Latest laughable BB scenario

[Lekota40]

Well after all the "isssues" of the past couple of weeks of daring to challenge the powers that be that seem to think they are better than me just cause they are my supervisors the latest is that we are now only supposed to work on one patient at a time. I'm like seriously??? and in what reality??? This is of course coming from someone once again that sits in her office all day and pretends to know blood banking. Supposedly we will "confuse" patients by working on more than one at a time.

Of course I have to deal with 6 plus at a time at my other job and the phone and people coming for blood and gee on weekends even another whole department. So yeah I can only handle 1 patient at a time.

[Malcolm Needs ☆]

These people live in another world I am sure!

Edited August 11, 2009 by Malcolm Needs
Guess what - SPELLING AGAIN!

[RR1]

Well after all the "isssues" of the past couple of weeks of daring to challenge the powers that be that seem to think they are better than me just cause they are my supervisors the latest is that we are now only supposed to work on one patient at a time. I'm like seriously??? and in what reality??? This is of course coming from someone once again that sits in her office all day and pretends to know blood banking. Supposedly we will "confuse" patients by working on more than one at a time.

Of course I have to deal with 6 plus at a time at my other job and the phone and people coming for blood and gee on weekends even another whole department. So yeah I can only handle 1 patient at a time.

It is very easy to mix samples when working with more than one request. Over the years many of us have been involved in sorting the consequences caused by multi-tasking in these critical areas- it isn't pleasant. Anyone, regardless of their experience can make these errors, so it's not impossible your supervisor is trying to help you and not just being difficult.

I agree that working on one sample at a time would be very time-consuming, but does the supervisor actually mean one at a time from start to result input and blood issue or is this setting one sample up and while incubating set the next sample, the main thing being not to work on more than one patient in the initial setting up period?

[Lekota40]

Here's the scenario. I work both at a blood center which serves as a reference lab to smaller hospitals primarily for antibody IDs and also at a trauma center which is a constant unknown as far as how much multitasking you need to do in order to provide the best patient care in blood bank. I agree in that being human we can make mistakes but I'm sure all of us do multiple checks, even while rushed to ensure accuracy knowing someone can die if we ***** up. The superior that made this 1 patient at a time rule works as the technical director of the blood center. She has book knowledge and no hands on knowledge past when she got her SBB over a year ago. She always has to look up questions she receives or ask one of us. She hasnt worked in a hospital environment in probably 5 years or more. Therefore her attempting to dictate how we should perform bench work when she cant and doesnt is ludicrous.

This is the same person who refused to disagree with my supervisor on an incorrect antibody ID I questioned cause she doesnt have the knowledge to recognize that gee the supervisor could be incorrect. She basically agreed with her logic cause she is inept at looking at what's there and analyzing it. How does someone get in this position one might ask-lots of smoozing and you know what kissing and appearing to know what they are doing to those that dont know the difference.

Anyone reading this may think I appear bitter and jealous but that is not the case. I pride myself on turning out good results because I care for the patient and I also dont want to lose my license based on turning out something wrong cause my superiors tell me to.

[L106]

Actually, Lekota40, working on only one patient at a time was something that was a "recommendation" 3 or 4 years ago. JCAHO (Joint Commission for the Accreditation of Healthcare Organizations) recommended in a bulletin titled "Sentinel Event ALERT", dated 8/30/1999, as a means to prevent blood transfusion errors. (Honest! I pulled the bulletin out of my files just now.) The bulletin also suggested revising the staffing model to prevent errors. (I'm not sure what they were smoking when they wrote this.) They also recommended no blood refrigerators in the surgery suites, but that didn't go over too big either.

Actually, the article does have several reasonable and worthwhile suggestions (better/unique patient identification systems, enhanced computer support, etc.) (I'm not sure whether you can pull up this bulletin on JCAHO's website since it's so old.)

But if your supervisor said "This is the new policy," then you are obligated to adhere to the institution's policy. (I'm assuming the new rule was for all techs, not just you, right?) If this really is the policy and you continue to do multiple patients at once, God forbid is there is ever an error/problem that involves your work, because you could be hung out to dry. If the "one pt at a time" rule causes certain work to be undonet or prolonged turn-around time, then the supervisor is going to have to answer for it.

Edited August 11, 2009 by L106

[Malcolm Needs ☆]

Many of the samples my staff work on have extremely strong auto-antibodies.

They require an initial antibody investigation, multiple differential alloadsorptions, followed by three more panels (one for each adsorption cell) and sometimes extra cells if the panels are inconclusive, and then, often a cross-match. This lot, on average, takes about five hours.

We average about 25 samples a day (not all of them are that complicated to work on) with, at best, 5 staff at the bench. On average, each of them has two of these complicated samples a day.

If they worked on one sample at a time, I calculate that many of the patients would die of old age before we could get the results out. Yes, you do have to be VERY careful about identification, etc, but one at a time.

Utterly preposterous and totally impractical!

:mad::mad::mad:

Edited August 11, 2009 by Malcolm Needs
Missed out a word!

