Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3852_Библиотеки_им_академика_М_И_Перельмана
.pdf
262
https://t.me/med1917
FIGURE 18-6 Application of the tourniquet is one preanalytic
variable over which the phlebotomist has complete control.
CHAPTER 18 Quality Phlebotomy http://evolve.elsevier.com/Warekois/phlebotomy
the right order. The sample volume must be
matched to the quantity of additives in the tube,
and the tube size should be chosen to provide
adequate volume for the test required. The specimen must be mixed gently and thoroughly by
inversion immediately after being drawn.
FLASHBACK
You learned the order of draw in Chapter 8.
• Labeling. Incorrect or incomplete labeling makes
a specimen useless and requires redrawing the
specimen at a later date. Label tubes immediately
after they are drawn, before leaving the patient’s
room (Figure 18-7). Be sure that the labeling is
complete, and note any special patient conditions
on the requisition.
FLASHBACK
You learned about the elements of a complete label in
Chapter 9.
Patient’s Perception
The patient’s perception of the level of care he or she
receives is directly affected by the skill, professionalism, and care you show as a phlebotomist. This
perception reects not only on you but on the entire
laboratory as well. You should strive to avoid painful
probing, unsuccessful punctures, and repeated draws
and be scrupulously careful regarding site selection,
accidental arterial puncture, and nerve injury. In addition, infection control procedures must always be
followed. Break the chain of infection by performing
hand hygiene upon entering and leaving the
room, and by wearing gloves during the procedure
(Figure 18-8).
Accidental Puncture
Accidental puncture with a used needle must be
reported immediately to a supervisor. Immediate and
follow-up testing for bloodborne pathogens, plus
counseling, is standard protocol for accidental needle
sticks. QA procedures include monitoring the number of accidental punctures and instituting additional
training or equipment modications in the event of
frequent accidents.
TRANSPORTATION
Specimen transportation variables include the
method of delivery, the treatment of the sample
during transportation, and the timing of delivery.
FIGURE 18-7 Make sure that all specimens are properly labeled.
FIGURE 18-8 Infection control procedures are a vital part of qual-
ity phlebotomy. Hand hygiene and gloving should be performed
for every procedure. (From Bonewit-West K: Clinical procedures
for medical assistants, ed. 9, Philadelphia, 2015, Saunders.)
Copyright 2016, 2011, 2007, 2002 by Saunders, an imprint of Elsevier Inc. All rights reserved.
http://evolve.elsevier.com/Warekois/phlebotomy CH APTE R 18 Quality Phlebotomy
https://t.me/med1917
263
FLASHBACK
You learned about specimen transport and handling in
Chapter 16.
Samples requiring either cold or warm temperatures during transport must be placed in the appropriate container and must be handled so that the
appropriate temperature is maintained throughout
the transport process (Figure 18-9). Aheel-warmer
packet gradually loses its heat, for instance, and if
the sample is not delivered before heat loss, the
sample will be compromised. Short turnaround
time (stat) specimens require prompt delivery and
analysis, and the on-time record of the phlebotomist and the laboratory is analyzed in QA programs
to determine whether changes must be made in
transportation procedures.
Pneumatic tube systems require special monitoring to ensure that the sample is not overly agitated
during transport, causing hemolysis. Some samples
cannot travel by pneumatic tube, and it is the phlebotomist’s responsibility to ensure their proper handling. The directory of services contains precisely
this type of information.
PROCESSING
Specimen processing is another area in which the
phlebotomist and other laboratory staff have almost
complete control over the variables that arise. These
include the time between collection and processing,
the centrifugation process, the possibility of contamination and evaporation, the proper storage conditions,
and the processing of aliquots.
Separation Times
No more than 2 hours should elapse between the
time a specimen is collected and the time serum
or plasma is separated from formed elements.
After this time, the sample will begin to show
falsely lowered glucose and falsely elevated potassium and lactate dehydrogenase. Even less
time should be allowed for determinations of
potassium, adrenocorticotropic hormone, or cortisol. Ammonia samples must be separated
within 15 minutes of collection. The exception
is for samples collected in serum separator
tubes, which are stable once they are spun and a
good gel seal is in place.
Centrifuge Maintenance
Centrifuges must be calibrated every 3 months with
a tachometer to ensure that they are running at the
reported speed. Variation may indicate the need to
replace worn parts. Spinning samples below the required speed may result in incomplete separation of
liquid from formed elements, affecting test results
(Figure 18-10).
