SbbPerson

I agree, except for the first time Red Cell Immunohaematology at NHSBT-Tooting Centre were inspected by the Medicines and Healthcare products Regulatory Authority (MHRA), who had previously only inspected the donor side of things.  We (RCI) were "inspected" by the top inspector (no name, no pack drill), who knew s*d all about blood group serology, but who was determined to make his mark by finding anything he could (however minor) and making it a major.  As a result, we lost six months of screening for rare donors (it's a long story).

Since then, I agree with you that more inspections actually help (and the MHRA inspectors now seem to have done their homework - although most of them would still not pass a reasonably difficult examination in blood group serology - but at least they now realise that).

Personally, I never minded inspections/assessments.  My blood bank and transfusion service were "visited" no less than twice every year by inspectors.  Either FDA (we were licensed to ship blood interstate at one facility I supervised), AABB, CAP or JCHO.  Being inspected that often meant we never had the opportunity to let things slip unlike other areas of the lab that were inspected less frequently.  On the other hand it did become very expensive paying memberships as well as buying materials required to stay current on the requirements of each agency.  When cost cutting measures were called for reducing in this area was always discussed but for some reason was never acted upon.

 

I'd be in favor of keeping both CAP and AABB.
If one of them is doing your CMS inspection, then the other can be used as "practice".

A number of years ago in a meeting of the corporate transfusion service supervisors we discussed the possibility of dropping our AABB membership.  After much discussion the corporate transfusion service medical director decided that we would not be dropping the AABB membership.  Her reasoning, the prestige of being in charge of a group of facilities fully accredited by AABB was very important to her.  She actually told us that!

In New York State, we also are inspected by the state.  FDA, NY State, AABB, CAP.  You can make a sound argument that this is wasteful and duplicative.   Obviously we don't have any choice about FDA and NY State.  CAP and AABB, as accreditation organizations, will accept the results of each other's inspections, which is a plus, but you are still dealing with two sets of requirements.  My advice to smaller facilities is to pick one if you can do so, and not duplicate your efforts and expense.  Both organizations are essentially trade organizations, not scholarly/research societies. They both provide important educational opportunities, but you don't need both to keep your staff current, in my view.  With the shortage of medical technologists, reducing non-productive non-clinical effort is a priority to prevent staff burnout and keep everyone focused on the main mission, patient care.

My current hospital lab is JC and FDA inspected. My prior lab was CAP, with the hospital being JC. I honestly don't see a difference without the CAP inspection here, as we follow all AABB standards anyway. We used to be AABB inspected in BB, but dropped it in 2004 or 2005, before I got here, due to costs and not much gain for a hospital transfusion service that doesn't irradiate, wash or pool. My two cents: you don't need inspections by 4 organizations, just pick one.

We have been used HFAP (now part of ACHC--Accreditation Commission for Health Care) for at least the past 20 years.  I have no experience with any other accreditation organization so can't really compare to CAP, but they are another option.

We dropped AABB for our satellites - these days I'm even questioning the need for the largest Blood Bank to stay with AABB.  Combing through multiple standards and performing 2 self-inspections with minimal staff and trying to keep things running makes me wonder why we need both CAP and AABB- especially with the fees that are charged. AABB wouldn't answer either phone or email about getting a copy of the new standards so we had to purchase them.  

There's been a debate over dropping CAP accreditation after the VA did it.  Has anyone done this?  Please share any pros/cons you experienced.  Right now we can only speculate.   That would leave us with Joint Commission, CLIA/FDA, and AABB.

My 2nd job is only per-diem, but I have been working almost everyday on my days off from my 1st job.  We are so short of staff, the Lab Manager has to fill in for several evening shifts herself. That means, she does her day shift work and then continues on to evening shift and goes home at midnight almost everyday. They are so happy to see me on my days off from my 1st job, because they sorely need the help. The only upside to all this is I am getting so much overtime $$$. That's about it.  

I just answered this question.

My Score PASS  

I just answered this question.

My Score PASS  

Thank you very much for the info!

