Dr. Pepper

Wholeheartedly agreed! Here's what I posted on a similar thread earlier this year:
"For decades we hired only MTs, but have had to hire a few MLTs over the last couple of years due to MT shortages. I find the quality of work varies not from the number of college courses they took but the innate ability, initiative and interest of the worker. We train equally and job responsibilities are equal (although the MTLs cannot do some things, like review results etc).
I had a MLT generalist on last weekend. He had a patient who got 4 units of blood the week before who now presented with anti-c and a positive DAT, weak mixed field. Pretty classic delayed reaction, except that the eluate reacted with all the panel cells. DAT was negative the week before. He dug into it and tested some more c-negative cells and found that there was also anti-Fya and -Jkb in the eluate (but not in the plasma yet). En route he tested the eluate with ficin-treated cells and PeG and ficin-treated some additional ones himself to help untangle the specificities. I did give him some phone coaching along the way, but it was an excellent job of blood banking. "Just" a MLT, but he really digs BB."
 

You are a blood banker - you have the guts.  Just present the changes you are requesting in a logical, professional way.  I always found the biggest hurdle was the staff and "we've always done it this way" mentality.  If you explain your "why's" it may make change go smoother.

Wholeheartedly agreed! Here's what I posted on a similar thread earlier this year:
"For decades we hired only MTs, but have had to hire a few MLTs over the last couple of years due to MT shortages. I find the quality of work varies not from the number of college courses they took but the innate ability, initiative and interest of the worker. We train equally and job responsibilities are equal (although the MTLs cannot do some things, like review results etc).
I had a MLT generalist on last weekend. He had a patient who got 4 units of blood the week before who now presented with anti-c and a positive DAT, weak mixed field. Pretty classic delayed reaction, except that the eluate reacted with all the panel cells. DAT was negative the week before. He dug into it and tested some more c-negative cells and found that there was also anti-Fya and -Jkb in the eluate (but not in the plasma yet). En route he tested the eluate with ficin-treated cells and PeG and ficin-treated some additional ones himself to help untangle the specificities. I did give him some phone coaching along the way, but it was an excellent job of blood banking. "Just" a MLT, but he really digs BB."
 

With all due respect to the AABB Technical Manual and the "Standards", a unit cannot "contain" the corresponding antigen!  A unit can "express" the corresponding antigen, but it cannot "contain" the corresponding antigen.  After all, red cell antigens are "expressed" on the surface of the red cell membrane (even those, such as Ch, Rg and Lewis, that are adsorbed on to the surface from the plasma are still "expressed" on the surface of the red cell membrane), and antibodies sensitise these surface antigens, rather than being absorbed into the cytosol of the red cell and sensitise red cell antigens "contained" in the red cells of the units.
 
One would have hoped that such a eminent organisation would have got that correct!!!!!!!!!!!!!!!!
 

Diatribe on Shall vs Must
 
1. "Shall" has three strikes against it.
First, lawyers regularly misuse it to mean something other than "has a duty to." It has become so corrupted by misuse that it has no firm meaning.
Second—and related to the first—it breeds litigation. There are 76 pages in "Words and Phrases" (a legal reference) that summarize hundreds of cases interpreting "shall."
Third, nobody uses "shall" in common speech. It's one more example of unnecessary lawyer talk. Nobody says, "You shall finish the project in a week."
For all these reasons, "must" is a better choice, and the change has already started to take place. The new Federal Rules of Appellate Procedure, for instance, use "must," not "shall."
Prof. Joe Kimble, Thomas Cooley Law School

Over this side of the pond, an MT would be the equivalent of a HCPC Registered Biomedical Scientist.  BELIEVE ME when I say that I have come across some of these who have become our equivalent of your MT's, and not only stopped studying, but have regressed, and are a damned sight more dangerous than some people who work in transfusion, but have never taken such exams (our equivalent of your MLT's).