FIGURE 18-9 It is the phlebotomist’s responsibility to ensure the
proper handling of specimens.
Copyright 2016, 2011, 2007, 2002 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Evaporation and Contamination
Specimens should not be left uncovered any longer
than necessary during processing. Evaporation of
liquid, especially from small samples, can affect
ABGs, alcohol, and ammonia, among other tests.
Contamination may occur while the sample is uncovered, arising from airborne dust or talc from
gloves. Contamination may also occur from incomplete separation, such as when RBCs are left in the
sample after incomplete centrifugation.
Refrigerators and Freezers
Fluctuations in cold storage units can degrade
sample quality. Temperatures of refrigerators and
freezers must be monitored daily, with temperatures
recorded either automatically or manually at speci-
ed times of day. Temperature readings that are too
high or low indicate that the unit needs maintenance
or replacement.
264
https://t.me/med1917
FIGURE 18-10 Correct use and maintenance of the centrifuge are
important in quality specimen processing.
CHAPTER 18 Quality Phlebotomy http://evolve.elsevier.com/Warekois/phlebotomy
Aliquot Handling and
Labeling
Multiple aliquots prepared from a single specimen
allow different departments to share a single sample
for multiple tests. Each aliquot must be properly
labeled as to the source and additives present.
Specimens with different additives should never be
combined in a single aliquot.
ANALYTICAL VARIABLES
An analytical variable is any variable that affects the
testing process. Although most samples are tested by
MLS, MT, and MLT laboratory personnel, the phlebotomist may be trained to perform CLIA-waived
testing. It is important to understand the analytical
variables that can have a negative impact on test results. Point-of-care testing instruments require calibration and controls to be performed before testing
patient samples. If the instrument is malfunctioning
or the reagents are bad, calibration and control values will fall outside the predetermined range of acceptance. If pipetting of reagents is required for a
test, improper pipetting technique may yield results
that fall outside the expected range or falsely fall
inside the expected range. No tests should be run
until the instrument is working properly. Always follow the manufacturer’s guidelines and any facility
guidelines for ensuring that a POCT instrument is
functioning properly before testing a patient sample.
POSTANALYTICAL VARIABLES
A postanalytical variable is any variable in the
reporting and follow-up of test results. The phlebotomist may be responsible for reporting POCT
results that he or she performed. Before a result is
reported, it must be interpreted as being valid. A
delta check, discussed earlier in this chapter, helps
ensure that results generated are correct. If the
result is outside the expected range, it may be
necessary to perform the test again. If the phlebotomist is unsure, a MLS, MT, or MLT should be
consulted. Once the result has been veried, the
result is delivered to the physician ordering the
test. The method of delivery is determined by
the facility, and may include telephone, fax, computer, or hand delivery.
REVIEW FOR CERTIFICATION
Quality phlebotomy refers to a set of policies
and procedures designed to ensure the delivery
of consistent, high-quality patient care and specimen analysis. Quality phlebotomy includes
quality control (QC), the group of quantitative
methods used to monitor the quality of procedures. Quality control is part of quality assurance
(QA), the larger set of methods used to guarantee
quality patient care. Total quality management
(TQM) is the entire set of approaches used by
the institution to provide customer satisfaction.
Continuing quality improvement (CQI) is the
major goal of TQM programs. QA programs
use written documentation to set standards for
the performance of procedures and to monitor
compliance. Two important documents are the
procedure manual, which contains protocols and
other information about all the tests performed in
the laboratory, and the floor book, which contains a variety of information pertinent to the
smooth coordination of nursing staff and laboratory personnel. Within the scope of TQM, the
phlebotomist is most responsible for controlling
preanalytic variables, those that occur before the
specimen is analyzed. These variables include
test ordering and requisition handling, equipment
integrity, patient identication and preparation,
specimen collection, and transportation. The patient’s physical condition at the time of the col-
lection has a signicant effect on sample quality
and may be inuenced by fasting, dehydration,
Copyright 2016, 2011, 2007, 2002 by Saunders, an imprint of Elsevier Inc. All rights reserved.
http://evolve.elsevier.com/Warekois/phlebotomy CH APTE R 18 Quality Phlebotomy
https://t.me/med1917
265
and other states. Specimen collection variables
include site selection, tourniquet application, and
site cleansing. Postcollection variables include labeling, method of delivery, treatment of the sample
during transportation, and timing of delivery. Specimen processing variables include time between
BI BL IOG R AP H Y
Bologna LJ, Mutter M: Life after phlebotomy deployment:
Reducing major patient and specimen identication errors,
J Healthc Inf Manag 16:65-70. Retrieved from http://www.
himss.org/content/les/jhim/15-4/original02.pdf.
