shutterstock.com RF; Safety & Infection Control icon (samples in hand)
Copyright © 2019 by McGraw-Hill Education
©motorolka/Shutterstock.com RF.
Chapter Waived Testing
Practicing Professional
16
acculturation
attributes
burnout
certification
CLAS Standards
code of ethics
continuing education
cross-trained
culture
diversity
externship
essential terms
hard skills
interprofessional
liability
licensure
litigation
Behavior
malpractice
multicultural
multiskilled
negligence
networking
professional
professional
development
professionalism
registration
résumé
risk management
scope of practice
soft skills
stereotypes
stress
Learning Outcomes
. Model professional behavior and
appearance.
. Summarize healthcare diversity and
competent professional communications.
. Discuss risk management and policies and
protocol designed to avoid medicolegal
problems.
. List the causes of stress in the workplace
and discuss the coping skills used to deal
with workplace stress.
. Recognize the different elements of the
professional community of the phlebotomist.
©Stewart Cohen/Getty Images RF
Related NAACLS Competencies
. Communicate (verbally and nonverbally)
effectively and appropriately in the workplace.
. Maintain confidentiality of privileged
information on individuals, according to federal
regulations (e.g., HIPAA).
. Demonstrate respect for diversity in the
workplace.
. Interact appropriately and professionally.
. Model professional appearance and
appropriate behavior.
. Define and use medicolegal terms and
discuss policies and protocol designed to avoid
medicolegal problems.
. List the causes of stress in the workplace
and discuss the coping skills used to deal with
workplace stress.
Introduction
This chapter provides insights into professional behaviors and cultural competence. It also explores the types and causes of stress on the job and potential
solutions to avoid burnout. Finally, it describes professional life after phlebotomy training.
.
Professional Behavior
The concept of professional behavior is important not only in healthcare but
also in nearly any field in which a person works, whether this person is an auto
mechanic, a butcher, a fashion retailer, or an investment banker. Consider what
the phrase “professional behavior” means to you and the images that you might
associate with such behavior. A professional is an individual who performs a
vocation or job requiring specialized educational training. Professionalism is
behavior that exhibits the traits or features that correspond to the models and
standards of that profession, which, in this case, is phlebotomy. Models and
standards are developed by professional organizations, such as the American
Society for Clinical Laboratory Science, the National Phlebotomy Association,
and some state and other governmental entities.
In addition, some organizations have developed a list of professional standards, called a code of ethics. A code of ethics is a statement adopted by a
profession that states the expected professional and personal conduct of its
members. It is a moral framework that is used to assist professionals in understanding and applying professional behavior in everyday practice and especially in challenging situations. Phlebotomy Code of Ethics statements and
Pledges to the Profession can be found on the professional society websites
listed in Table 16-2 near the end of this chapter. Community needs and cultures also play roles in developing standards of professionalism.
Two types of skills are needed in any profession:
1. Hard skills—technical skills that require specific training as well as
operational proficiencies within a professional’s scope of practice.
Hard skills represent the minimum proficiencies necessary to do the
job. Examples of hard skills for phlebotomists are
●
●
●
dermal (capillary) and venipuncture techniques
specimen handling and processing
computer data entry
The ability to perform hard skills is readily observable by trainers and
supervisors who can help students or employees correct any deficiencies.
The hard skill set is the first screen employers use to determine if applicants are qualified for the position.
2. Soft skills—personal attributes (defining qualities) or behaviors that
enhance an individual’s interactions, job performance, and career
prospects.
Soft skills are more elusive and less concrete. These are the char-
acteristics, attributes, or attitudes—such as respect, dependability, and
integrity—that people develop throughout their lives and bring with
them to their educational programs and jobs. Although these are generally personal attributes, when they are sought after and significant for
specific jobs, they are also professional attributes or behaviors. Keep in
mind that technical (hard) skills associated with phlebotomy are the
Copyright © 2019 by McGraw-Hill Education
Chapter Practicing Professional Behavior
reasons most graduates are hired. However, the lack of a specific soft
skill or professional behavior is the reason for most terminations. Weakness in the soft skills is also a major reason that students do not successfully complete their phlebotomy education. Therefore, knowing how to
do something is important, but behaving professionally while on the job
is essential. The practical application of soft skills in the workplace is
treated throughout this book. The chapter Phlebotomy and Healthcare discusses the qualities of a phlebotomist including professionalism as well
as communication and customer service skills. Patient communications
and the application of healthcare ethics are examined in the chapter
Patient and Specimen Requirements.
