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I am retired but volunteered several years as an AABB assessor. Both CAP and AABB send the deficiencies from the previous assessment to the assigned assessor with the submitted plan of action to correct the previous deficiency. Most plan of actions have a time frame documented to correct the issue. We were supposed to make checking completion of the plan of action a priority. My first question would be if this individual had completed any work before his training records were completed. Then, I would ask for his competencies that were completed during the allowed time frames. If I performed a tracer on your FDA reportable, could you provide completed training and competency records for all the employees who worked on that patient? Your pathologist may be young, but he does not want repeat deficiencies. Document everything!

If we only do D typing on babies from D negative mothers and a weak D or Du test needs to be performed, the results of the weak D is only valid if the DAT is negative, so a DAT would need to be performed. Therefore, an ABO and DAT would be a good place to start. Just my thought.

We had stopped doing cord blood panels on O Pos moms for several years. Then a Family Practice physician took over as chair of OB/Peds and insisted that we resume cord blood testing on all O Pos moms. Why? ... because his children were born with elevated bili levels and his spouse is O Pos. Was there a difference in the treatment of these infants because their DAT was positive? ... probably not. We need to revisit this issue because we do a lot of cord blood panels on O Pos moms and it adds to their bill w/o adding much, if any, benefit to the infants care.

I would think that a 4th option in the poll should be: Routinely perform only D typing on babies from D negative mothers. Why do ABO and DAT routinely on these babies?

Are your techs generalists or dedicated blood bankers? If they are generalists, chances are they are not going 2nd guess BB Mgr. If they are dedicated blood bank techs they should know better. Unfortunately I have known SBBs who would give inappropriate plasmas (gr O to gr A) just because they were thawed. Laziness. Do you have a BBIS? It should have required an override to give the O plasma. Having been an inspector/assessor for AABB and still a CAP team leader I would think these issues should have been flagged in your quality plan and subsequently made their way to lab management and hospital quality folks. Don't be derelict in your duty to your performance program AND your patients. I'm certain your Medical Director should be in the know as he/she is ultimately responsible. I would not bring up this individual's past history (though how you discovered this would be an interesting aside). Don't let your lab's quality suffer because of an individual's poor performance, both the manager and the tech involved. The transfusion of inappropriate plasma should have resulted in a Biological Product Deviation to the FDA. Is this in your purview? I would recommend jumping immediately on errors of this type as soon as they are found. I also would recommend going directly to the Medical Director as it seems your manager has some serious BB judgement issues. In the past I have commented to a Medical Director that one would not want to practice Laboratory Medicine in jail. The Feds can take you out in handcuffs if they think you are culpable (rare but they do have an enforcement arm). I'm being kind of verbose here but the bottom line is as the quality person for your BB, don't hesitate to call a spade a spade. Inform lab upper management with your concerns, especially your Medical Director.