Calmarza P, Cordero J: Lipemia interferences in routine clinical
biochemical tests, Biochem Med (Zagreb) 21(2):160-166, 2011.
CLSI: Procedures for the collection of diagnostic blood speci-
mens by venipuncture; Approved standard—sixth edition. CSLI
document GP41-A6 (formerly H03-A6). Wayne, Pa., 2007,
Clinical and Laboratory Standards Institute.
CLSI: Tubes and additives for venous and capillary blood speci-
men collection; Approved standard—Sixth edition. CSLI document GP39-A6. Wayne, Pa., 2010, Clinical and Laboratory
Standards Institute.
Drew N: Monitoring specimen collection errors, Adv Med Lab
Prof, 2000.
collection and processing, centrifugation process,
possibility of contamination and evaporation, proper
storage conditions, and processing of aliquots. In
some situations, the phlebotomist may also be responsible for analytical variables and postanalytical
variables.
Ernst DJ, Balance LO: Phlebotomy puncture juncture: Prevent-
ing phlebotomy errors—Potential for harming your patients,
Med Lab Obs, September 2006.
Howanitz PJ, Renner SW, Walsh MK: Continuous wristband
monitoring over 2 years decreases identication errors: A College of American Pathologists Q-tracks study, Arch Pathol Lab
Med 126:809-815, 2002.
Kalra J: Medical errors: Impact on clinical laboratories and other
critical areas, Clin Biochem 37:1052-1062, 2004.
Lippi G, Salvagno GL, Montagnana M, et al: Inuence of short-
term venous stasis on clinical chemistry testing, Clin Chem
Lab Med 43:869-875, 2005.
Ogden-Grable H, Gill GW: CFIAC Authors and Disclosures,
Lab Med 36(7):430-433, 2005.
STUDY QUESTIONS
See answers in Appendix F.
1. Explain the purpose of QA.
2. Describe how QA differs from QC.
3. What is the role of The Joint Commission in quality assurance?
4. List the four criteria that make up documentation processes.
5. What information does a procedure manual contain?
6. What is the purpose of a delta check?
7. If a patient presents with the smell of cigarettes on his or her breath, why should this be noted on the
requisition?
8. What information should be labeled on aliquoted specimens?
9. Explain quality phlebotomy and its purpose.
10. Describe the philosophy, role, and purpose of TQM.
11. Explain the difference between the procedure manual and the oor logbook.
12. Explain preanalytic variables, and give examples of how to control or monitor such variables.
13. Describe a negative outcome of improper patient identication. Give two examples of how you
would ensure that proper patient identication is achieved.
14. Give four variables of which a phlebotomist must be aware during a phlebotomy procedure and
examples of how to control or prevent such variables.
Copyright 2016, 2011, 2007, 2002 by Saunders, an imprint of Elsevier Inc. All rights reserved.
266
https://t.me/med1917
CHAPTER 18 Quality Phlebotomy http://evolve.elsevier.com/Warekois/phlebotomy
CERTIFICATION EXAMINATION PREPARATION
See answers in Appendix F.
1. What organization mandates QA programs?
a. Occupational Safety and Health
Administration
b. National Phlebotomy Association
c. American Society for Clinical Pathology
d. The Joint Commission
2. If there is a question concerning the principle
behind a particular specimen collection,
consult the
a. QC logbook.
b. oor book.
c. policy manual.
d. procedure manual.
3. If a phlebotomist wants to know the turnaround
time for a specic procedure, it can be found
in the
a. policy manual.
b. patient’s chart.
c. directory of services.
d. Physician’s Desk Reference.
4. Which of the following compares previous
patient data with current data?
a. Postanalytic variables
b. Delta check
c. Accession numbers
d. Collection logbook
5. Fasting specimens should be collected
a. 24 hours after the fast.
b. 2 hours after waking up.
c. 8 to 12 hours after eating.
d. any time after midnight.
