NCCT Quality, Law, and Ethics 2 — Questions and Answers
Question 1: What does the term 'chain of custody' mean in phlebotomy?
- The order in which tubes are drawn during venipuncture
- A documented trail tracking a specimen from collection through testing to ensure legal integrity (Correct answer)
- The hierarchy of authority in a laboratory
- The process of labeling tubes at the bedside
Correct answer: A documented trail tracking a specimen from collection through testing to ensure legal integrity
Chain of custody is the documented process that tracks who has possession of a specimen from collection to final result, ensuring it has not been tampered with for legal proceedings.
Chain of custody documentation creates an unbroken, legally defensible trail of specimen handling from the moment of collection to the reporting of results. It records who collected the specimen, who transported it, who received it in the lab, and who performed the testing, along with dates, times, and signatures at each transfer point.
Question 2: Which of the following is an example of a preanalytical error?
- Incorrect calculation by the laboratory analyzer
- Clerical error in transcribing results to the patient chart
- Drawing blood from a site above an active IV line (Correct answer)
- Improper calibration of the testing instrument
Correct answer: Drawing blood from a site above an active IV line
Drawing blood from above an IV line is a preanalytical error because it occurs before laboratory testing and contaminates the specimen with IV fluid.
Laboratory errors are classified into three phases: preanalytical (before testing), analytical (during testing), and postanalytical (after testing). Preanalytical errors account for 46-68% of all laboratory errors and include patient misidentification, improper collection technique, and specimen labeling errors.
Question 3: What does HIPAA require regarding the sharing of patient laboratory results?
- Results can be shared with anyone who asks
- Results can only be shared with authorized individuals as defined by the patient's consent (Correct answer)
- Results must be posted on a public board for transparency
- Results can be shared with the patient's family without restriction
Correct answer: Results can only be shared with authorized individuals as defined by the patient's consent
HIPAA requires that protected health information, including laboratory results, only be shared with authorized individuals who have a legitimate need to know.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 establishes strict rules for protecting Protected Health Information (PHI), which includes laboratory results. PHI can only be disclosed to the patient themselves, healthcare providers directly involved in care, entities processing claims, and public health authorities when required by law.
Question 4: What is the purpose of quality control (QC) in the phlebotomy laboratory?
- To increase the speed of specimen processing
- To monitor the accuracy and reliability of testing procedures using known standards (Correct answer)
- To reduce the cost of laboratory supplies
- To track employee attendance
Correct answer: To monitor the accuracy and reliability of testing procedures using known standards
Quality control involves testing known standards alongside patient specimens to verify that testing procedures are producing accurate and reliable results.
Quality control (QC) is a systematic process using control materials with known, established values (normal and abnormal ranges) that are tested alongside patient specimens. If QC results fall within the expected range, the testing system is considered accurate and patient results can be reported.
Question 5: A phlebotomist discovers that a coworker has been falsifying specimen collection times. What is the appropriate action?
- Ignore it as it is not a serious issue
- Confront the coworker privately and ask them to stop
- Report the issue to a supervisor immediately (Correct answer)
- Help the coworker falsify times to maintain workplace harmony
Correct answer: Report the issue to a supervisor immediately
Falsifying specimen times is a serious ethical and legal violation that must be reported to a supervisor immediately, as incorrect times can affect patient diagnosis and treatment.
Falsifying collection times is a serious ethical violation, potentially fraudulent, and directly impacts patient safety. Many laboratory results are time-dependent: timed drug levels determine dosing adjustments, cortisol levels require specific collection times for accurate interpretation, and glucose tolerance test results depend on precise timing.
Question 6: What does the legal term 'informed consent' mean in the context of phlebotomy?
- The patient signs a form without needing an explanation
- The patient is given adequate information about the procedure and voluntarily agrees to it (Correct answer)
- The physician gives consent on behalf of the patient
- The laboratory gives permission to perform the test
Correct answer: The patient is given adequate information about the procedure and voluntarily agrees to it
Informed consent means the patient has been given understandable information about the procedure, its purpose, and any risks, and has voluntarily agreed to proceed.
Informed consent is a legal and ethical principle requiring that patients receive sufficient information to make a voluntary, educated decision about a medical procedure. For phlebotomy, this includes: what the procedure involves, why it is being done, potential risks, and alternatives.
NCCT Quality, Law, and Ethics 2
What does the term 'chain of custody' mean in phlebotomy?