Latest laughable BB scenario

[RR1]

Hi Lekota40,

You seem to have followed the correct channels, the only remaining thing to do is to document any discrepancies - such as the panel problems, if possible write this on the panel sheet itself and keep a copy.

Regarding the processing of one sample at a time.you could always arrange a meeting with your colleagues to see if this is causing them problems too, and then collectively write a formal letter to your senior management about any concerns. Request (nicely!) a written response from them.

During the last 18mths I have also had personal communication from other lab folk about line managers/ senior staff not listening to their techs concerns- it can be a very stressful situation and unpleasant working in that environment.

It's good you can relieve some of your stress on this site, but this won't help you back at work. Try and chill out there - after all, like the rest of us, you spend most of your day at work . People make bad judgements-even managers!

Just do what you can and document anything that you can't.

[BSIPHERD]

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.

Your original posting and the panels you posted led to a valuable and interesting discussion. So I guess you could still have posted that and say there were differing opinions in your lab and ask for others input. I sympathize with your problem and it makes me feel lucky that I work with a great team of people where there is open discussion of problems.

[GilTphoto]

Our hospital has only 1 Blood Bank tech per shift. The first and second shifts average about 15-20 patients per shift. We could never survive only doing one at a time. I usually do 5 at a time (sometimes more). We label all the tubes with patient's initials. Pipet all reagents first into all tubes. Then pipet the patient sample, spin, read, and report, one patient at a time. The antibody screens and XM are all done together after incubation.

Last year administration sent a consultant in to evaluate our staffing. Our staff was cut by 10 FTE's for the entire lab, which was more than a 20% cut. They recommended the second shift Blood Banker also do Micro. While administration has been pushing it, our Lab Manager has resisted (thank god).

[Malcolm Needs ☆]

Of course, this solution may be seen as a little extreme, but aren't guns legal in the USA........................

:plotting:

[irshadaad]

these are rules writen by those who never touch a sample on the bench,spend time in a room with computer in front and keep on scratch in the computer ,so outcome is they always think of new rules they forget about the work load and how its done practically.....................like in our scenario....we are 2techs usualy on crossmatch bench...on one hand do cord blood samples and type and screen mix with crossmatching both emergency and routine and face the antibodies if present do penal ,screen blood for sicklers and other antibody positive pts....write results in work sheets enter them in the computer, recieve vague phone calls from various units of the hospital ,we feed 450 bed hospital with at least 4-5 open heart surgeries done everyday,,,, imagin the sceane when cardiac surgery falls into panic due to heavey bleeding of pt in cOR.we thaw ffp,cryo, cross-match blood...issue it enter it in the computer.........and besides recieve request from other wards too especialy OBG .,there are times we stand 10 hours in a 12 hrs duty shift....and our supervisor sits in the office making schdule for oncoming tree months .arranging vacations for the coming year...and @10 am runs for tea break @1:30 runs for lunch break @4pm is the 1st one to leave the department...and on the notice board writes note...ON CALL.....that we have to call in her house and ask permission if we will issue certain blood ..where pt has antibodies.................on the door of the office there is a nitice ...that as per AABB #1 boss is always right #2 if the boss is wrong refer to #1.. ...HOW CAN YOU EXPECT SOMETHING PRACTICAL FROM SUCH OFFICERS.....

Edited August 13, 2009 by irshadaad

[RR1]

I would like to suggest that your Quality incident system (or whatever you call it) is the correct place for you to lodge complaints about working practices. If the system is run properly, every problem will be transparent - there needs to be openness and good communication within the lab culture.

The QI system data will also give a good indication of areas within the lab that are suffering due to inadequate staffing- and could help prevent staff cuts and even be quoted in a business case to improve staff levels.

We have probably all worked at some stage with a poor manager, but some of us have been privileged to have had a very good one that has nurtured and developed us over the years. Just because a manager sits behind a desk paper shuffling- doesn't mean they are not doing anything valuable, even some mundane jobs such as making rotas need to be done. Planning improvements is an on-going process as is sorting paperwork for regulatory issues, stats, training .

I would be very surprised if most managers just had a 9-5 working day, quite a few probably work long days, late evenings, weekends and during holidays.

Regarding the one sample at a time business- I suggest folk check out the SHOT reports over the last 6yrs. www.SHOTuk.org

[Malcolm Needs ☆]

"but some of us have been privileged to have had a very good one that has nurtured and developed us over the years."

You know, it's very nice of you to say this Rashmi, but I really can't recall you ever having worked for me!

;)

Edited August 13, 2009 by Malcolm Needs

[John C. Staley]

Of course, this solution may be seen as a little extreme, but aren't guns legal in the USA........................

:plotting:

I left my previous position just prior to resorting to your suggestion!!!!

[Malcolm Needs ☆]

i left my previous position just prior to resorting to your suggestion!!!!

love it!!!!!!!!!!!!!!!

:d:d:d:d

Edited August 13, 2009 by Malcolm Needs

[RR1]

:cool:

"but some of us have been privileged to have had a very good one that has nurtured and developed us over the years."