6. The phlebotomist usually does not have
complete control over which of the following
variables?
a. Collection equipment
b. Patient preparation
c. Specimen collection
d. Specimen labeling
7. No more than ________ should elapse between
the time a specimen is collected and the time
serum or plasma is separated from formed
elements.
a. 30 minutes
b. 1 hour
c. 2 hours
d. 3 hours
8. ____________ refers to a set of policies and
procedures designed to ensure the delivery
of consistent, high-quality patient care and
specimen analysis.
a. Quality phlebotomy
b. QA
c. QC
d. TQM
9. The phlebotomist is most responsible for
controlling
a. analytic variables.
b. postanalytic variables.
c. TQM.
d. preanalytic variables.
Copyright 2016, 2011, 2007, 2002 by Saunders, an imprint of Elsevier Inc. All rights reserved.
CHAPTER 19 Legal Issues in Phlebotomy
https://t.me/med1917
267
egal and ethical considerations form an impor-
L
tant underpinning to the practice of medicine,
and phlebotomy is no exception. An increasingly
complex and litigious health care environment has
made familiarity with legal issues an important part
of the phlebotomist’s training. Medical malpractice
is the most common legal claim in the health care
eld. Injuries that arise from failure to follow the
standard of care may be grounds for a nding of
malpractice. Careful observance of the standard of
OU TL I NE
Why Study Legal Issues?
The Legal System
Laws
Settlement and Judgment
Professional Liability
Medical Malpractice
Other Examples of Potential
Malpractice in Phlebotomy
Defense against Malpractice
Liability Insurance
Confidentiality
Health Insurance Portability
OB J E CT IV E S
After completing this chapter, you should be able to:
1. Discuss why legal issues are important to the
phlebotomist.
2. Differentiate the following types of laws: statutory,
case, administrative, public, and private.
3. Define plaintiff, defendant, felony, misdemeanor,
and tort.
4. Define liability, and give examples of situations in
which a phlebotomist may be held accountable for
the consequences of an action.
5. Explain how the accepted standard of care is
determined, and give examples of these standards
as they relate to phlebotomy.
care, and documentation of that practice, is the best
defense against malpractice. Comprehensive federal regulations governing the privacy of medical
information have affected every sector of health
care delivery. In addition to the legal requirement to
protect patient condentiality, there is an ethical
duty to do so. Although full consideration of all the
relevant legal issues is beyond the scope of this
chapter, we introduce some important legal and ethical
concepts that have an impact on the profession.
and Accountability Act
Review for Certification
6. Define malpractice, and explain what is necessary
to prove it.
7. Differentiate between punitive and compensatory
damages.
8. Describe steps the phlebotomist can take to avoid
being accused of malpractice.
9. Explain the importance of confidentiality.
10. Define protected health information under Health
Insurance Portability and Accountability Act
(HIPAA) regulations.
11. Describe how the phlebotomist can safeguard a
patient’s privacy.
KE Y TE R M S
accepted standard of care
administrative law
assault
battery
case law
civil action
criminal action
Copyright 2016, 2011, 2007, 2002 by Saunders, an imprint of Elsevier Inc. All rights reserved.
damages
dereliction
event report
liability insurance
liable
malpractice
negligence
out-of-court settlement
plaintiff
private law
protected health
information (PHI)
public law
scope of practice
statutory law
tort
267
268
https://t.me/med1917
CHAPTER 19 Legal Issues in Phlebotomy http://evolve.elsevier.com/Warekois/phlebotomy
AB BR E VI AT IO NS
HIPAA Health Insurance Portability and Accountability
Act
IRS
Internal Revenue Service
OSHA Occupational Safety and Health Administration
PHI
protected health information
WHY STUDY LEGAL ISSUES?
The health care system has become increasingly
complex in the past two decades. This complexity
stems from the interplay of technologic advances,
associated increased costs of delivering care, and
fear of litigation.
Several factors have led to the dramatic rise in
health care costs in recent decades. First is the
gradual ination in the price of all goods and services. More important has been the growing sophistication of medical technology, with consequent
higher costs for equipment purchase and maintenance, plus the need for highly trained operators at
all levels of health care delivery. For instance, the
cost of drawing a blood sample has risen signicantly since the development of safety needles and
other systems designed to protect the phlebotomist.