[RR1]

The wording of working on 'one sample at a time' is the issue. Not so many years ago some of us would have no hesitation in setting up a rack of IAT test for crossmatching and screening that would be upto 12 or more tubes (approx 3-4 patients), in fact, it used to be a challenge to see how many requests you could clear by testing a large batch. Hey- I was probably the worst offender!

This is no longer acceptable practice. We all know mistakes can happen when you are processing more than one sample at a time. This doesn't mean you have to start and finish the full test before you begin the next sample (at least not in my books), just that the set up is comprised of one patient and then you stagger the set up of the next patient- very much like a conveyor belt.

[L106]

Oh, I totally agree with you, Malcolm. What a luxury it would be to work on one patient at a time. (In my dreams!)

[L106]

Whether you set 3 or 4 pts up at once, or stagger them like a conveyor belt, or put each patient in a separate rack, etc..........It all boils down to whether you are organized, consistent, and concentrate on what you are doing. I'm not convinced that any one method is better or worse than another.

[clmergen]

Our policy is that you can only have one specimen open at a time and that you check patient identification on the specimen and in the computer at that time.

For tube testing, I would stagger my patients but have only one patient on my work rack at a time. My first patient's screen would incubate about 20 minutes and my 4th patients would incubate 10 minutes. I could finish 4 Type and Screens in good time and not feel like I had compromised patient care.

I would definitely get clarification on what is considered "one patient at a time".

I am so glad we installed automation. Now it really isn't an issue. They are all being done at the same time.

[Malcolm Needs ☆]

The wording of working on 'one sample at a time' is the issue. Not so many years ago some of us would have no hesitation in setting up a rack of IAT test for crossmatching and screening that would be upto 12 or more tubes (approx 3-4 patients), in fact, it used to be a challenge to see how many requests you could clear by testing a large batch. Hey- I was probably the worst offender!

This is no longer acceptable practice. We all know mistakes can happen when you are processing more than one sample at a time. This doesn't mean you have to start and finish the full test before you begin the next sample (at least not in my books), just that the set up is comprised of one patient and then you stagger the set up of the next patient- very much like a conveyor belt.

Yes Rashmi, I know what you mean and know what you are talking about - and it is still utterly preposterous and impracticable.

When you are performing differential adsorptions on a sample, you have to perform three full panels at the end of the process - that's a minimum of 30 indirect antiglobulin tests. Sometimes these have to be hand washed to keep them warm. Even if you stagger these, and I have NO idea how you could do this, you could STILL only get through one patient's sample a working day. This is not the kind of serology you can load on to a grouping machine and walk away. It is intensive, hands on.

I repeat, patients would die of old age, or worse, die from lack of blood, or, worst of all, be given blood as an emergency without testing, because we wouldn't be able to perform the proper testing in time.

Mind you, I could always leave your hospital's samples until we've finished all the others, if that is what you want!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:rolleyes::rolleyes:

[Malcolm Needs ☆]

Our policy is that you can only have one specimen open at a time and that you check patient identification on the specimen and in the computer at that time.

For tube testing, I would stagger my patients but have only one patient on my work rack at a time. My first patient's screen would incubate about 20 minutes and my 4th patients would incubate 10 minutes. I could finish 4 Type and Screens in good time and not feel like I had compromised patient care.

I would definitely get clarification on what is considered "one patient at a time".

I am so glad we installed automation. Now it really isn't an issue. They are all being done at the same time.

I would not argue for a single second about the idea of having one sample open at a time.

That is quite a different matter.

[RR1]

I agree L106 that it does boil down to concentration, however by having a process as described by clmergen you are reducing the risk of errors. I have seen very methodical and experienced folk make errors, primarily due to working on more than one open sample at the same time.

[RR1]

Yes Rashmi, I know what you mean and know what you are talking about - and it is still utterly preposterous and impracticable.

When you are performing differential adsorptions on a sample, you have to perform three full panels at the end of the process - that's a minimum of 30 indirect antiglobulin tests. Sometimes these have to be hand washed to keep them warm. Even if you stagger these, and I have NO idea how you could do this, you could STILL only get through one patient's sample a working day. This is not the kind of serology you can load on to a grouping machine and walk away. It is intensive, hands on.

I repeat, patients would die of old age, or worse, die from lack of blood, or, worst of all, be given blood as an emergency without testing, because we wouldn't be able to perform the proper testing in time.

Mind you, I could always leave your hospital's samples until we've finished all the others, if that is what you want!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:rolleyes::rolleyes:

I don't think that practices and pressures in a reference lab are always comparable to a hospital blood bank setting. If you are happy for your staff to handle multiple samples -that's not a problem, but you need to risk assess this.

[Malcolm Needs ☆]

I don't think that practices and pressures in a reference lab are always comparable to a hospital blood bank setting. If you are happy for your staff to handle multiple samples -that's not a problem, but you need to risk assess this.

Ture, there are not so many samples, but they are all complicated, otherwise the hospitals shouldn't have sent them to us in the first place, so what we lose in numbers, we gain in difficulty, and some of them are urgent, such as the trauma victim I worked on on Saturday with a positive DAT, whilst working on another patient with symptomatic anaemia and a positive DAT. SHould I have chosen which one to work on first?

We risk assess each time we do the work, and always have.

[RR1]

Hi Malcolm,

I know some of us think about the risks each time we work-but there still needs to be a formal risk assessment written on these practices- and i'm sure your dept has one, and if not- maybe time to write one?

Edited August 11, 2009 by RR1

[Ann Viernes]

In the past, The Joint Commission (TJC) usually didn't visit the labs or blood bank if they were accredited by CAP or AABB. However with their new tracer methodology, the patient's service activity will usually lead one or more members of the TJC inspection team to the lab or blood bank. Three years ago (yes we are up for a visit any day now) the inspection traced a patient to the blood bank and we were asked if we allow work on only one patient at a time. Of course in a very active transfusion service with 100-200 type and screens a day and only 2-3 techs on the type and screen bench per shift, most techs work on more than one patient at a time. We were then asked to describe and show the SOP for patient identification and avoidance of mix ups. Techs were then observed by the inspectors on whether they followed these procedures. The inspectors were satisfied with our response. If you are going to work on more than one patient at a time, be advised to have well written and followed SOPs on patient ID and prevention of mixups, down to the detail of how you label your tubes, gel card, micro wells or whatever you use in testing.

Bit of advice to the originator of this thread: if you have issues with your superiors you should address them, then getting nowhere, request a meeting with this person's superior or with an employee relations person in HR. Don't air them in a public forum. You can tactfully get the advice of your peers on this forum without bashing your superiors.

[tbostock]

Difficult to do one patient at a time in a very busy transfusion service and not compromise patient care. I've always trained new staff in the BB how to process multiple samples. How to set them up in your rack (alphabetically front to back...yes, I am that neurotic). Then, one at a time, load up all the gel cards for the ab screen and get them all incubating. Then put reagents in all the tubes for the blood typing. Then, one at a time, put the patient cells and plasma in the tubes, spin, read, document, and discard them before touching the next patient. They are not allowed to centrifuge two blood types at the same time. So, essentially, turn around time is not compromised, but the blood types are being performed "one at a time", carefully and methodically, to prevent errors. I also tell them to "get in the zone" when reading their blood type and resulting it; when shaking and reading your tubes, you do NOTHING else. Don't talk, don't answer a phone, don't even acknowledge someone walking into the room. Your patient deserves your undivided attention for that 10 seconds.

[Malcolm Needs ☆]

Bit of advice to the originator of this thread: if you have issues with your superiors you should address them, then getting nowhere, request a meeting with this person's superior or with an employee relations person in HR. Don't air them in a public forum. You can tactfully get the advice of your peers on this forum without bashing your superiors.

[Lekota40]

I have addressed issues with my superiors with HR etc it has got me nowhere. So why do I continue to work there you may ask? I do because I like what I do and do believe I do it well and jobs as a Med Tech where I live are limited and I cant move. The "bashing" as you call it in a public forum is a serious stress reliever and since I do not and will not mention names I'm not really harming anyone. I am I guess attempting to point out the fact that those in charge of us are NOT always the best qualitfied. It would be nice to have to take some sort of test to qualify and have unbiased HR personal but real world is that doesnt happen.

[Mary**]

:bonk:As Dilbert once put it, "Leadership is nature's way of removing morons from the productive flow". I saw that in the Canadian Blood Bank newsletter Traq. Since I am a supervisor/bench tech, I guess that includes me!

[Malcolm Needs ☆]

:bonk:As Dilbert once put it, "Leadership is nature's way of removing morons from the productive flow". I saw that in the Canadian Blood Bank newsletter Traq. Since I am a supervisor/bench tech, I guess that includes me!

Tee-hee!

You and me both Mary!

Love the quote.

[clmergen]

It may be serious stress reliever but under the hospital system that I work for it is grounds for disciplinary action. They jsut released an internet posting policy and it specifically covers this. If you can be identified by someone, you could be held accountable even if you don't use a name.

[L106]

:bonk:As Dilbert once put it, "Leadership is nature's way of removing morons from the productive flow". I saw that in the Canadian Blood Bank newsletter Traq. Since I am a supervisor/bench tech, I guess that includes me!

Love it!!! !:tongue:

[Lekota40]

cimergen and anne that commented on my venting on this forum about my superiors I thank you for your coments and concerns. I will refrain from doing so in the future. What would you recommend as an alternative? Not trying to be coy here looking for serious constructive criticism. I really have had a bad time lately with my job as have coworkers working under the management we have and anytime we attempt to address it with HR or others over them we are dismissed as it being "our" problem and attitude. Understandably that could be an arguent tor management if one 1 or so people were complaining but when pretty much everyone in a department does that to me shows something should be addressed. I have been in supervision so I know that end of the scope and I at least attempted to listen to people and admit when I was wrong.