You know, it's very nice of you to say this Rashmi, but I really can't recall you ever having worked for me!

;)

Cheeky xxxxer !!!!!!!

[Malcolm Needs ☆]

:cool:

Cheeky xxxxer !!!!!!!

moi?

:shocked:

[TimOz]

An interesting a philosophical post.

I want to add a comment that it is important to regard each lab and situation as quite different and I agree with Rashmi that you should critically examine you testing policy and put in a thoughtful Risk Assessment and also seek other external points of view (maybe an external audit).

What is a good and safe practice in one lab may be terribly dangerous in another and a lot of this can be put down to the "soft" issues like ergonomics and work environment. I have seen labs that run on a day to day basis in a constant state of chaos. Poor lab set up, no lab space, poorly set up work stations, noise, phones going off, staff interupted........you get the point. Other labs are spacious, have great workstations and equipment. I may have even seen a lab once with adaquate numbers of well trained staff - but that could have been in a dream.

So Lekota40, from your original post it seems like the management have announced an edict that has profound effects on work practices without consideration or support. This may sound simplistic, but at face value I would think a lab that worked on one patient at a time would be great BUT you would need to have more staff to enact this without sacrificing patient care due to delays in testing. I bet the change was made without due consideration of workflow and staffing levels.

Can you use the system that imposed the rules to improve things? I know from my experiences with HR that they will not yield positive results (is that diplomatic?). They have different drivers and are not there to improve patient care. Most HR people I have seen are there to reduce staff costs but I have seen some fine exceptions. One thing is for sure, they won't understand patient safety and technical aspects of lab workflow. You need an external technical review and a solid risk analysis by someone who knows what they are doing and has credibility and clout. I don't know where you are, but we in the antinpodes can achieve this fairly easily. We have a group called NATA down there who accredit labs and carry a big stick. They can and have shut down dangerour or non-compliant labs. They can and do have a very positive effect on providing detailed technical and impromed reviews of lab practices, quality and safe operation. Do you access to such a service?

Edited August 13, 2009 by TimOz

[LaraT23]

My two cents:

I constantly question the validity and reason behind policies. I make people justify their decisions based on scientific fact or an actual occurence, issue. When I train my techs if they are new, I do tell them to be cautious about working on more than one at a time. but, in essence it is their repsponsibility and their name is going on those specimens. If they demonstrate that they are able to do more than one at a time, then fine. I don't really micromanage that. We do not have a policy prohibiting doing more than one. I am currently working on three ( incubating at present).

We recently instituted a review system whereby new policies, procedures and placed in a review binder for everyone to make notes on or have thoughts on for one week following proposal. The supervisor than takes in to consideration each person's input. If the tech is adamant, I make an appointment with them to discuss their concerns and explain why are are doing things the new way. It works well for us, and I have changed a fefw things based on what my techs say. That all being said, the super has the last word, afterall. It is our butts in a sling. Have you tried asking for a meeting with the lab director, this woman and yourself?

OH, and to Malcoms post, yes guns are legal in the us and here in Texas are kind of required equipment for each citizen!

[bday]

When I trained, oh so many years ago, the rules were one patient at a time. We even had racks that could only hold the tubes needed for one patient at a time. As I began working in the real world, it has been as many as 15 at a time. I know the chances of mix ups increase when you increase the amount of samples that you work on, but if you follow the rules - identifying the sample with patient demographics on worksheets or computers, and the spin, read, record, the chances are few. When the JCAHO recommendation came out, we looked at it, but realistically, no hospital system can afford that many techs in a blood bank to meet that recommendation - if you can, bless your lucky stars, cause I certainly cannot!

[donellda]

If we worked on one patient at a time we would never get anything done and we would have the trauma surgeons all over our case (not that they aren't anyway). Our lab director once asked if we should do that. I did not answer her (coming from a tech that entered 203 results yesterday).

[eric1980]

I love this topic.

I myself worked under a 9-years-of blood-banking-experience-of-following-the-SOPs supervisor which resulted in my recent resignation.

In the past, the work is quite lean, and after the change of leadership, more and more steps (under the name of safety) appeared due to mistakes (including isolated mistakes which were never seen before, and not expected after) and this resulted in more deviation from the rules and so, of course, more and more mistakes were documented.

To all (would-be)supervisors, PLEASE ADD MORE STEPS CAUTIOUSLY!!! BE PRUDENT!!!

Adding more traffic lights (safety) along a straight road (our work) will either lead to ultimate frustrations of the drivers (the techs), or provoke some drivers to beat the red light (deviations from protocol). This will result in either some drivers' licenses being revoked (termination of employment), or loss of human lives (patients' lives).

At the end of the day, everyone loses.

Regarding the topic originator's case, as well as a couple of our participants' who were not happy with the leadership of their supervisors: If this is how the supervisors work, it already shows something about those supervisors! Therefore, if the forum participant follows the "proper channel" to bring up what's right to the management, it either spell the end of the career of the tech, and/or the supervisor will attempt to do even more wrong things in a bid to prove his/her competency (or the lack of).

At the end of the day, everyone loses as well.