Cert III in Pathology
(Collection)
HLT32612
Cluster 1: Blood Collection1 | Page
Cert III Pathology (Collection) HLT32612
Table of Contents
Legislation, Ethics and Codes of Practice
Worksheet: Legislation
Standard and Additional Precautions
Worksheet: Standard & Additional Precautions
Anatomy
Worksheet: Anatomy
Equipment
Worksheet: Equipment
Request Form & Documentation
Worksheet: Request Form
Correct Technique for Blood Collection
Worksheet: Correct Technique for Blood Collection
Medical Terminology
Worksheet: Terminology
Cluster 1: Blood Collection1 | Page
Cert III Pathology (Collection) HLT32612Legislation
Name:Date:Legislation, Ethics and Codes of Practice
Introduction
It is important for a phlebotomist to have an understanding of relevant organisational policies standards and legislative requirements and how they relate to their own work role. Any uncertainties should be discussed with a senior member of staff or supervisor if the meanings and applications are unclear.
PathologyLegislative Bodies
As is the case in any workplace, the pathology industry is regulated by a number of legislative bodies that ensure safe and effective work practices. These authorities ensure the industry is regulated and that a minimum standard is held by all parties concerned.
Accreditation by these organisations ensures accountability within the workplace as standards need to be maintained in order to achieve and maintain accreditation.
NATA (National Association of Testing Authorities)
NATA's role is to serve the national and public interest by ensuring that member facilities comply with relevant international and Australian standards and so is competent to provide consistently reliable testing, calibration, measurement and inspection data to government, industry and the wider community.
- NATA (1947) is the authority that provides independent assurance of technical competence through a network of best practice industry experts for customers who require quality and reliability in the delivery of their products and services
- NATA accreditation is required by pathology laboratories in order that they are eligible to provide services to Medicare and to claim Medicare payments
- AS 4633 and ISO 15189 Accreditation in the field of Medical Testing
Medical Testing is only one of several fields covered by NATA’s laboratory accreditation program. It covers testing of human origin samples and includes diagnostic testing in such disciplines as Anatomical Pathology, Genetic Testing and Immunology.
National Pathology Accreditation Advisory Council (NPAAC)
Established in 1979 the council has members from all states and territories, private and public pathology peak bodies (AAPP, NCPP), professional bodies (RCPA, AMA, AIMS, AACB, HGSA, and ASM), consumer representatives and representatives from the Department of Health and Ageing. Its primary task is to develop standards for the accreditation of pathology laboratories.
International Organisation for Standardisation (ISO9000)
The ISO 9000 family of standards is related to quality management systems and designed to help organisations ensure that they meet the needs of customers and other stakeholders while meeting statutory and regulatory requirements related to the product. The standards are published by the ISO (International Association for Standardisation) and available through National Standard Bodies. ISO deals with the fundamentals of quality management systems including the eight management principles on which the family standards are based. All specimens delivered to a collection centre or taken at a collection centre are labelled in accordance with ISO 9000 or the National Testing Authority.
Australian Standards (AS)
Standards Australia is the nation’s most important non-government Standards organization. It is charged by the Commonwealth Government to meet Australia’s need for contemporary, internationally aligned Standards and related services. For example, AS4633 is based on ISO15189.
Codes of Practice
These are written guidelines issued by an official body or a professional association to its members to help them comply with its ethical standards. It is recommended practice that allows some discretion or leeway in its interprepation, complementation, or use. These are prinicples that when followed promote values such as trust, good behaviours and fairness. There is not one consistent set of standards that all companies follow, but each company has the right to develop the standards that are meaningful for their organisation. Below is a list of examples of codes that relate to the Health Industry;
- First Aid facilities and services, workplace amenities and facilities,personal protective clothing and equipment
- National Code of Practice Hepatitis and HIV
- Working hours risk management guidelines
- Violence, aggression and bullying at work
Pathology Policies and Procedures
Policy and Procedures manuals include a diverse range of content from management policy to patient rights to buying equipment, manufacturers and suppliers, infection control, human resources and continuous improvement.
NOTE: “It is the responsibility of each pathology organisation to ensure it complies with all relevant legislation. Legislative requirements take precedence over, or provide additional criteria to, those detailed in this document. It is strongly recommended that laboratories hold copies of relevant legislation.” NATA AS4633 (ISO15189)
Policies are the principles, rules and guidelines developed or adopted by an organization to reach its long term goals.
The first policy statement is the mission and vision of the organisation. This is to identify goals set by the company, a strategic framework for success, and a vision for the future. Values are the way in which you will reach these goals.
Procedures are the methods by which the policies are expressed and carried out day to day.
