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Terry Kotrla, MS, MT(ASCP)BB

Professor
Austin Community College
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Ä The Joint Commission for Accreditation of

Healthcare Organizations (JCAHO) requires that all
healthcare staff annually meet competency
expectations in performing Age Specific Care.
Ä An interpretation of the standards and their intent
relates to all staff members who assess, treat, and
manage, or who work in areas that have direct
impact on, patients in age-specific populations.
Ä Managers are being challenged to make sure their
phlebotomists are not only proficient at phlebotomy,
but proficient with all age groups.
 
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Ä Basic knowledge of human growth and

development
Ä Age specific interpersonal skills
Psychological needs
Social needs
Appropriate tone of voice, eye contact and active
listening skills
Ä Technical expertise ± physical skills
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Ä Deonate/Infant 0-1
Ä Toddlers 1-3
Ä Pre-School 4-5 years
Ä School Age 5-12 years
Ä Adolescent 13-18
Ä Young Adult 19-35
Ä Adulthood 36-65
Ä Late Adult 65+
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Ä Total dependence on parents/adults

Ä Older infant has fear of strangers and separation
from parent
Ä Parent may hold child and provide comfort
Ä Pacify with bottle/pacifier or distract with toys
Ä Primary interaction will be with parent
Introduce yourself
Gentle, comforting tone of voice
Compassionate expression and body language
Clearly explain the procedure
Older infants - talk slowly and make eye contact
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Ä Try not to separate from parent unless

absolutely necessary
Ä Do not perform venipunctures on infants less
than 6 months of age unless absolutely
necessary
Ä For heelsticks follow recommended
procedures to the letter.
Ä Collect minimum amount of blood necessary



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Ä Try not to separate from parent unless absolutely

necessary.
Ä Parent may assist by holding, explaining to and
comforting the child
Ä Friendly, cheerful and empathetic manner.
Ä Speak before you touch, use child¶s name
Ä Explain procedure in soothing tone using age
appropriate terms, children this age fear pain
Ä Emphasize cooperation
Ä Praise child during procedure
Ä Encourage parent to praise child after procedure



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Ä Childproof area, no supplies in reach

Ä Be prepared, have all supplies needed to avoid
delay
Ä DEVER say ³This will not hurt´, rather use age
appropriate terms and it¶s ok for them to say ³ouch´
Ä Distract with a toy or other object
Ä If appropriate, keep child informed on how much
longer it will be
Ä Bandaids may not be appropriate, child may swallow
and choke.


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Ä Parent may be present to provide emotional support

and to assist in obtaining child's cooperation.
Ä Approach in friendly, cheerful & empathetic manner,
use child¶s name.
Ä Explain procedure in soothing tone using age
appropriate terms, children this age fear pain
Ä DEVER say ³This will not hurt´, rather use age
appropriate terms and it¶s ok for them to say ³ouch´
Ä Keep child informed on how much longer it will be.
Ä Praise for bravery, say ³Thank you´


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Ä Child proof collection area

Ä Fear of pain
Ä Avoid delays, have all equipment
Ä Assemble equipment out of child¶s eye sight.
Ä Use your best judgment whether to
encourage child to look away.
Ä Involve child in after care by allowing
selection of bandaid and sticker.
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Ä Increased language skills and self-control.

Ä Move from security seeking behavior towards
independence.
Ä Try not to embarrass the child.
Ä Must communicate with them as an individual using
age appropriate words and appropriate eye contact.
Ä May want parent to hold hand.
Ä Explain the procedure and why blood is needed.
Ä Be prepared to answer questions.
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Ä Younger ages fear of pain, older ages may

³act´ brave.
Ä Younger ages may need distraction such as
a toy or other object.
Ä Explain use of equipment if appropriate.
Ä Reassure the patient during the procedure.
Ä Let them know how much longer.
Ä Explain the importance of maintaining
pressure after completion of procedure.
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Ä Maintain privacy.
Ä Concerned with the present more than the future.
Ä Conscious of appearance.
Ä Actively involved in anything concerning the body.
Ä Engage in behaviors to establish they are an adult.
May be hypersensitive or non-interactive
May act hostile to hide fear.
Important to assess the patient and use appropriate
interpersonal skills.
Ä Take extra time for explanations and or preparation.
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Ä Embarrassed to show fear.

