ASU Custom Form | Medical Laboratory Technology - Clinical Evaluation: Phlebotomy

Medical Laboratory Technology

Clinical Evaluation: Phlebotomy

Please evaluate the student in the following areas.

Grading Scale: 6.5 points = Unsatisfactory; 7.5 = C; 8.5 = B; 9.5 = A;
N/A - Our lab does not perform this task or student was not asked to perform this task.

Clinical Evaluation

Affective

1. Reports to work as scheduled

2. Maintains effective communication and good interpersonal relationships with laboratory coworkers, students and others on the healthcare team

3. Accurately and effectively communicates with patients

4. Maintains the HIPPA level of patient confidentiality

5. Complies with dress code and maintains professional demeanor

6. Prudently uses laboratory resources

7. Completes work with minimal supervision

8. Able to effectively manage an emergency or STAT situation while maintaining a professional composure

9. Able to organize the work load effectively as to maintain the most efficient use of time

10. Responds positively to criticism and challenges

11. Seeks assistance from proper authority when needed

Cognitive Evaluation

1. Knowledge of specimen collection and processing requirements

2. Knowledge of critical values

3. Knowledge of Quality Control monitoring

4. Knowledge of problem solving/trouble shooting techniques

5. Knowledge of disease states in relation to laboratory testing

6. Knowledge of safety requirements

7. Knowledge of regulatory requirements

8. Knowledge of laboratory information systems and computer skills

Exams

Exam grade 1:

Exam grade 2:

Exam grade 3:

Exam grade 4:

Exam grade 5:

Psychomotor Evaluation

1. Follows appropriate safety procedures

2. Correctly identifies patient using two patient identifiers

3. Clearly and politely instructs patients before phlebotomy as to the method being used

4. Collects samples following the correct order of draw

5. Correctly labels each specimen

6. Demonstrates the ability to collect special orders such as blood cultures, glucose tolerance testing, or blood alcohol

7. Correctly collects at least 25 venipunctures

8. Correctly collects at least 5 skin punctures

9. Demonstrates the ability to perform venipunctures using a variety of needle systems including vacutaners, butterflies, or syringes

Student Name:

Date:

Evaluator Name:

Date:

Albany State University

Medical Laboratory Technology

Clinical Evaluation: Phlebotomy

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