Both the policies and procedures together, ensure that the opinion of the governing body of an organisation is converted into steps that result in an outcome compatible with that view. These documents assist in the compliance with regulatory standards. This dictates that sets of policies and procedures are individual for each organisation but with a common theme.
Procedures are written representations of the way to perform bleeds, hand washing, disposal of sharps to name a few. They may be found in the following forms:
Pathology Manuals
Typically manuals are required in a clinic as they contain different types of information.
General Policy manual contains overall policies and management plans for every aspect of the blood collection operation. Provides the background information necessary to understand the job as it relates to work in the pathology clinic.
Standard operating Procedures (SOP)provides written instructions for each blood collection centres procedure performed. This manual includes several of the detailed ways to collect including quality control, safety, proficiency testing and calibration.
Safety Manual provides a written review of all safety issues in the laboratory and all employees should be very familiar with them.
Quality Control Manual contains written descriptions of QC procedures and records of QC test results.
Instrument Calibration and Maintenance Manual contains instructions and dated records of laboratory instrument calibration and maintenance.
Inventory Control Manual maintains records of the routine inventory of supplies on hand and orders that have been placed.
Duty of Care
The definition of Duty of Care is the legal obligation to safeguard others from harm while they are in your care, using your services, or exposed to your activities. In a collection clinic a phlebotomist has the duty of care to the patient and other persons who come into the facility. The relationship between a phlebotomist and a patient is such that the patient places trust in the care, skill and integrity of the practitioner. It is the duty of staff to act with due diligence at all times and not abuse this trust in any way.
The Workplace Health and Safety Act 2011 divides duty of care into sections relating to how you are employed. The two most relevant parts to working in a collection centre are the duties of employers and employees. Employers have a duty to provide as far as is practicable, a safe working environment where the worker is not exposed to undue risks and hazards. Employers also need to provide instruction and training to employees to enable them to perform their work safely.Employees need to take reasonable care to ensure their own safety and not to adversly affect the health and safety of any other person. This is extremely important in any healthcare setting and not least in the collection room as there is a much greater potential for harm given the nature of the work undertaken.It is important to remember that working effectively and providing a duty of care does not just involve physical tasks in a collection centre. It must include the rights of the patient. Each patient must freely wish to give informed consent and has a right to refuse tests. They must feel that they are not being coerced into having a test when they are fearful and receive fairness in being treated equally as other patients.
The Workplace Health and Safety Act 2011
We all work under the Workplace Health and Safety Act and Regulations to provide a safe work environment for all concerned. These documents are legally binding and provide a framework for safe work practices .The Workplace Health and Safety Act and Regulations provide a safe work environment for all concerned. These documents are legally binding and provide a framework for safe work practices and available in the workplace for staff to access written form for staff to access.
The Workplace Health and Safety Act 2011
- provides for the promotion, coordination, administration and enforcement of occupational safety and health in Western Australia;
- places emphasis on the prevention of accidents and injury; and
- Covers all employees in Western Australia, excluding those employed by Commonwealth Government or employees who work in a mine or petroleum sites.
- Regulations may prescribe minimum standards and have a general application, or they may define specific requirements related to a particular hazard or particular type of work. They may also allow the licensing or granting of approvals and certificates
Ethics and confidentiality
All organizations and businesses should have a confidentiality policy in order to maintain patient information privacy. There are structures in place for the collection, storage and access to patient data. Government regulations in addition to state legislation must be consulted.
The Privacy Act 1988
Many of the patients who enter the collection centre will be unwell and suffering from some form of disease or infection. All patients have a right to privacy and it is the responsibility of the phlebotomist to ensure that patient information is on a need to know basis and confidentiality is maintained. Patient information can be of a sensitive nature and must never be discussed outside of the collection room , with members of the patients family or colleagues.
Ethical Considerations
It is an important aspect of care to behave with courtesy, respect, dignity, discretion, tact and empathy with patients who present for blood tests, and recognise that all patients have individual needs and rights in relation to their care.
There are both ethical and legal requirements in relation to communicating and working effectively in health.
Right to Refuse Tests
Each patient has the right to refuse to have any procedure which includes specimen collection. The High Court of Australia first articulated this principle in Marion’s case, stating that a legally competent person has a right “to choose what occurs with respect to his or her own person.” If a patient refuses to have a blood test they must not be coerced. The phlebotomist should record on the request form that the patient has refused to have the test and the requesting doctor should be notified.Duty of care involves acting as the patients advocate. If a phlebotomist witnesses a breach of standards related to the patients care or an adverse event it would be part of the duty of care to report and thereby act as the patients advocate. The definition of “ Advocate” is a person who speaks for or writes in support or defense of another person. As a healthcare provider it is a duty of care to act as advocate for a patient recieving care. For example, if a colleague was not adhering to safe practice it would be a duty of care as the patients advocate to intervene; or report the adverse event or practice to appropriate personnel such as a supervisor. If it were a serious breach of conduct or malpractice the matter would be referred to the manager of the company. Taking action in cases of suspected misconduct is primarily aimed at protecting the patient and thereby maintaining public confidence but also protecting the integrity of the pathology company as a whole.