Before I attempt to answer your query, I must explain that I am NOT a doctor.  I am what is called in the UK, a Biomedical Scientist and, as such, am not qualified to make a diagnosis, but I am the Chief Examiner in Transfusion Science for the Institute of Biomedical Science, and used to by the Reference Laboratory Manager in the Red Cell Reference Laboratory in the National Health Service Blood and Transplant Centre in Tooting, London, so I can claim some expertise.
Although a warm auto-antibody in a person's  plasma is by no means common, it is something we use to see on a daily basis at Tooting.  To put it at its most basic, it results from your immune system producing an antibody directed against a red cell antigen expressed upon your own red cells, which could, under certain circumstances, lead to you becoming (usually mildly) anaemic.
The "autologous adsorption" bit means that the laboratory, either at your hospital, or at a Reference Centre has been able to remove the antibody from the plasma in your blood sample by using  your own red cells (thus proving beyond doubt that the antibody is indeed an auto-antibody).  They have then tested this adsorbed plasma in tests to see if there are any unusual antibodies in your plasma that are directed against antigens expressed on the red cells of other individuals; so called allo-antibodies.  They include in their report the caveat that concerning the "common blood group antigens" because it is all but impossible to test for antibodies against all the known antigens, of which there are well over 600, some of which are incredibly rare.
Most auto-antibodies have a specificity within the Rh Blood Group System, which, at present, contains 55 different antigens (but other antigens are being found on a regular basis).  Most of these auto-antibodies are directed against either the Rh antigen known as Rh17, or against that known as Rh18 (I realise these names will mean nothing to you - but bear with me).  Almost everybody in the world expresses both of these antigens on there red cells, and the actual specificity of the auto-antibody is not really of any consequence.
It is highly unusual, to say the least, for a maternal auto-antibody to cause any problems with a condition known as haemolytic disease of the foetus and new-born (or HDFN), particularly at an early stage of pregnancy.
To me, this suggests that your early miscarriages and your auto-antibody status are coincidental, rather than the auto-antibody being the cause of your early miscarriages.  Red cells are not really produced in early foetal life (indeed, there is not much in the way of blood in a foetus until about 12 weeks of gestation), so there are very few foetal red cells available to be affected by your auto-antibody.
Having said all of that, I would reiterate that I am NOT a doctor, and even if I were, it would be impossible (and stupid in the extreme) to even attempt to make a diagnosis without FULL knowledge of your case.  As such, I would suggest that you do discuss your case with your own physician (or your obstetrician) and be guided by what he or she suggests in terms of further testing.
I hope that helps a little bit, and that I have not "blinded you with science" (which was not my intention), and I apologise for me English spelling!

We are experiencing all of that.  
The fact that my hospital refuses to even think about sign on bonuses makes it even worse.  The hospital down the street has an $8-12K bonus and their benefits and pay were already better than ours.
I saw a few weeks ago that a hospital in Philadelphia is offering a $20K sign on bonus.

If the candidate has commercial lab experience running HPLC or LC/MS/MS they will have direct transferable skills and experience with following SOPs/procedures, running QC and tight deadlines. So they would definitely be trainable. However you would have to teach them everything BB as BetnaSBB described above. Do you have the time for that commitment? 

This is so incredibly disheartening to hear. Since my last post 6 months ago, the BB staffing is still going well, and I thank my people ALL the time! Other hospitals nearby continue to offer sign on bonuses, and we still cannot afford to do so, for lab or nursing. The core lab was down 13 positions at one point, mostly nights and evenings, and has a revolving set of 2 travelers every few months. 
We have our own MLS school for post BS training, and will graduate 8 people in November. Everyone is hanging on for that basically. The only other MLS school in the state graduates about 20 every May, and they always head to the bigger better sign on bonus so far through the pandemic. In Denver, there are TONS of MLS jobs, with a bunch in blood bank, so people can take their pick. 

When I was moving to the area I couldn't find ANYTHING blood bank specific.  That's why I'm in Cheyenne.  Sad to hear there's such a vacancy increase.  The lab here is on the upswing.  Having trouble finding generalists for nights, but we've had luck with H1B visa sponsorship in the past and are considering that again.

Nancy,
I echo everything you said, but I am experiencing the same things in a 400 bed hospital in downtown San Antonio. This is not sustainable and some sort of major intervention needs to happen very soon. After 37 years, I want out of this field. 

Personally, I'm ready to start traveling.  Did a short stint a few years ago.  I'm getting tired of the regulatory environment.  Just be a tech for a few more years and let someone younger deal with the reg folks.  I really like Blood Bank work. 
 
 
 
 

I've only had 2 the last couple of years, but I was able to go to different countries, instead of just staying home. 

You can give them the lit on giving type A plasma for traumas.... Yazer had a good paper. But honestly, they should be following SOP, and if they're not, they need discipline!  If you have good SOPs that direct them to use the best possible option of first expiring units, they need to be following it. We attempt ABO compatible as much as possible, but it's not always feasible. 

Vacation???? I'd settle for a day off without being called in because we have no staff coverage in the blood bank. 

There has been quite a few H1B Visa lab techs that were hired from the Philippines in the last couple of years. Most of them are pretty good workers. We also have been hiring travellers.  That's basically it.  The last couple of years have been pretty rough. At least I have been getting so much over time. I was able to buy a bunch of toys like guitars and gadgets and go on vacations and stuff. 

Thanks for your feedback!  I'm surveying the audience to see what can be pieced together as most efficient.  Currently, my LIS requires override when a specimen being used for XM has not had a T&S on it.  This LIS is going away next year tho.
I have only used blood bands at my current institution and am evaluating getting rid of them.  They cause a scary % of redraws (nurses cutting the wrong band, or rebanding when transferring between units, etc) and delay in patient care when patient ID isn't at question. And they're expensive.