OBLIGATIONISM balances the idea of “dividing equa- 123docz.net

An understanding of these basic ethical theories will help the phlebotomist visualize the big picture of professional standards in the medical fi eld.

VALUES

It is important for phlebotomists to be aware of their own value systems, so they can understand feelings and actions when working within the medical environment. Values are strongly held personal and professional beliefs. The word value comes from the Latin valere, which means to be strong. Values may reflect positive or negative feelings. The following might be examples of phlebotomists’ value statements:

Phlebotomists are integral members of the health care team.

•

Phlebotomists should be paid more for what they do.

•

Phlebotomy is a skill.

•

Not all phlebotomists would agree with all of these value statements.

Value conflicts are common among phlebotomists, as they are among other health care workers.

Understanding personal values is an important part of develop- ing a professional ethic. Phlebotomists should clarify their own values and decide if they are consistent with ethical standards of the medical profession.

Finally, phlebotomists must know and understand the mission statement of their employer. Knowing the employer’s mission statement and values helps to build teamwork, pride, and a sense of ownership among professionals.

PATIENT RIGHTS

An employer’s mission statement will usually incorporate a statement of patients’ rights. Phlebotomists need to know and understand patients’

rights if they are to perform phlebotomy duties in an appropriate manner

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consistent with the medical profession. Today’s phlebotomy patients are more knowledgeable and assertive than in the past, and they are more involved in decisions concerning their treatments. They are also more likely to initiate malpractice suits when the quality of care does not meet their expectations.

Phlebotomists must support their employer by knowing and ensuring appropriate, quality service. An understanding of patient rights and how they apply to the phlebotomist is important.

The American Hospital Association drafted a Patient’s Bill of Rights in 1975. It listed 12 specifi cs rights of the patient when receiving care in the hospital. The bill was replaced in 2003 by the Patient Care Partnership.

The Partnership was written to ensure greater satisfaction of the patient, physician, and health care facility by clarifying expectations, rights, and responsibilities of the patient and health care providers.

The patient may expect the following during their hospital stay:

High quality hospital care

•

A clean and safe environment

•

Involvement of the patient in the patient’s care

•

Protection of privacy

•

Help when leaving the hospital

•

Help with billing claims

•

The hospital may expect from the patient:

Accurate information about past hospitalizations, illnesses, medi-

•

cations, and other information concerning health matters

Questions and requests for clarifi cation when additional informa-

•

tion is needed in order to participate in the healing process A copy of the patient’s advance directive

•

Reasonable requests regarding accommodations

•

Necessary information for insurance claims and the provision of

•

payment arrangements

Recognition of the impact of lifestyle on personal health

•

Although the American Hospital Association has no enforcement mechanism, many hospitals use this statement as a model. If patients believe a hospital has violated their legal rights, they may take legal action. Whether a patient’s rights statement is legally binding or not, the phlebotomist should consider patient’s rights to be professionally binding. Phlebotomists must uphold and support the mission statements of their employer, governmental regulations, and professional organizations in the fi eld.

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HIPAA

Separate from the Patients’ Bill of Rights, HIPAA provides for several patient rights. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is the fi rst comprehensive federal protection law for the privacy of health information. It provides for patients’ rights and control over their information by setting limits on the use and disclosure of their health information. In addition, it establishes safeguards to protect the privacy of the information in all forms, including paper records, oral com- munications, and electronic information. The fi nal HIPAA Privacy Rule took place on April 14, 2003.

Before HIPAA, personal health information could be distributed to others without either notice or authorization from the patient. Because computers make information exchange so easy, laws had to be enacted to protect patient privacy. HIPAA provides for several patient rights, including these:

The right to notice of a service provider’s privacy practices

•

The right to access health information

•

The right to request restrictions on how health information is used

•

and disclosed

The right to request amendments or corrections to health

•

information

The right to accounting of disclosures

•

Phlebotomists should apply all patient rights to privacy by doing the following:

Preserving, protecting, and safeguarding patient privacy and

•

confi dential health information at all times

Not sharing patient information with others unless necessary for

•

the treatment of the patient

Not writing down computer passwords or sharing them with

•

anyone

Logging off the computer when leaving the work area so other

•

students or professionals cannot use your password

Using care when it is necessary or appropriate to discard

•

patient health information. Confi dential materials should be shredded.

Penalties for breaking the HIPAA privacy rules are twice the penalty for Medicare and Medicaid fraud and abuse. Breaching patient confi dentiality and/or breaking the privacy policies and procedures will most likely

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lead to disciplinary action or perhaps even termination of your course of student clinical courses. Additionally, the federal government can impose monetary penalties as low as $100 per violation and up to $250,000 and 10 years in prison.