The simple compound microscope that was used
to do a differential blood count in the 1940s cost
perhaps a few hundred dollars and required only
occasional adjustment and cleaning. In contrast,
today’s automated cell counters cost thousands of
dollars and require frequent calibration and regular
maintenance, as well as a higher level of training to
operate (Figure 19-1). Similarly, the fast pace of
drug discovery and development has increased the
cost of medical treatment for the typical patient. All
these advances have enhanced the quality of patient
care, but at a signicant price. In addition to these
sources of cost increase, more stringent regulations
designed to safeguard health care providers have
led to higher costs for service delivery.
Even more signicantly, the availability of sophisticated technology has meant that more doctors
order more tests on more patients, and that more
patients expect them to order the tests. As the standard of care has risen, multiple sophisticated and
expensive tests have been prescribed to supplement
(and sometimes substitute for) a physician’s clinical
judgment. Increased fear of litigation has also fueled the rise in the use of multiple tests, often as
much to protect against future lawsuits as to provide
FIGURE 19-1 Although the invention of automated laboratory equipment has improved the quality of care, it has
also contributed to the rising costs of health care.
Copyright 2016, 2011, 2007, 2002 by Saunders, an imprint of Elsevier Inc. All rights reserved.
http://evolve.elsevier.com/Warekois/phlebotomy CHAPTER 19 Legal Issues in Phlebotomy
https://t.me/med1917
269
crucial medical information. Such “defensive medicine” is understandable, given the very high cost
of malpractice insurance and the potential for a
ruinous liability judgment in the event of an oversight or mistake.
The rising cost of health care has led to efforts to
keep costs under control, including reimbursement
restrictions on diagnostic tests and limitations on
prescription drugs. Meanwhile, the rights of patients
have been increasingly recognized and expanded,
and the level of care expected by patients has
grown. The American Hospital Association has
BOX 19-1 The Patient Care Partnership
Understanding Expectations, Rights, and Responsibilities
What to expect during your hospital stay:
• High-quality hospital care
• A clean and safe environment
• Involvement in your care
• Protection of your privacy
• Help when leaving the hospital
• Help with your billing claims
When you need hospital care, your doctor and the nurses
and other professionals at our hospital are committed to working
with you and your family to meet your health care needs. Our
dedicated doctors and staff serve the community in all its ethnic,
religious, and economic diversity. Our goal is for you and your
family to have the same care and attention we would want for
our families and ourselves.
The sections that follow explain some of the basics about
how you can expect to be treated during your hospital stay.
They also cover what we need from you to care for you better.
If you have questions at any time, please ask them. Unasked or
unanswered questions can add to the stress of being in the
hospital. Your comfort and confidence in your care are important to us.
What to Expect During Your Hospital Stay
High-Quality Hospital Care
Our first priority is to provide you the care you need, when you
need it, with skill, compassion, and respect. Tell your caregivers if
you have concerns about your care or if you have pain. You have
the right to know the identity of doctors, nurses, and others involved in your care, and you have the right to know when they
are students, residents, or other trainees.
A Clean and Safe Environment
Our hospital works hard to keep you safe. We use special policies
and procedures to avoid mistakes in your care and keep you free
from abuse or neglect. If anything unexpected and significant
happens during your hospital stay, you will be told what happened, and any resulting changes in your care will be discussed
with you.
created the Patient Care Partnership, a statement of
what patients should expect during a hospital stay
with regard to rights and responsibilities (Box 19-1).
It emphasizes the patient’s right to quality care, a
clean and safe environment, and protection of pri-
vacy, among other rights. Because of the conicts
arising from the interplay of these factors, along
with the general rise in litigation in our society, the
health care professions have been subjected to more
and more lawsuits. Understanding your legal
obligations and rights in this complex system is an
important part of your professional training.
Involvement in Your Care
You and your doctor often make decisions about your care before
you go to the hospital. Other times, especially in emergencies,
those decisions are made during your hospital stay. When decision making takes place, it should include the following:
Discussing Your Medical Condition and Information
About Medically Appropriate Treatment Choices
To make informed decisions with your doctor, you need to
understand:
• The benefits and risks of each treatment.
• Whether your treatment is experimental or part of a
research study.
• What you can reasonably expect from your treatment and
any long-term effects it might have on your quality of life.
• What you and your family will need to do after you leave
the hospital.
