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Inappropriate Override by a Manager

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About two and a half years ago, I received a promotion to CLS Coordinator of Transfusion Services for my hospital. I applied for this job while we also had an opening for manager. I did not apply for the manager job. My job description essentially states that I assure the quality plan is followed. I have come to Pathlabtalk many times since then for guidance on various topics. I have not signed up or commented until now. The manager job at my hospital was open for a year and we finally got someone to take the job from another area location. There were no internal applicants. From the beginning, it has not gone well. For one thing, he spent a good amount of time in his office playing games on his phone. After a year and a half, I complained to his boss. It is the first time I have ever done this. As a consequence, I know that he was written up and he apologized to all of us for not being a good manager.

Before I get to my problem today, I want to give a little background. One of the things I do is review all issue overrides. In March of this year, I found one that the manager had approved that appeared inappropriate. I investigated and my conclusion was that a patient had received emergency release type specific blood without a current type. I asked the tech that had done the issuing and he said, he had thought the type was done. When he received the override factor, he thought it was referring to the screen not being done and asked for the override. He said he realized very quickly that this was not the case. I asked him if he had told the manager and he said yes.  Though I think the manager should have investigated more before approving the override, I could see how the manager might make this mistake. However, he ignored it, did no investigation and did not report it to the FDA. I asked him twice to report it to the FDA and he did not. I included this detail in my complaint about him as I thought it showed both his carelessness and dishonesty. It was finally reported to the FDA about two and a half months after the fact.

Which gets me to my current problem. Once again, I was reviewing issue overrides. I reviewed one for late September approved by the manager that appeared inappropriate. My investigation concluded that a known A patient had been issued 2 O plasma's. I confirmed with our pathologist that he had not and would not have approved the issue.  The manager was off the day I did the review and I asked him the next day about it. He said "Yeah, that guy was weird." I struggle to think what would cause a patient to be weird enough to receive the wrong type.  This was the first issue for an MTP. Our policy is to give 6 O RBCs and 4 A plasma's. Subsequent issues will be the patient's type or a compatible type. This patient was issued 4 A plasma's and 2 O plasma's, I asked the tech whose ID is on the issue and she said she doesn't remember it but thinks it's possible he grabbed them out of the fridge and handed them to her and she didn't question it because he is the manager. She also said that she no longer knows what we are supposed to be doing in these circumstances since the communication has been so bad. The patient was transfused one of the O's and one was returned.

Once again, the manager has not mentioned it again and apparently thinks there is not going to be an investigation. 

I do have information that he was once let go as a tech at another local hospital for falsifying QC records. I can't imagine that we would hire someone to be manager who was once terminated as a tech so I suspect this was a you're free to leave effective immediately situation without an official termination.

I'm not even sure what question I'm asking here and I may just be venting. I guess I'm just looking for a little guidance from the experts on how to proceed. I intend to wait approximately one week to give him time to do an investigation if he intends to and then inform the Lab Manager. I know he has no intention of doing so but I don't want him to use that as an excuse and I think that is an appropriate amount of time to show that he was not going to do anything. Beyond that, I'm not sure.  Any thoughts?

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Dear Misty, so much happening!   Does this person have training records?  Competency?  Does your facility have an institutional patient safety reporting?  However, I think this goes well beyond that.  It is a patient safety issue and would recommend you take your documentation to his manager.  This seems like reckless behavior, which in the event management world should become an HR issue.

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The issuing tech should have questioned the "O" plasma even though it was her boss.  Without pathology approval (at our facility) we cannot give inappropriate units knowingly.  I'm interested in what the pathologist is saying because at least at our facility, the pathologist is ultimately responsible. The "boss" at the very least should be counseled and or written up personally if this is the second blunder perhaps he should be gone.  The issuing tech should at the very least receive a verbal warning.  all my opinions..

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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.

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Thanks for your replies. 

As for the first question - does he have training and competency records? That is actually what he got written up for. We received a citation from AABB in September 2018 for incomplete training records, namely his. After 8 months, he had made no progress on getting these completed and was written up for it. I don't think this would have happened without my complaint. After finally completing his training records, I asked if he was given any expectation for competencies whether it be now or 6 months from now and he said he didn't know. I don't believe he's completed any of his competencies yet.