Being a new blood bank supervisor can be a real trial by fire especially depending on how good of a ship your predecessors kept. (the following is not all inclusive and is definitely my opinion only)
You should review each blood bank procedure/policy/form. Are they in line with blood bank regulations and generally accepted practice standards? Does practice match policy? Are you well versed in your blood bank's accreditation manual? If not, become so and/or work closely with your quality assurance team. Are you well versed in the hospital accreditation manual to where it applies to blood bank? If not, same as before.
Get familiar with laboratory/hospital procedure/policies/protocols and how they intertwine with the blood bank. 
Develop a relationship with your medical director/sectional medical director. They will be a huge resource for getting things done.
If you use an LIS, review the entire blood bank dictionary (tests, products, antibodies, antigens, billing codes, etc). If you have CPOE, review every blood bank order.
Carefully review recent occurrence reports (nonconforming events, incident reports, sentinel events, whatever your institution calls them) for compliance/patient safety issues. If you don't have a good occurrence reporting system, work towards developing one. Promote a just culture.
Be prepared to revise basically anything and everything. Be prepared for resistance from your technologists, even if what you're doing is what the rest of the world has been doing for years and/or is a federal mandate.

Wholeheartedly agreed! Here's what I posted on a similar thread earlier this year:
"For decades we hired only MTs, but have had to hire a few MLTs over the last couple of years due to MT shortages. I find the quality of work varies not from the number of college courses they took but the innate ability, initiative and interest of the worker. We train equally and job responsibilities are equal (although the MTLs cannot do some things, like review results etc).
I had a MLT generalist on last weekend. He had a patient who got 4 units of blood the week before who now presented with anti-c and a positive DAT, weak mixed field. Pretty classic delayed reaction, except that the eluate reacted with all the panel cells. DAT was negative the week before. He dug into it and tested some more c-negative cells and found that there was also anti-Fya and -Jkb in the eluate (but not in the plasma yet). En route he tested the eluate with ficin-treated cells and PeG and ficin-treated some additional ones himself to help untangle the specificities. I did give him some phone coaching along the way, but it was an excellent job of blood banking. "Just" a MLT, but he really digs BB."
 

There's the key right there. The easy things to do are the ones you have total control over. The difficult ones are when they involve other areas.....

That is exactly what I was hoping to hear Linda !  
 
Thank you so much for sharing your experience with us.   I will definitely be putting in a request to go next year.  

Good Morning-
I have attended the UBS course,  and have found it extremely valuable. I am a blood bank manager and we do NOT have either a TSO position in our hospital, nor have we a formal blood management program.
I used the knowledge I gained to empower transfusion committee to push for several blood management strategies to be implemented, and our organization is realizing great benefits since I attended the class in Sep 2014.
We have reduced transfusions by over 50% and are still realizing continued reductions 14 months later. We are predominantly orthopedics based, and after a presentation to our arthroplasty group this past fall, we are in the process of writing/publishing our process improvement project as best practices in orthopedics.
The class was comprised of~50% each RN's and Blood Bank supervisors/managers, and there were sessions included to help each background learn/understand each other's roles and what they bring to a TSO position. The rest of the class is very good as well---highly technical and indepth in many subjects despite the actual brevity of the full course. Strong BB, donor collection, and quality tools is helpful as the course does help push you to the next level.
My belief is the best background for the TSO'---IF the basis of your program is to also advocate for strong blood management processes to be employed, can be either professional background as long as they are set to colloborate well between BB and various medical disciplines, because without their buy in, the benefits of a trememdous amount of hard work that needs to be put in, may wind up being minimal/unsustainable.
Just one colleagues journey--hope it helps and if anyone has more questions on the course or how I used the lessons learned, I'm happy to try to help!

They drew the line at me making nametags for their foreheads.

Until the next day, when it's back to where you started.

