Name:
Email:
LAST 4 OF SSN:
This checklist was electronically signed on (Today’s date)
This checklist is designed to guide our client facilities in assessing your proficiency in your nursing specialty. Please use the scale provided to indicate your level of experience and expertise in each of the areas listed below.
Skill Level Indicator:
★ = No Experience
★★ = Requires Training
★★★ = Capable with Supervision
★★★★ = Capable Independently
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
Positions Patient and applies tourniquet
Palpates antecubital area to select venipuncture site
Properly cleanses venipuncture site
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
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
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)
Resource location – Lab Test information Guide
5
Blood Ethanol Collection – cleanse site with soap and water
Blood Culture Collection Review
I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
