Staff Reading SOPs

[RR1]

[quote=Malcolm Needs;22078

That having been said, the onus is still on the trainee to make the effort to read and understand the document, and if no such effort is made, we have the option of disciplinary action.

It is one thing to make the effort, and yet still not understand it, or not be confident to perform the task; it is quite another not to make the effort in the first place.

:([/quote

When I discuss this with folk (qualified staff) at work the answer is usually they are not given dedicated time to read the documents. Does anyone give protected time on a regular basis to staff for this task, or do you expect them to manage within normal working hours?

[Malcolm Needs ☆]

My staff have protected time.

:D

[RR1]

My staff have protected time.

:D

From you or to read the SOPs?????

[Malcolm Needs ☆]

From you or to read the SOPs?????

Touche!

Mind you, I am deeply, deeply wounded!

No, to read the SOPs (and other documents). I also try to give them protected time to read journals and papers for their CPD, but am less successful at that (the trouble is hospitals, such as ****** keep sending us samples with nothing in, but we still have to run them)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:tongue::tongue::tongue::tongue::tongue:

[jcoburn]

First off: It is impossible to make ANYTHING foolproof, because fools are so ingenius!

That said, all you can do is document on annual competencies that the staff member attests to the fact that they have read and understand the SOP's. I find that including an index of the manuals, with a space to initial as each one is reviewed will work, but you still have to keep up the documentation.

If you do stumble upon a "foolproof" way, please let me know.

[RR1]

Touche!

Mind you, I am deeply, deeply wounded!

No, to read the SOPs (and other documents). I also try to give them protected time to read journals and papers for their CPD, but am less successful at that (the trouble is hospitals, such as ****** keep sending us samples with nothing in, but we still have to run them)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:tongue::tongue::tongue::tongue::tongue:

You know I don't really mean it!!!!!!

So how much time do you give them....careful with this- I might check up!

Regarding the samples with nothing in them....do you mean you didn't detect it?????????????. What do we pay all that money for!!!:tongue:

[Malcolm Needs ☆]

You know I don't really mean it!!!!!!

So how much time do you give them....careful with this- I might check up!

Regarding the samples with nothing in them....do you mean you didn't detect it?????????????. What do we pay all that money for!!!:tongue:

a) You do - but I don't care!

I'm not sure, because this is handled by Doris Lam (my excellent deputy), but I do know they all get time.

c) NO. I mean there were no atypical alloantibodies present (by a multitude of techniques, except super glue), and the money spent on us doing this is wasted!!!!!!!!!!!!!!!!!!!!!!!

:D:D:D:D

Edited December 22, 2009 by Malcolm Needs

[tlorme]

Does anyone have a foolproof way to get their staff to read all relevant SOPs and policies?

Thanks!

Nothing is 'foolproof', but.....Annual SOP review is tied to our Performance Review tool. I give the techs 2 months to review and sign-off on policy review each year. Anyone who has not completed by the deadline receives a zero for that category in their annual performance review. Last year was the first year that I had techs not complete on-time and I reflected this in their performance. This year everyone completed ahead of schedule. Apparently $ is a motivator

[adiescast]

a) You do - but I don't care!

I'm not sure, because this is handled by Doris Lam (my excellent deputy), but I do know they all get time.

c) NO. I mean there were no atypical alloantibodies present (by a multitude of techniques, except super glue), and the money spent on us doing this is wasted!!!!!!!!!!!!!!!!!!!!!!!

:D:D:D:D

In reference to c: we also experience this to the point that I tell the hospitals that are part of our system not to interpret their results in the computer because they will end up having to correct the record, which is a major pain. With outside hospitals, we have had samples sent in which we detected nothing by multiple methods, sent them crossmatch compatible blood appropriately tagged for the patients, and they turned around and said when they re-crossmatched the blood that it was incompatible! If I know they have used tube method, I usually very gently ask when they last cleaned their cell washer . Since we do not use column agglutination technology (I know, we are behind the times, but we really aren't a reference lab...), we have had tiny hospitals that do use it tell us that when they re-crossmatched the unit it was incompatible by CAT. For those clients, I suggest that they either cease re-crossmatching or send it to a real reference lab.