• The financial consequences of using uncovered services or
out-of-network providers.
Please tell your caregivers if you need more information
about treatment choices.
Discussing Your Treatment Plan
When you enter the hospital, you sign a general consent to treatment. In some cases, such as surgery or experimental treatment,
you may be asked to confirm in writing that you understand what
is planned and agree to it. This process protects your right to consent to or refuse a treatment. Your doctor will explain the medical
consequences of refusing recommended treatment. It also protects
your right to decide if you want to participate in a research study.
Getting Information From You
Your caregivers need complete and correct information about
your health and coverage so that they can make good decisions
about your care. That includes the following:
• Past illnesses, surgeries, or hospital stays
• Past allergic reactions
• Any medicines or dietary supplements (such as vitamins
and herbs) that you are taking
• Any network or admission requirements under your health plan
Continued
Copyright 2016, 2011, 2007, 2002 by Saunders, an imprint of Elsevier Inc. All rights reserved.
270
https://t.me/med1917
CHAPTER 19 Legal Issues in Phlebotomy http://evolve.elsevier.com/Warekois/phlebotomy
BOX 19-1 The Patient Care Partnership—cont’d
Understanding Your Health Care Goals and Values
You may have health care goals and values or spiritual beliefs that are
important to your well-being. They will be taken into account as
much as possible throughout your hospital stay. Make sure your
doctor, your family, and your care team members know your wishes.
Understanding Who Should Make Decisions When You Cannot
If you have signed a health care power of attorney stating who
should speak for you if you become unable to make health care
decisions for yourself, or a living will or advance directive that
states your wishes about end-of-life care, give copies to your doctor, your family, and your care team. If you or your family members need help making difficult decisions, counselors, chaplains,
and others are available to help.
Protection of Your Privacy
We respect the confidentiality of your relationship with your doctor and other caregivers and the sensitive information about your
health and health care that is part of that relationship. State and
federal laws and hospital operating policies protect the privacy of
your medical information. You will receive a Notice of Privacy
Practices that describes the ways in which we use, disclose, and
safeguard patient information and that explains how you can
obtain a copy of information from our records about your care.
Preparing You and Your Family for When You Leave
the Hospital
Your doctor works with hospital staff and professionals in your
community. You and your family also play an important role in
your care. The success of your treatment often depends on your
efforts to follow medication, diet, and therapy plans. Your family
may need to help care for you at home.
You can expect us to help you identify sources of follow-up
care and to let you know if our hospital has a financial interest in
any referrals. As long as you agree that we can share information
about your care with them, we will coordinate our activities
with your caregivers outside the hospital. You can also expect
to receive information and, where possible, training about the
self-care you will need when you go home.
Help With Your Bill and Filing Insurance Claims
Our staff will file claims for you with health care insurers or other
programs such as Medicare and Medicaid. They also will help
your doctor with needed documentation. Hospital bills and insurance coverage are often confusing. If you have questions about
your bill, contact our business office. If you need help understanding your insurance coverage or health plan, start with your insurance company or health benefits manager. If you do not have
health coverage, we will try to help you and your family find financial help or make other arrangements. We need your help in
collecting needed information and other requirements to obtain
coverage or assistance.
While you are here, you will receive more detailed notices
about some of the rights you have as a hospital patient and how
to exercise them. We are always interested in improving. If you
have questions, comments, or concerns, please contact: (relevant department here).
Reprinted with permission of the American Hospital Association, copyright 2003.
THE LEGAL SYSTEM
To understand your rights and obligations under the
law, it is helpful to know a little bit about how the
legal system operates.
Laws
Laws are created in a variety of ways. Statutory
law is created by a legislative body. At the federal
level, this is Congress, made up of the Senate and
the House of Representatives. These laws are called
statutes. State legislative bodies vary from state to
state but usually follow the federal model.
Case law is law determined by court decisions,
usually as an interpretation of existing statutory law.
State courts rule on state laws, and federal courts rule
on federal laws. The U.S. Supreme Court has ulti-
mate jurisdiction over all laws, both federal and state.
Administrative law is created by administrative
agencies, such as the Internal Revenue Service
(IRS) or the Occupational Safety and Health Administration (OSHA). The regulations promulgated
by these agencies are given the force of law by the
statutory laws that created the agencies.
Laws are also classied as either public or private.
