Kingston Hospital NHS Trust

Competency Based Assessment Tool

Confirmation sheet

Phlebotomy

Candidate:
Performance and knowledge criteria of this competency.
Date completed:
Name

Signature

Candidate
Assessor

This confirmation sheet needs to be completed and sent to the Training Centre who on receipt
will issue a certificate of competence to the member of staff. The completed competency form
is to be retained on the individuals file, and they may wish to keep a copy for their professional
portfolio.

Nov 01

Competence Based Assessment Form

Candidate name:

CMG/Ward area:

Phlebotomy
Assessor those who hold ENB 997/998, D32/D33, A1/A2 or equivalent.
All competences will be judged according to current Trust and Professional guidelines
All staff are required to work under supervision until deemed independent
in all performance and knowledge criteria.
Statement of Outcome: The practitioner will be able to accurately and safely undertake
phlebotomy.

Phlebotomy
Performance criteria:

Date Competency
Achieved

Equipment and materials are checked for safety and function

Equipment and materials chosen are appropriate for the analyses
requested and blood sample type
Equipment for safe disposal of hazardous and/or contaminated equipment
is provided and properly prepared for use before undertaking the procedure
Materials used to prepare site and cover wound on completion are
appropriate to the patient and phlebotomy site
Equipment for transfer of specimens and request forms is prepared before
the procedure and appropriate to the sample and analyses requested
Hands are washed effectively before and after the activity
The patient is identified using reliable and accurate information
The patient is informed of the activities related to obtaining the samples in a
manner which is sensitive to his/her concerns and needs and is at the
appropriate level and pace
Any questions from the patient are answered correctly or referred to the
appropriate member of the care team
An appropriate site for sample collection is selected to minimise patient
discomfort and to ensure an adequate blood supply
The specimen is collected using the correct technique and at an appropriate
time(s) according to the analysis requested
The puncture site is dressed appropriate to the needs of the patient and
checked to ensure there is no haemorrhage
The samples are distributed in the correct containers and handled in a
manner appropriate to the analysis, labelled accurately and legibly, the
relevant documentation attached and put in the appropriate place for
storage, collection or transportation
Where the practitioner is unable to obtain a sample, the relevant
professional is informed without delay, and an explanation given to the
patient
Any condition or behaviour which may signify adverse reactions to the
procedures is reported without delay and action appropriate to the patients
condition taken
Following the procedure, the patient is assisted to reach as comfortable a
position as possible given his/her current state of health
After use, all equipment and materials are disposed of in an appropriate
Nov 01

Phlebotomy
Performance criteria:

Date Competency
Achieved

safe manner in accordance with organisational policies

Phlebotomy
Knowledge requirements:

Date Competency
Achieved

The correct techniques and containers for particular specimens

The colour codes used for request forms and samples containers
The difference between hazardous and non-hazardous waste, safe disposal
and organisational policies related to disposal of waste
When and what protective clothing should be worn for the patients and the
practitioners protection
The possible causes of infection
How infection is spread and how its spread may be limited through the safe
transfer of equipment and effective hand washing
The procedures and materials available to prepare and dress the puncture
site, when their use is appropriate and possible adverse reactions
The particular patient condition which may affect the taking of blood and the
particular needs of different patient groups in relation to the procedure
undertaken whether this be due to condition, ethnic group or age
The role which the preparation and support of the patient has in the taking
of the sample and how actions should be sequenced
The concerns which different patients may have in relation to the procedure
What to do if it proves impossible to obtain a specimen and reasons why it
may be difficult
Signs and symptoms which may indicate the need for clinical intervention
Common adverse reactions
The need for confidentiality and how this can be maintained
The procedures for accurately identifying a patient
Appropriate procedures for anti-coagulating blood samples and the affect of
these on the sample condition
The candidate has presented valid evidence to demonstrate competence in each of the above
performance criteria and aspects of knowledge and understanding.
Date completed:
Name of
Candidate:
Name of
Assessor:

.
Signature:
Signature:

Definition of Independent Level

This applies to practice that focuses on the patients needs. The practitioner performs independently with
speed, accuracy and adaptability in routine and complex situations.

Nov 01

Action Plan
Please identify competency elements to be achieved and state the date of review
Date

Action Plan

Review
Date

Candidates
Signature

A record of competent Practitioners must be kept and maintained by the Ward Sister/ Charge
Nurse. This document should be filed in the practitioners personal records and a copy may be
taken for his/her Portfolio.
.

Nov 01