Phlebotomy Competency Skills Checklist Personal InformationName(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) Date MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyPreparationIntroduces self to patient and explains blood tests have been ordered by physician. 1 2 3 4 Identifies the patient with two unique identifiers (armband, ask for name & DOB). Compare patient ID information with barcode label. 1 2 3 4 Checks testing requirements (ie fasting). 1 2 3 4 Prepares supplies and tube selection. 1 2 3 4 Washes hand, dons gloves. 1 2 3 4 Getting StartedPositions Patient and applies tourniquet. 1 2 3 4 Palpates antecubital area to select venipuncture site. 1 2 3 4 Properly cleanses venipuncture site. 1 2 3 4 Sample CollectionStablizes vein. 1 2 3 4 Inserts needle, bevel up. 1 2 3 4 Smoothly pushes tube(s) into holder without changing needle position. 1 2 3 4 Adjusts needle, if necessary, to obtain flow then stablizes vacutainer. 1 2 3 4 Releases tourniquet as blood begins to flow. 1 2 3 4 Changes vacutubes without changing needle position. 1 2 3 4 Fills vacutubes in correct order. 1 2 3 4 Mixes anticoagulated vacutubes properly. 1 2 3 4 Removes last tube from needle before withdrawing needle. 1 2 3 4 Withdraws needle from arm smoothly. 1 2 3 4 Applies pressure to site after withdrawing needle. 1 2 3 4 Disposes of needle properly and safely, Discards tourniquet. 1 2 3 4 Handling & ProcessingLabels tubes immediately (ie at bedside). 1 2 3 4 Legibly completes label/requisition with username and date/time of collection. 1 2 3 4 Observe special handling requirements. 1 2 3 4 Checks puncture site to ascertain bleeding has stopped. Applies bandage. 1 2 3 4 Places tubes into biohazard bag. Label(s)/requisiton are placed in sleeve of bag. 1 2 3 4 Removes gloves and practice hand hygiene. 1 2 3 4 Transport specimens to lab via porter or pneumatic tube system. STATs are sent immediately. 1 2 3 4 Age Specific CompetenciesInfant (Birth - 1 year) 1 2 3 4 Preschooler (ages 2-5 years) 1 2 3 4 Childhood (ages 6-12 years) 1 2 3 4 Adolescents (ages 13-21 years) 1 2 3 4 Young Adults (ages 22-39 years) 1 2 3 4 Adults (ages 40-64 years) 1 2 3 4 Older Adults (ages 65-79 years) 1 2 3 4 Elderly (ages 80+ years) 1 2 3 4 CertificationsResource location – Lab Test information Guide. Yes Resource location Expiration Date Month Day Year Blood Ethanol Collection – cleanse site with soap and water. Yes Blood Ethanol Collection Expiration Date Month Day Year Blood Culture Collection Review. Yes Blood Culture Collection Review Expiration Date Month Day Year AuthorizationsSignature(Required)The information I have given is true and accurate to the best of my knowledge. I hereby authorize Hired by Matrix, Inc. to release this Case Management Skills Checklist to Client facilities of Hired by Matrix, Inc. in consideration of my assignment to work at those facilities.