When a public law is violated, the offense leads to a
criminal action, and the violator is prosecuted by the
public in the person of the government’s attorney (the
district attorney). The offense may be either a felony
or a misdemeanor, depending on the seriousness of
the crime.
Phlebotomists can be charged with violations of
public law. Failing to obtain informed consent from a
patient before any procedure is example of this. There-
fore blood must never be drawn without rst obtaining
the patient’s consent. A patient can give consent either
in writing or verbally. If a patient refuses to have his or
her blood drawn, the phlebotomist must not attempt to
force the patient to comply. To persist can lead to
criminal charges of assault and battery. Assault is an
unjustiable attempt to touch another person, or the
threat to do so. Battery is the intentional touching of
another person without consent.
Copyright 2016, 2011, 2007, 2002 by Saunders, an imprint of Elsevier Inc. All rights reserved.
http://evolve.elsevier.com/Warekois/phlebotomy CHAPTER 19 Legal Issues in Phlebotomy
https://t.me/med1917
271
There are only a few situations in which the
person whose blood is being drawn is not the person
whose consent must be obtained. Parents have the
right to give consent for a child to have his or her
blood drawn, even though the child may refuse and
may even be combative (Figure 19-2). Legally appointed guardians give consent for patients who are
incapacitated. If there is any doubt about who is
entitled to give consent, always ask the nurse or
physician before proceeding with the draw.
In contrast to public law, when a private law is
violated, the offense may lead to a civil action, in
which the defendant is sued in civil court by the
plaintiff, the person claiming to have been harmed
by the defendant. Civil wrongs include torts. A
tort is dened as any wrongful act that causes
harm or injury to another person. Torts can be
either intentional or unintentional. Unintentional
torts are the basis for most medical malpractice
suits. A malpractice suit may be brought against
the individual causing the harm, or the institution
employing the individual, or both. Supervisors
may be held liable for the harms caused by an individual under their supervision.
A patient may choose to bring a civil action in a
case for which a criminal action was also brought,
whether or not the defendant was found guilty in
the criminal action. For instance, a patient with a
damaged nerve may sue for malpractice even if the
case was not strong enough to sustain a criminal
action. Other causes of action could include reusing needles, careless probing for a vein, accidental
artery stick resulting in injury to patient, drawing
FIGURE 19-2 Child refusing phlebotomy procedure.
samples not requested by the physician, or releasing test results to someone not authorized to re-
ceive them. A patient must le a civil action within
a specic time period after the damaged occurred,
often within 2 years. This time period is called the
statute of limitations.
Settlement and Judgment
Almost all civil and criminal actions are settled out
of court. In an out-of-court settlement, the two
parties reach an agreement without the intervention
of a judge or jury. When a civil case is settled out
of court, the settlement often includes a condition
stating that neither party may discuss the amount of
the settlement.
When the parties cannot reach agreement, the
case goes to court for trial and judgment. A judgment
against the defendant in a civil case usually results in
a ne (known as damages), which may be only compensatory (to pay for costs incurred because of the
injury, such as further medical care) or punitive.
Headline-making damage awards are most often for
punitive damages. Judgments in either civil or criminal actions can be appealed if the losing party feels
that some part of the court proceeding was in error.
Judgments may be upheld, reversed, or modied on
appeal.
PROFESSIONAL LIABILITY
To be liable for an action means that you are legally responsible for it and can be held accountable
for its consequences. As a medical professional,
you are liable for both your actions (called an act of
commission) and, in some cases, your failure to act
(called an act of omission). For instance, if you
damage a nerve while performing routine venipuncture, you may be held liable for an act of commission (i.e., something you did that you shouldn’t
have). If a physician orders a test that you fail to
perform and, as a result, the patient suffers harm,
you may be held liable for an act of omission (i.e.,
something you didn’t do that you should have).
You are legally responsible for any action you
perform as a medical professional, whether or not
it is a duty assigned to you or you have received
training for it (Figure 19-3). For instance, if you
perform an arterial puncture, you are liable for any
injuries that may result from it, whether or not you
have been properly trained to perform it. Therefore
a professional should not attempt to perform duties
for which he or she is not trained. As a phleboto-
mist, you must perform only those procedures that
Copyright 2016, 2011, 2007, 2002 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Соседние файлы в папке Библиотека им академика М.И. Перельмана