Our old Jewett refrig came with these mounting strips on the shelves in which you could insert a paper label "Unprocessed" etc. The strips were held on by an adhesive which gave up the ghost after a decade or so. Now I have labels from a Dymo label printer (they have very cool ones which work from your PC - my favorite lab toy) that I stick directly on the ends of the shelves. If you remove the shelf and let it warm up and/or wipe any moisture off and quickly apply your label they stick pretty well. Mine have been on for a couple of years and still are in good shape. The labels peel off pretty easily too.

Whenever I review panels I look for patients with at least a 1+ antibody and grab all the old lab specs from other depts I can lay my hands on. I pool the serum/plasma and aliquot in 1-2 ml samples and freeze. They seem to keep their reactivity well at -28o. If they're weak you can always do a little demo on differences in sensitivity between LISS, PEG, enzyme, gel etc.
I agree about the monoclonal reagents; if I use them I warn the students to just cross out and look for the specificities and that the human-source ones don't react like that.
Quotient offers free or cheap deals on expired antisera for student use.

Aside from the CAP titer survey I really don't do anything else.  Never been a problem with inspections.

The concentration of the maternal alloantibody is actually higher in the baby's circulation than in the mother's circulation, as the transfer of the antibody across the placenta is active, rather than passive (see Mollison), and so, if the DAT is positive, but there is no detectable antibody in the maternal circulation at birth, then it may be worthwhile identifying the specificity from an eluate from the baby's red cells - the positive DAT may just be ABO antibody, after all.  If there is no specificity, other than ABO, then I would quite happily give c+ blood to the baby, rather than hang about waiting for c- blood, when there is absolutely no reason so to do, other then a "vague worry".  Even if the baby was a female, and c-, I still wouldn't worry about giving c+ blood because, as I said above, the baby is unable to make anti-c at this stage.

They drew the line at me making nametags for their foreheads.

The other thing you have to remember is that the charges are not for the blood itself, but for the processing needed to provide the blood.  These charges are the same regardless of how much of the unit is actually administered.

Yes Amy. If they receive any amount of a unit the charge goes through. Keep in mind that hardly anyone pays out of their pocket for anything anyway.
Phil

Isn't it interesting how the simplest things can thrill us so much?  The Velcro idea is really something you can get stuck on!

We use Velcro shelf labels.  For the part that gets stuck to the fridge / freezer, we use Gorilla glue.

Until the next day, when it's back to where you started.

Folks,
You're falling behind the times. (Malcom you're in the clear in the UK)  The commentary published in last March in Transfusion has snowballed at every meeting since. AABB, ARC, ABC, Armed Services Blood Program , CAP, and Am College of Ob/Gyn(ACOG) have all come to terms on a recommended workflow for managing any D typing that does not conform to a clear D+.
The AABB meeting in Anaheim was loaded with Technical and Scientific presentations to push this agenda. ACOG has devoted an issue of their journal to educate the docs most affected by the change in reporting. (Glory Halelujah)  Even the CMS reimbursement and coding was thoroughly discussed. Which is the crux of the matter for those of us working in hospitals. Sure we'd love to know which weak D patient was Type I, 2 or 3 so we could save our RhIg & D- units but at what cost to our operating budget?
This is the time for us to take control of a change we won't be able to avoid forever. There is a licensed product on the market but it isn't a perfect fit for what we need now. We need to push back at the manufacturers(tell any sales rep that tries to push molecular testing) We need to tell them we'll look at this IF they design the product we need to identify D genotypes and make it cost effective. Otherwise it would cost us way too much in training, equipment, proficiency and competency programs to manage full genotyping which we don't need. And for some of the smaller hospitals that might use it once or twice a month, totally negates any saving they would see in RhIg and D- blood.
If the Powers that Be are pushing this agenda and they do not want serologic weak D testing reinstated, then they need to get with the program and support our concerns. Otherwise D typing will remain the muddled mess on a seesaw that it has been for the last 40yrs.
Just my opinion
 

Until the next day, when it's back to where you started.