Phlebotomy Competency Skills Checklist

Phlebotomy Competency Skills Checklist
Answer Key

1. No Experience 2. Requires Supervision 3. Proficient 4. Can Teach Others

Preparation*

	1	2	3	4
Friendliness
Introduces self to patient and explains blood tests have been ordered by physician.
Identifies the patient with two unique identifiers (armband, ask for name & DOB). Compare patient ID information with barcode label.
Checks testing requirements (ie fasting).
Prepares supplies and tube selection.
Washes hand, dons gloves.

Getting Started*

	1	2	3	4
Friendliness
Positions Patient and applies tourniquet.
Palpates antecubital area to select venipuncture site.
Properly cleanses venipuncture site.

Sample Collection*

	1	2	3	4
Stablizes vein.
Inserts needle, bevel up.
Smoothly pushes tube(s) into holder without changing needle position.
Adjusts needle, if necessary, to obtain flow then stablizes vacutainer.
Releases tourniquet as blood begins to flow.
Changes vacutubes without changing needle position.
Fills vacutubes in correct order.
Mixes anticoagulated vacutubes properly.
Removes last tube from needle before withdrawing needle.
Withdraws needle from arm smoothly.
Applies pressure to site after withdrawing needle.
Disposes of needle properly and safely, Discards tourniquet.

Handling & Processing*

	1	2	3	4
Stablizes vein.
Labels tubes immediately (ie at bedside).
Legibly completes label/requisition with username and date/time of collection.
Observe special handling requirements.
Checks puncture site to ascertain bleeding has stopped. Applies bandage.
Places tubes into biohazard bag. Label(s)/requisiton are placed in sleeve of bag.
Removes gloves and practice hand hygiene.
Transport specimens to lab via porter or pneumatic tube system. STATs are sent immediately.

Age Specific Competencies*

	1	2	3	4
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)

Undertaking*

The Information I Provided is True & Accurate
Name Signature*
Date*

MonthDayYear
Date
Should be Empty: