MT Scope of practice

[bmarotto]

Our BB techs perform therapeutic apheresis (TAP) and HPC collections. It has been that way for over 25 years. Back when I started, it seemed it was maybe 60% RN and 40% tech so I was not concerned. My most recent survey has shown it is almost universally an RN duty. My staff has expresssed concern about having to deal with sicker patients and more reactions. They have been called to the recovery room to plasma exchange patients having immediate acute renal or liver transplant rejection. In addition to the common citrate and vasovagal reactions, they have had two cases of TRALI, several cardiac arrythmias, and an MI. In reviewing hospital policies, I have found that only RNs are allowed to (1) access central lines, (2) infuse IV fluids, and (3) administer any form of medication. BB techs may perform each of these tasks during plasma exchange. I also learned that only pharmacy can "compound" meds. We often have to add Calcium Gluconate to replacement fluid and we add heparin to ACD-A for HPC collections. OK, so we are working with pharmacy to have them do the compounding. Since my techs are on record as being uncomfortable dealing with patients and questioning whether they should even be allowed to perform therapeutic apheresis, I consulted with someone from Quality & Safety. Her opinion is to bring this to Professional Affairs for a ruling. She said I will be asked if therapeutic apheresis is within the scope of practice of a medical technologist. I can not find anything to support this. I have come to agree that these procedures should not be performed by technologists but our lab director (not the BB director) does not feel the same way. My techs are willing to work through a transition period but if Professional Affairs feels it is too big a liability we may not be given the option to work through a transition.

Does anyone have any suggestions on how to deal with this dilemma? What are your thoughts on the scope of practice of a MT? I know I learned nothing about pheresis in MT school (but that was ages ago). In SBB school, it was pretty much limited to donor collections. Even then, we were not allowed to perform any TAP procedures because RNs did it, and that was in 1980.

[David Saikin]

In the past, my BB techs performed platelet pheresis. Obtaining the instrument also allowed our hospital to do plasma exchanges. This procedure fell under the purview of Critical Carel. Though the CCRNs were trained to operate the device, the procedures were too few and far between for them to retain competency. My techs would operate the device BUT the RNs and the CC Medical Director were in charge of replacement fluids, etc. This was a viable option for our institution . . . the techs were never alone with any of these patients and only rand the machine. I would hazard a guess that your lab director realizes that there are big bucks associated with these procedures and probably wants to garnish them for the lab.

[bmarotto]

David,

You are absolutely correct about the revenue being a driving force for wanting it to stay in the Blood Bank.

In your case, were patients admitted to a critical care unit for each procedure, even outpatients? Was a CC RN and/or MD required to be in the room durng the procedure?

[David Saikin]

The CCRNs were always with the patient;, who was admitted to that service (or consulted). The CCMD usually made an appearance, but tended to drift in and out during the procedure.

[bmarotto]

Thanks David. You wrote in the past tense. Was this your experience at a previous job? I would be interested in learning if the practice has changed or remains as you describe.

[David Saikin]

It was my previous employer (1992).

[TStec]

I wonder if the ASCP certification for HP would help with your MT situation. This specialist certification much like SBB would demonstrate advanced knowledge for apheresis. I would contact ACSP because the last I knew they did not have enough interest in the HP exam. You could also contact ASFA (American Society for Apheresis) at apheresis.org where experts in the field may be able to answer your question.

[bmarotto]

The HP exam is no longer offered from what I see on the ASCP website. Even when it was, I doubt my techs would have qualified. It required two years of FT apheresis experience. I have 7 techs who perform between 20-40 procedures each per year. The exam covered all aspects of apheresis and my techs do not perform any donor procedures. I did call ASCP the other day and was put through to someone's voicemail. No one has called me back yet.

[heathervaught]

If you want to define the scope of practice for a MT, then I would recommend contacting a university that offers a degree in Clinical Laboratory Science and getting a copy of their cirriculum. I know that the university that I attended has a lot of information online at http://pathology.iupui.edu/body.cfm?id=6360 ... but there seems to be a formatting issue, so some information has been lost. If you have a close relationship with a university, you may be able to get an official list of Course Objectives for each program, which would further reinforce that MTs are not trained in the three areas that you mentioned (accessing central lines, administering IV fluids and medications)

My program director also had a breakdown of the scope of the ASCP exam, and what topics are covered. That would be further evidence that MT certification does not automatically qualify someone to perform therapeutic apheresis.

[bmarotto]

Thanks Heather. Last week, I left a message for the program director at the university we get our students from. I have not heard back from her yet. She may be busy with the end of the school year coming up. I think I will try to get something from ASCP that shows what is covered in the MT exam.