[Malcolm Needs ☆]

In reference to c: we also experience this to the point that I tell the hospitals that are part of our system not to interpret their results in the computer because they will end up having to correct the record, which is a major pain. With outside hospitals, we have had samples sent in which we detected nothing by multiple methods, sent them crossmatch compatible blood appropriately tagged for the patients, and they turned around and said when they re-crossmatched the blood that it was incompatible! If I know they have used tube method, I usually very gently ask when they last cleaned their cell washer . Since we do not use column agglutination technology (I know, we are behind the times, but we really aren't a reference lab...), we have had tiny hospitals that do use it tell us that when they re-crossmatched the unit it was incompatible by CAT. For those clients, I suggest that they either cease re-crossmatching or send it to a real reference lab.

That really annoys me too!

If we've cross-matched, we take responsibility for the cross-match in law. If the units are incompatible and do the patient harm, then we take the wrap. For what on Earth are the hospitals re-cross-matching, when they sent the samples to us in the first place because they didn't have the reagents (and, in some cases, the know-how) to do it themselves in the first place????????!!!!!!!!!!!!!!!!!

:angered::angered:

[Mary**]

:rolleyes:Not all reference labs in the US take the respnsibility for the crossmatch. They feel it is the hospital's decision to call it compatible or incompatible.

[Malcolm Needs ☆]

:rolleyes:Not all reference labs in the US take the respnsibility for the crossmatch. They feel it is the hospital's decision to call it compatible or incompatible.

I must confess I didn't know that, but then how do they decide what blood to transfuse to a WAIHA patient, with a strong panagglutinin? Surely, the Reference Laboratory must cross-match in such cases and the Hospitals go with that result?

:confused::confused:

[Mary**]

Yes, they do the crossmatching at the Reference Lab, but defer to the hospitals. Because they do that, I feel that we must repeat it.

[Malcolm Needs ☆]

Yes, they do the crossmatching at the Reference Lab, but defer to the hospitals. Because they do that, I feel that we must repeat it.

Fair comment Mary**, but what happens if there is an impasse (e.g. the Reference Laboratory says the units are suitable for the patient after cross-matching, but the Hospital Laboratory doesn't think they are suitable)? Is the transfusion not delayed unreasonably?

:confused::confused:

[adiescast]

I don't see how a reference lab could do a crossmatch and then defer the interpretation to the hospital lab. That makes no sense at all and I don't think it would hold up in a court of law. I do know that when our blood center does an antibody ID (they only perform simple IDs), they do not crossmatch the blood. They send antigen negative blood to the client for crossmatching. If the antibody ID is complex, they send the whole thing to us and we perform crossmatching as part of the workup. The difference is that they (the blood center) do not have transfusion services as part of their scope of work, whereas we do. They make no claim to performing crossmatching at all.

[Malcolm Needs ☆]

I don't see how a reference lab could do a crossmatch and then defer the interpretation to the hospital lab. That makes no sense at all and I don't think it would hold up in a court of law. I do know that when our blood center does an antibody ID (they only perform simple IDs), they do not crossmatch the blood. They send antigen negative blood to the client for crossmatching. If the antibody ID is complex, they send the whole thing to us and we perform crossmatching as part of the workup. The difference is that they (the blood center) do not have transfusion services as part of their scope of work, whereas we do. They make no claim to performing crossmatching at all.

Good Lord, if the Reference Service of the NHSBT in the UK could not/would not do cross-matching in really difficult cases, we would have Blood Bank Managers and Pathologists battering down the door to throttle us (actually, that's probably the only reason we do it - self preservation - ask Rashmi - she'd be first in line to string me up)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:eek::eek::eek:

[Steven Jeff]

Malcom needs little support from me in his discusions on this forum, however, the support from the reference laboratories within the UK Blood Transfusion service is vital for the hospital laboratory. Most hospital laboratories within the UK refer all the most difficult antibody and incompatibility problems (and some simple ones too) to the Blood transfusion reference laboratories and consider them the experts and we do like to challenge them. In my lab we would not even think of resolving a WAIHA case, but would send it to Malcolms laboratory and expect his team to provide crossmatched blood for the patient. We would NOT repeat the crossmatch in the hospital laboratory, it would be issued as being crossmatched by the NBS reference laboratory. Malcolm is right we would be banging on his door if they didn't provide this service.!!!!!!!