LEGAL ISSUES Confi dentiality

The main purpose of confidentiality is to encourage communication at an intimate level between a professional and a patient. According to Principles of Biomedical Ethics, “A rule of confi dentiality prohibits (some) disclosures of (some) information gained in certain relationships to (some) third parties without the consent of the original source of information”

(Beauchamp & Childress, 1989).

Confi dentiality is important for professionals in many fi elds. Law- yers, teachers, counselors, and other professionals must be concerned with confi dentiality. In a medical context, confi dentiality in regard to a patient’s diagnosis and prognosis is of utmost importance. Confi dentiality excludes unauthorized persons from gaining access to patient information. In addition, it requires that people who do have access to privileged information refrain from communicating it to others. If patients do not believe that a physician or other health care professionals will maintain confidences, they may not supply personal information important for their care and treatment.

Frequently, many different health care workers need access to a patient’s medical records in order to provide proper care. Phlebotomists will have access to such information as a patient’s diagnosis, treatment plan, personal history, billing information, and so on. Such information is confi dential. Even though the information is accessible, this does not mean that curiosity is a suffi cient reason to open a patient’s fi le. A phlebotomist must demonstrate self-discipline when dealing with patient information. The phlebotomist must be careful not to discuss confi dential information in public areas such as cafeterias, halls, or elevators.

Such conversations may be overheard by visitors, family members, and others. When patient cases are used as examples in classrooms or other teaching areas, care must be given to mask the identity of the patients.

The phlebotomy student will be anxious to share daily activities with family and friends, but here, too, it is very important that the identity of patients not be disclosed. Confi dentiality must be ensured to protect the patient.

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[ A L E R T ]

Patients have the right to refuse to have their blood drawn, even if ordered by a physician. Comply with the patient’s wish, and do not collect a blood sample. Notify the appropriate nurse, physician, or supervisor.

Refusal of Treatment

A patient may legally refuse treatment. A phlebotomist will experience situations in which a patient refuses to have blood drawn. As a professional, you must respect that decision. You should not argue with the patient concerning this decision. Never ignore a patient’s decision to refuse to have blood collected and attempt to proceed regardless of that decision.

A patient can sue you for battery, which means intentionally touching another person without authorization to do so. If a patient should refuse to have blood drawn, you should follow these steps:

1. Explain to the patient that the doctor has ordered the tests and needs the test results for decisions regarding treatment.

2. If the patient continues to refuse, notify the physician and, if applicable, the patient’s nurse.

3. Notify the appropriate person in your department.

4. Document the patient’s refusal.

RISK MANAGEMENT

AND QUALITY ASSURANCE

It is very important for phlebotomists to maintain high professional standards of practice for themselves and for coworkers. Phlebotomists, like all health care professionals, usually want to ensure accurate and efficient work. Mistakes will happen, however. To address errors and ensure top-quality care, hospitals have created mechanisms for monitoring the quality of patient care. Such mechanisms fall under the categories of risk management and quality assurance. Quality assurance may also be referred to as continuous quality improvement, or CQI.

As a phlebotomist, you have a legal duty to report any inappropriate incident of which you have direct knowledge. Specifi cally, a phlebotomist must be willing to take appropriate action to safeguard the patient if

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incompetent or illegal actions are observed. Failure to report an incident may lead to termination of employment or even exposure to personal liability for malpractice.

Fear of negative peer pressure or of making the accused angry may make the phlebotomist apprehensive about reporting on a colleague.

However, reporting inappropriate behavior can be carried out successfully if it is done in a systematic manner. The following process should be fol- lowed when reporting any illegal or incompetent behavior of a coworker:

1. Gather information. Complete an incident report.

2. Report the incident to the appropriate person, according to the employer’s chain of command.

3. Maintain a record of efforts to report the incident through appropriate channels.

4. After a reasonable duration, determine whether the problem has been corrected.

5. If the problem still exists, report the incident to the person at the next level of command.

An incident report may be used to report other types of problems as well. An incident is an event that is inconsistent with ordinary procedure.

For instance, any injury to a patient would require an incident report.

Incident reports may also be used to document patient complaints, errors, and injuries to professionals and visitors. Phlebotomists have a legal duty to report any incident of which they have fi rsthand knowledge. Incident reports serve three purposes:

1. To inform administrators, so that patterns and trends can be monitored. This is called risk management. The goal is to prevent future similar incidents.