Checkpoint
Questions .
1. Define professionalism.
2. What is the difference between a hard skill and a soft skill?
.
Have you heard the expression “It takes all kinds”? Professionalism involves
understanding people who are different from you and respecting their right to
be different. After all, from their point of view, you are the one who is different!
Diversity is a term used to encompass variations of a category, such as the various types of life found on earth, the various ways one can invest money, and the
various cultures displayed by human beings. Culture is usually understood to
mean a specific ethnic, religious, or socioeconomic background (see Figure 16-1).
Diversity in Healthcare
Culturally Aware Communication
Every person has a basic worldview that shapes his or her beliefs about health
and disease, the methods for treating disease, and the role of heathcare providers. These belief systems can create challenges for the healthcare worker because
individual preferences affect how patients respond to healthcare. National standards have been developed by the Office of Minority Health, within the U.S.
Department of Health and Human Services, to serve as a guide for the delivery of quality healthcare to diverse populations. These standards are called the
National Standards for Culturally and Linguistically Appropriate Services in Health
Figure - Healthcare workers and patients come from a
variety of backgrounds.
©monkeybusinessimages/iStock/Getty Images RF
and Health Care (CLAS standards). The intent of
these standards is to help eliminate misunderstandings in healthcare interactions, improve patient compliance, and eliminate healthcare disparities. See
Table 16-1 to read the CLAS standards in full.
Communicating with people of diverse backgrounds can be difficult because of barriers that
may naturally result from diversity. For example,
stereotypes are one type of barrier to communicat-
ing with people from different cultures. Stereotypes
are beliefs and concepts about a specific cultural
group of people that are often based on assumptions
about that cultural group. Phlebotomists and other
healthcare workers should avoid stereotyping individuals and realize that everyone is different, regardless of whether they come from the same culture or
a different one. Although people of the same culture
Copyright © 2019 by McGraw-Hill Education
Chapter Practicing Professional Behavior
TABLE National Standards for Culturally and Linguistically Appropriate Services in
Health and Health Care
Principal Standard:
. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse
cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Governance, Leadership, and Workforce:
. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through
policy, practices, and allocated resources.
. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are
responsive to the population in the service area.
. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and
practices on an ongoing basis.
Communication and Language Assistance:
. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at
no cost to them, to facilitate timely access to all health care and services.
. Inform all individuals of the availability of language assistance services clearly and in their preferred language,
verbally and in writing.
. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained
individuals and/or minors as interpreters should be avoided.
. Provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the
populations in the service area.
Engagement, Continuous Improvement, and Accountability:
. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them
throughout the organization’s planning and operations.
. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures
into measurement and continuous quality improvement activities.
. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health
equity and outcomes and to inform service delivery.
. Conduct regular assessments of community health assets and needs and use the results to plan and implement
services that respond to the cultural and linguistic diversity of populations in the service area.
. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural
and linguistic appropriateness.
. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify,
prevent, and resolve conflicts or complaints.
. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and
the general public.
or background can share the same beliefs, many factors affect the way an individual reflects and acts on these beliefs. The following are a few of these factors:
●
Place of birth
●
Place of upbringing (urban,
suburban, rural)
●
Current place of residence
●
Family history
●
Social status
●
Economic status
Copyright © 2019 by McGraw-Hill Education
●
Education
●
Spiritual beliefs
●
Superstitions and folklore
●
Length of time in the United
States
●
Level of acculturation (changes
made by minorities in response
to the dominant culture) to
mainstream American culture
Chapter Practicing Professional Behavior