Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
| Preparation | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Introduces self to patient and explains blood tests have been ordered by physician. |
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| Identifies the patient with two unique identifiers (armband, ask for name & DOB). Compare patient ID information with barcode label. |
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| Checks testing requirements (ie fasting). |
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| Prepares supplies and tube selection. |
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| Washes hand, dons gloves. |
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| Getting Started | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Positions Patient and applies tourniquet. |
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| Palpates antecubital area to select venipuncture site. |
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| Properly cleanses venipuncture site. |
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| Sample Collection | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Stablizes vein. |
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| Inserts needle, bevel up. |
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| Smoothly pushes tube(s) into holder without changing needle position. |
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| Adjusts needle, if necessary, to obtain flow then stablizes vacutainer. |
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| Releases tourniquet as blood begins to flow. |
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| Changes vacutubes without changing needle position. |
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| Fills vacutubes in correct order. |
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| Mixes anticoagulated vacutubes properly. |
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| Removes last tube from needle before withdrawing needle. |
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| Withdraws needle from arm smoothly. |
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| Applies pressure to site after withdrawing needle. |
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| Disposes of needle properly and safely, Discards tourniquet. |
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| Handling & Processing | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Labels tubes immediately (ie at bedside). |
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| Legibly completes label/requisition with username and date/time of collection. |
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| Observe special handling requirements. |
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| Checks puncture site to ascertain bleeding has stopped. Applies bandage. |
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| Places tubes into biohazard bag. Label(s)/requisiton are placed in sleeve of bag. |
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| Removes gloves and practice hand hygiene. |
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| Transport specimens to lab via porter or pneumatic tube system. STATs are sent immediately. |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infant (Birth - 1 year) |
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| Preschooler (ages 2-5 years) |
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| Childhood (ages 6-12 years) |
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| Adolescents (ages 13-21 years) |
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| Young Adults (ages 22-39 years) |
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| Adults (ages 40-64 years) |
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| Older Adults (ages 65-79 years) |
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| Elderly (ages 80+ years) |
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