2. To alert administrators to possible liability claims.

3. To provide a means of documenting, in a factual manner, information that may be used for detecting possible future problems.

Most employers make incident report forms available to professionals.

Forms vary with each facility. However, they usually require the following information:

The identities of the persons involved and any witnesses

•

What happened

•

Consequences to the person(s) involved

•

Date and time of incident

•

Location of incident

•

Signature of person making report

•

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Incident report forms should be completed in an objective, factual manner. Incident reports should not include the following types of statements:

Emotional descriptions of what happened

•

Opinions (such as what you think may happen because of the

•

incident)

Assumptions (what you think caused the incident)

•

Finger pointing (who you think was responsible for the incident)

•

If an incident results from the phlebotomist’s own error, the phlebotomist still has the responsibility to fi le an incident report. It is possible that the phlebotomist’s supervisor will take corrective action because of the incident, but a reprimand is likely to be less severe in this case than if the phlebotomist does not report the incident or attempts to cover up the error.

Immediate, factual, and accurate reporting are essential for risk management and quality assurance. In fact, risk management and quality assurance are closely related. Both activities are important for the protection of the patient, the employer, and the health care professional. Phlebotomists need to understand the concepts of risk management and quality assurance so that they may contribute to the well-being of the patient and the employer. Risk management and quality assurance both make use of the information gathered through the reporting system and use the information in the same way, applying the same methodology:

Identifying a risk or problem

•

Monitoring

•

Identifying trends

•

Summarizing

•

Prescribing corrective action

•

Evaluating the effectiveness of the correction

•

The difference between the two areas is that risk management is involved with fi nancial liability issues, while quality assurance seeks to eliminate or reduce patient case problems. The goal of risk management is to avoid risks that could cause fi nancial loss. Quality assurance uses most of the same processes as risk management to assure quality care. Qual- ity assurance is not fi nancially oriented. Both activities are geared toward protection, however. They are intended to protect the patient, the health care worker, and the health care institution through the elimination or reduction of risk.

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HEALTH CARE FACILITIES THAT UTILIZE PHLEBOTOMISTS

Phlebotomists have the opportunity to work in a variety of health care facilities. Hospitals, clinics, physician offi ces, nursing homes, blood donor centers, insurance companies, and commercial laboratories all employ phlebotomists. Job duties may vary greatly, but the primary job duty is to collect blood samples.

Hospitals vary in size, the type of care and services provided, and the type of ownership. The size of a hospital is usually described by the number of patient beds in the facility. For instance, a large hospital such as Cedar-Sinai Medical Center in Los Angeles, California, had 952 beds and 55,486 inpatient admissions in 2007. A medium-sized hospital like Baptist Health South Florida in Miami, Florida, had 680 beds and 31,792 admissions in 2008. Penrose-St. Francis Hospital in Colorado Springs, Colorado, also a medium-sized hospital, had 522 beds and 23,258 admissions in 2008.

A smaller hospital like Seattle Children’s Hospital in Seattle, Washington, had 250 beds with a huge number of outpatient visits (176,608) in 2007.

A phlebotomist may deduce that a large hospital will need a larger phlebotomy staff for inpatient laboratory collections. However, a small hospital such as Seattle Children’s Hospital requires a larger staff due not to the size of the hospital but to the number of outpatient visits. Hospitals offer a large variety of services and specialties. Services may include birth centers, cancer centers, critical care, emergency/trauma, pediatric care, rehabilitation services, surgical services, imaging/radiology, cardiovascular programs, neurological services, and many other specialties. For instance, Bellevue Hospital Center in New York City is the oldest public hospital in the United States with 809 beds. It has long been identifi ed with treating mental illness. The University of Texas M.D. Anderson Cancer Center is well known for outstanding cancer treatment and is a 521-bed hospital.

Hospitals are also categorized by their type of ownership. Private hospitals are owned by a corporation and are expected to produce a profi t from delivering health services. The profi t is returned to the owner or stockholders. A nonprofit hospital may make money, but the money is returned to the organization. Nonprofi t hospitals are normally run by a board of directors. Hospitals may also be owned by a state, county, or city government. Taxpayer dollars help fund the operation of the hospital.

Commercial diagnostic laboratories are another type of facility that employs phlebotomists. Commercial laboratories offer testing services for patients referred by their physician. Commercial laboratories such a LabCorp and Quest Diagnostics have large testing facilities with several off-site blood collection stations.

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OBLIGATIONISM balances the idea of “dividing equally” with that of “doing good and not harm.” According to this theory,