Yes, we have Risk Management that patient safety incidents get reported to. I intend to get this reported to the FDA but hadn't thought of that. I will definitely file a report with risk management. I reported it to the pathologist and he is concerned about it. He wants to have a meeting about it. He is fairly new. He completed his residency in 2016 and we are his first job. He is very bright and cares a lot but probably isn't experienced enough to know a bad manager when he sees one. He wants to discuss a process to get something signed by him at the time of issue. Unfortunately, I hurt my back last weekend and have only been able to work limited hours this week. I still need to write up a report and I am going to report this to my manager's manager. 

As for reporting of Biological Product Deviations, I have not reported any myself but report to him any that I find. He is supposed to do the investigation, any counseling, and the actual report.  We had a new night tech who had issues. He had 1 FDA reportable event which was a failure to issue a product in the computer which I knew was reported. The tech had a second one and I went to the tech and told him that he had another FDA reportable event. He said to me "What is that? What does that mean? Am I in trouble?" So I knew that although, the event had been reported, the tech had not even been told this happened, let alone counselled on it. I pulled a copy of the report to FDA and it stated that the tech had been counselled. I reported this and the one I found earlier this year to his manager. For this example I just gave you, I felt this was falsifying records. For the original one I posted here, I felt that he had not investigated and reported it because he thought no one would ever find out. 

As for our techs, days and evenings are all Blood Bank only. Night shift are generalists. Our BBIS is Safetrace and both times supervisory overrides were required by the software. Both times overrides were done by him inappropriately. I can't do any discipline of techs myself. Only he can.

Here's something else that happened shortly before I found this override. I attended AABB and took lots of notes. Me, the manager and our pathologist meet once a week and the pathologist asked if I had anything I wanted to discuss from AABB. I discussed a topic on internal audits and had written several things down that I thought we should implement. While discussing this, I said something I thought was funny that one of the speakers said and my manager interrupted me and asked me if I had told her she was a b---- . Not sure what the policy on cursing is here but you can fill in the blanks.  I was taken aback by this. I met with him later and I was supposed to discuss my goals for the coming year. I told him I hadn't written any, that I was considering resigning my position. I don't feel I have any path to success currently. Everything I suggest is ignored and never mentioned again. He can't be bothered to communicate with me about things I need to know.  I told him that I was very offended by what he had said about the AABB speaker. He said he was sorry and doesn't know why he says the things he does. We discussed ways to improve communication between us. He said he forgets things all the time and is kind of dumb (his words, not mine) I felt I had to make the attempt for the benefit of all the techs. I don't trust him and I don't think this is a memory problem. I think his comment speaks to his attitude that I have been feeling all along. He wants to be the big shot with his own office and the big desk and refer to Blood Bank as my crew and I'm the old lady ruining his fun. (I'm not that old but I'm older than him.) Even though he apologized, I am considering reporting this to his manager as well. Am I overreacting? I don't know. I thought it was unprofessional, rude and a little strange.


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You are not overreacting.  You are being responsible, which is what all healthcare workers need to be.

Other than discussing all of this with your department administrative director (your manager's manager -- maybe you have done this already -- at our hospital, this is at the department director level), I am not sure there is much else you can do within your department.  You mentioned talking to the FDA and your risk management department. 

Your hospital should also have a corporate compliance fallback for things like this (that cannot be resolved through management -- you can report anonymously if you desire)  For corporate compliance issues, the business must respond to your concerns and report back to you within a limited amount of time. 

Good luck.


Edited by SMILLER
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If you feel that you are not being heard or appropriate action is not being taken you have the option of reporting to your accrediting agency AABB, CAP, TJC. This can also be done anonymously. The agency will contact the lab for information/investigation.

If patient safety is being put at risk then you need to do everything you can to get these situations addressed which it sounds like you are doing.

The other thing I would highly recommend is that you keep written/hard copy documentation of everything. You may need it sometime in the future to have proof of your diligence in trying to force compliance. Always remember the old adage "If it's not in writing, it never happened"

Good luck

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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!  

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