John C. Staley

It's good to be famous and remembered!!

When tube testing was all we had, my moto was; "when in doubt, shake it out!" One of the first things I did as transfusion supervisor at a new facility was convince the medical director that we needed to stop using the microscope for routine testing. It was much harder to convince the rest of the staff. I couldn't remove the microscopes from the department because we were doing KBs at the time and I'm pretty sure a few of the "older" staff still used them for routine testing when I wasn't looking. Once again inertia is proven to be the most powerful force in the universe!

I had always found it difficult to convince nurses that we were working with a person/patient and not a room/bed! This became even more difficult after all the privacy rules and regulations came about. It was almost as if they were terrified to say a patient's name aloud!

I especially like the way you phrased it as "transfusion error stories" and not transfusion horror stories. Looking back I sometimes think I could write a book on the subject. Well, maybe not a book but at least a novella! Some of the stories would be comical and others terrifying. Luckily, in over 35 years in the business none of my stories are fatal but a few had the potential.

Regardless of all the possible causes along the way the ultimate human failure occurred at the bed side!! People are probably getting tired of me saying this but as long as there are humans involved in a process human error will occur. All we can hope to accomplish is minimizing both the number of times it occurs and the resulting ramifications.

Sadly, I can't open the attachment of the answer. I was hoping to see what was considered "critical thinking". From the responses of others it would appear I am not missing much. Carry on folks.

Not to be too nit picky but while 72 hours is 3 days, depending on who is counting and why, 3 days could be anywhere between 48 hours 1 minute and 72 hours. Just thought I'd mention that. Glad you got the computer figured out. It can be no easy task.

I would also like to see the definition of critical thinking used by the original question setter. That might help trying to understand what they were getting at. I know from past question writing experience for students, that an answer which I considered so blindingly obvious was in fact not anything of the sort.

Malcolm's answer seems reasonable but I'm with you that all the original question does for me is lead to more questions and no answer. Such as; what does "Investigation of the label issued at the blood bank verified the unit's correct labeling." actually mean?? Was this a real case or just something someone made up?

My only recommendation is, what ever process you decide on, keep it as simple as possible. On first thought I would keep everything in-house. By that I mean you do all the testing and transporting. At least with these patients you know they will be transfused and the chance of a unit being wasted is very small. It may not be convenient but it is simple.

I have no answers to your questions but instead have a question for you. Are you aware of any bad outcomes which could have been the result of the practice at your facility?

Is there someplace local that can do flow cytometry for you. I never understood why everyone thought KBs are so difficult. We were forced to stop doing KBs and send out for flow cytometry by the corporate transfusion service medical director. I have my suspicions why but I won't voice them here. We never had any issues with doing the KBs and we really didn't do all that many.

Where was that when I was still working!!! Would have worn it to work everyday.

Thankfully I'm R1R2!!!!

Couple of more strange questions, how sure are you that it is anti-Jka? If you are sure, why were you doing a ficin panel? Can't wait to see what Malcolm has to say.

I guess I've been out for too long, what is "pathogen reduced platelets"? If I remember correctly we used to refer to leuko filtered RBCs as reduced risk for CMV but I don't remember doing anything for platelets.

Thanks Malcolm, I'm sure the acknowledgements are both prestigious and well earned. Again, congratulations.

Malcolm, I'm always hesitant to show my ignorance but what is the difference between a Life Membership and a Fellowship?

As long as humans are involved in a process there will be human error! You best option, as suggested above by jinsat is to have the product ordable by the physician. Remember, complicating a process never makes it better.

Congratulations.

I would have used Notorious!!

Ok, here we go. First is from a personnel stand point. When promoted from with in you are no longer "one of the guys". This means that some of the staff will try to leverage your close friendship which in turn will cause problems with others. Both you and the rest of the staff need to recognize that things have changed on a personal level, at least in the work place. This does not have to be dramatic and should not be, but it is real. Some can do this and some find it very difficult. Now, when coming from outside your are exactly that, an outsider. Now the level of this can vary immensely depending on the situation. One time when I changed facilities it was just across town and I new many of the staff at the new facility so a lot of the unknowns were minimized. On the other hand, I also moved to another facility out of state and pretty much walked into an unknown from a staffing standpoint except for what little I could glean from the interview. As I noted in my previous post, be very judicious when using the phrase, "this is how we did it." I've had new employees who would say this at every opportunity and then go into detail about how we were either doing it wrong and that their way was just much better. This became very trying to everyone else on the staff and we finally just tuned them out. Because of that we probably did miss out on some good ideas. One last point, in either case be aware of any others staff who may have either applied for the position or simply been over looked. Depending on their personality they can either be a great help or a significant hinderance. Do everything you can to get them involved and engaged. They can be your greatest asset but it may take a little extra work on your part. For me, the personnel issues were always the most difficult. I'm assuming that you are new to the lead position and not knowing your previous experience here a couple of generalizations. Unless something is an obvious hazard to either patients, staff or the ability to pass an impending inspection/assessment don't be in a big hurry to make changes. As they say in the military, you need to understand the lay of the land. Become familiar with the blood bank/transfusion service medical director and let them have the chance to become familiar with and confident in you. They can and should be your greatest allies. Ultimately most of what you want to change will have to be approved by them. You need to understand the current processes before trying to change them. At one of the facilities I moved to I noticed that many of the staff were not following their procedures "to the letter". The way I dealt with this was at the monthly staff meeting we would go through a procedure as a group, line by line and I would ask the questions, "Is this how you are really doing it? If not, why not and how are you actually doing it?" This is when I would make suggestions for changes and generally a lively discussion would ensue. It took quite awhile to go through the procedure manual but by picking, what I considered the most important one first it was time well spent. This is getting a little long so I'll end with how I described my position as Transfusion Service Supervisor at a 350 bed level ll trauma center. My job was to provide the staff with the tools (equipment, knowledge, material and support) for them to do their jobs at the highest level possible. All this while keeping the dragons (administration) away from the door. Good luck and if I can think and anything else that others may miss I share a few more golden nuggets of wisdom with you. Above all else have faith in your self. Wow I think that's the longest post I've ever made.

To this I will add, pick your battles carefully. Make sure they are worth fighting. If you came from outside the facility be very judicious when using the phrase, "The way we did it"! Changing something to the way you did it else where is not necessarily a change for the better just because it makes you comfortable. Make sure you understand your new facility's processes before trying to incorporate sweeping changes. As I noted above, much of my advise would depend on if you came from outside or promoted from within. This is just one golden nugget for you to consider.

First question, were you promoted from within the organization or did you come in from the outside? Believe it or not it can make a significant difference n how successful you will be. I've experienced both in my career. After I see your response I'll provide my very wise advise. Rest assured you will find it worth every penny it will cost you.

I find it surprising that there have been no new members in 2 months. I don't remember there being a week go by without someone new coming on board. Hope it wasn't something I said!