The Freedom of Information Act 1992
It is a patients right to request access to information related to their health. Often a patient will request to see information that has been collected in relation to their blood test results.
There are forms that a patient can fill out to request copies of results and should be made available on request. A patient presenting with a test request will most often have some knowledge of the information contained within but sometimes will ask for an explanation of the test and why the doctor has ordered it. It is important for the phlebotomist to know that diagnosis or opinion on the patients health status is the doctors responsibility and should not be discussed with the patient.
Equal Opportunitities Act 1984
In any collection centre people from all walks of life will present for tests of all kinds. It is very important to treat everyone equally and with the same level of respect. The Equal Opportunities Act 1984 exists to
“eliminate discrimination on the grounds of sex, marital staus, pregnancy or breast feeding, family reponsibility or family status, race ,religious or political conviction, impairment, age or gender history in the areas of work,accomodation,education,the provision of goods, facilities and services, access to places and vehicles, land and the membership of clubs”
Anti-Discrimination Law
Direct Discrimination is where someone is treated differently or unfairly because of their sex, race or age. For example, if an employee decided not to interview a well qualified man because he thinks that women make better phlebotomists, this would be direct discrimination.
Indirect Discrimination is where everyone is treated the same, but the effect of treating everyone the same unreasonably disadvantages people from one racial, age and so on group rather than another. For example, if it is not possible for persons with disability to acces your facility, this will be indirect disability discrimination- unless it can be shown that given your business circumstances, for you to provide the access needed.When working in collection centers, it is of vital importance that a non-discriminatory approach is taken when working with all patients and colleagues. This is important not only to maintain good customer and working relations but also to comply with Australian anti-discrimination laws. A broad range of legislation exists within Australia to ensure the fair and equal treatment of everyone, they are:
- Age Discrimination Act 2004
- Australian Human Rights Commission Act 1986
- Disability Discrimination Act 1992
- Racial Discrimination Act 1975
- Sex Discrimination Act 1984
As well as ensuring that no one using the pathology service is discriminated against, it is also important to accommodate for certain differences when performing specimen collection. Such differences include cultural, physical, religious, economic and social. Adjustments to services should be made if required and possible to cater for these differences. All specimen collection centres must be accessible for people with disabilities and cater for people from different social and cultural contexts such as Indigenous Australians and those from non-English speaking backgrounds.
Informed Consent
Informed consent means that a patient understands the proposed procedure. All patients have a legal right to be informed of information that relates to the procedure. Without this information a patient is unable to make a fully informed choice and give valid consent for treatment. There are three types of consent:
Implied: or non-verbal communication. Where a patient’s actions clearly outline their wishes i.e. (holding out their arm to have blood taken)
Verbal: A patient may clearly state i.e. “Yes, you can take blood from me”
Written: Patient signs a declaration i.e. signing the request form.
It is important to consider the potential communication barriers when gaining consent from a patient:
- Patient comprehension skills, especially if English language is not the principle language.
- There is information available in a language of choice i.e. written, flip charts, or interpreter.
- Awareness of cultural sensitivities.
Cluster 1: Blood Collection1 | Page
Cert III Pathology (Collection) HLT32612Legislation
Cluster 1: Blood Collection1 | Page
Cert III Pathology (Collection) HLT32612 Worksheet:Legislation
Name:Date:Worksheet: Legislation
- How does NATA’s serve the national and public interest?
- Why do collection centers have to be NATA accredited?
- Who develops standards for the accreditation of pathology laboratories?
- What is the International Organisation for Standardisation responsible for?
- What are the Australian Standards responsible for?
- Codes of practice are written by an association to serve what purpose? Give one example.
- What is the definition of Duty of Care?
- In a phlebotomy clinic who do we have a duty of care to?
- Is the Workplace Health and Safety Act 2011 legally binding? Explain your response.
- Why is it important to keep all patient information private and confidential?
- Does a patient have the right to refuse treatment? Explain your response.
- How can a patient access health information related to their health?
- Why do we have the Equal Opportunities Act?
- If a patient presents their arm for blood collection procedure what type of consent is this?
- Define the following:
a)Anti-discrimination legislation: