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. |
![]() |
||||||
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 | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Positions Patient and applies tourniquet. |
![]() |
||||||
Palpates antecubital area to select venipuncture site. |
![]() |
||||||
Properly cleanses venipuncture site. |
![]() |
||||||
Sample Collection | Rating Stars (Click) | 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 | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
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 | Rating Stars (Click) | 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) |
![]() |