Answer to Question 1
Each health care facility must determine if a centralized phlebotomy or decentralized phlebotomy program is the best for that facility. There has been much written in the literature debating the pros and cons of each program. Studies have shown that with decentralized phlebotomy, there is an increase in hemolyzed specimens, patient identification errors, and contaminated blood cultures. Decentralized phlebotomy has been effective in many health care facilities. The key to effectiveness and reduction of errors is based on extensive training of individuals doing the phlebotomy.
Hybrid phlebotomy, where there is a blend of centralized and decentralized phlebotomy, has been used in some health care facilities to reduce the errors of decentralized phlebotomy. Hybrid phlebotomy typically sends laboratory-based phlebotomists to the nursing units during the early morning collections and then keeps a limited number of phlebotomists available the rest of the day to help patient care technicians with difficult collections.
Answer to Question 2
Having an advance directive gives your health care provider instructions about your health care before you are incapacitated. These instructions will give someone you choose the power to make decisions for you and will offer instructions about the type and degree of health care you wish to receive.
The patient and his family meet with the nurse to discuss progress on the patient care plan.
A general hospital
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An 1809 painting showing a wounded soldier as he lay dying of tetanus in a military hospital