Ä Adolescent male has greater potential for
fainting.
Periodically check for pre-syncope signs.
Be aware of sudden silence in a previously
talkative patient or extremely talkative after
previously silent.
Ä Keep up a running conversation to distract
the patient.
Ä Stress importance of post-phlebotomy care.
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Ä Reflect on interests, goals and aspirations for

the future.
Ä Focused on preservation and maintenance of
health.
Ä May work and play too hard and sacrifice
sleep, nutrition and exercise.
Ä May experience anxiety, stress and
depression related to work, marriage,
parenting and social expectations.
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Ä More involved with healthcare decisions, may
ask questions which put you ³on the spot´.
Ä Communicate in a professional manner.
Explain why you cannot answer certain questions
Do not patronize or talk down to the patient.
Clearly and honestly explain the procedure
Ä Avoid negative body language
Ä Eye contact critical, promotes sense of trust
but be aware of cultural differences.
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Ä Can possess same fears as pediatric patient.

Ä Confidence and professionalism are essential
to set patient at ease.
Ä Be aware of signs of syncope, especially in
fasting or GTT patients.
Ä Stress importance of post-phlebotomy care.
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Ä Generativity vs stagnation
Ä Prepares for empty nest
Ä Adapts to aging process.
Ä Older, wiser and more likely to be at peace
with society and self.
Ä Health problems may require prescription
drugs.
Ä Interpersonal skills the same as the young
adult.
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Ä Rarely fearful of the procedure.

Ä Stress post-phlebotomy site care
ESPECIALLY for patients on anti-coagulant
therapy.
Ä Site should always be checked before patient
leaves.
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Ä Aging process continues.

Ä Reduced attention span and memory.
Ä Experiences anxiety over loss, isolation and
changes.
Ä Reflect on their lives and come to accept death.
Ä Due to loneliness may take more of your time.
Ä Challenges due to neurological and physical
disabilities.
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Ä ³Dormal´ older adults not a problem

Ä Patients with physical or neurological problems can
present very challenging problems.
Ä Ask for assistance if limbs must be manipulated or
held still.
Ä Take GREAT care to select your equipment.
Ä Provide exceptional after care to prevent bruising.
Ä Bandaids MAY DOT be appropriate for elderly
patients with ³paper thin´ skin.
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Ä Observation
If all groups are being assessed VERY time
consuming
Subjective in nature
Ä Educational Packet and Test
Many commercially available but many parts may
not apply to your facility
Create your own ± requires educational expertise
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Ä Define competencies to be observed for each age

group, both interpersonal and technical
Ä Define/describe levels of performance and grading
system for each competency listed
Descriptions must be objective criteria DOT subjective
Grading: Satisfactory, needs improvement, unsatisfactory
Ä Allow employees to review competencies so they
know what is expected.
Ä Develop remediation plan for D and U
Allow review of study materials
Allow critiqued practice
Observe again
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Communicate verbally with the patient.

Acceptable Unacceptable Deeds Improvement

Soft, calm, soothing Angry, gruff, loud tone Dervous, excited,

tone of voice of voice. anxious tone of voice.

Do remediation Demonstrate Demonstrate

necessary appropriate tone of appropriate tone of
voice, critique voice, critique
practice, retest practice, retest
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Ä Find resources from journals and textbooks

Ä Materials should be applicable to YOUR
institution
Ä Include case study scenarios to illustrate
³best practices´
Ä Create test questions from materials
Good questions HARD to create
Beta test and revise based on input from test
group
Allow remediation for missed questions
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Ä Materials should be reviewed regularly

During first year several revisions may be
necessary to clarify materials and questions
Obtain feedback from test subjects and use to
improve materials (use brief questionnaire)
Ä Keep Materials Current
Most difficult task
Take a day once/year to research the topic
Take another day to make quality revisions



Ä Define the age specific categories

Ä Create study materials based on your
institution¶s unique patient population
Ä Define competencies
Ä Conduct annual assessments, observation,
written test or combination
Ä Develop remediation plan
Ä Research and revise annually
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Ä http://www.averalabnet.com/newsletters/JanFeb02.pdf
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 Advance For Laboratory Professionals
Ä UTMB Clinical Pathology Services,
http://www.utmb.edu/pps/EDUCATIOD/comfort.htm
Ä Please keep an eye on my web page for a sample test:
http://www.austincc.edu/kotrla/mlt_phb

Ä






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