However, I must say that in my short time as being a registered member of BloodBankTalk how fascinating it has been to read all the different posts from around the world and the different approaches to the management of the provision of blood components to the patient. In general the serological techniques used for blood transfusion are very similar.

The apparent differences in importance/responsibility of the Blood transfusion services from one country to another raises another question for me. The UK transfusion service guarantee's the labelling of the Red cells issued to the hospitals i.e. if labelled A Rh(D) negative then it is A Rh(D) negative, we do not check the donor unit in the hospital laboratory. Is this the same in other countries?

I thank all contributors for making this such an interesting and educational forum and you are all so friendly and approachable. I am sure you are right Rashmi they don't always pick up the antibodies we pick up in the hospital laboratory!!! (just jokimg Malcolm) and as for stringing Malcolm up, sounds a bit ike bondage to me!!!

Steven Jeff

:):)

[RR1]

Good Lord, if the Reference Service of the NHSBT in the UK could not/would not do cross-matching in really difficult cases, we would have Blood Bank Managers and Pathologists battering down the door to throttle us (actually, that's probably the only reason we do it - self preservation - ask Rashmi - she'd be first in line to string me up)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:eek::eek::eek:

Absolutely!!, .....but we do appreciate all the hard work from you folk really!

[adiescast]

Malcom needs little support from me in his discusions on this forum, however, the support from the reference laboratories within the UK Blood Transfusion service is vital for the hospital laboratory. Most hospital laboratories within the UK refer all the most difficult antibody and incompatibility problems (and some simple ones too) to the Blood transfusion reference laboratories and consider them the experts and we do like to challenge them. In my lab we would not even think of resolving a WAIHA case, but would send it to Malcolms laboratory and expect his team to provide crossmatched blood for the patient. We would NOT repeat the crossmatch in the hospital laboratory, it would be issued as being crossmatched by the NBS reference laboratory. Malcolm is right we would be banging on his door if they didn't provide this service.!!!!!!!

However, I must say that in my short time as being a registered member of BloodBankTalk how fascinating it has been to read all the different posts from around the world and the different approaches to the management of the provision of blood components to the patient. In general the serological techniques used for blood transfusion are very similar.

The apparent differences in importance/responsibility of the Blood transfusion services from one country to another raises another question for me. The UK transfusion service guarantee's the labelling of the Red cells issued to the hospitals i.e. if labelled A Rh(D) negative then it is A Rh(D) negative, we do not check the donor unit in the hospital laboratory. Is this the same in other countries?

I thank all contributors for making this such an interesting and educational forum and you are all so friendly and approachable. I am sure you are right Rashmi they don't always pick up the antibodies we pick up in the hospital laboratory!!! (just jokimg Malcolm) and as for stringing Malcolm up, sounds a bit ike bondage to me!!!

Steven Jeff

:):)

I always knew we were an earthy lot.

The AABB standard 5.12 requires serological confirmation of the donor ABO type on all red cell units and Rh type on Rh negative units (immediate spin only, not weak D) from an integrally attached segment. Standard 5.12.1 states that any discrepancies must be reported to the collecting facility and resolved before issue. These two standards are in a section titled "Transfusion Service Related Activities." So the answer for any facility assessed by AABB is that we do check the donor type in the hospital laboratory.

I started to say we do this in the US, but AABB has expanded internationally, so the requirement is also out there for facilities in other countries.

[Steven Jeff]

Hi adiescast

Are your reference laboratories located with your donation and testing facilities?

Steve Jeff

[Marilyn Plett]

Given the adversarial legal system in the US and AABB regulations, I understand why a reference lab would not want the responsibility of saying a unit of blood is compatible or incompatible. The scope of work performed by the laboratory is generally defined in a contract. Our reference lab does compatibility testing for health care facilities that have signed contracts specifically outlining each party's responsibilities. As I understand it, the AABB has said that if you do compatibility testing you are a transfusion service. If you are a transfusion service, there are a lot more questions that the inspector will ask: transfusion reaction workups, transfusion committees, physician oversight, transfusion criteria, etc. The lab which does compatibility testing must also report a transfusion-associated fatality to the FDA. A reference lab would be reluctant to take on those responsibilities for another hospital.

[Eagle Eye]

same as adiescast. Our reference lab do not crossmatch for us. They do Ab ID and give us antigen negative blood and it is our responsibility to crossmatch.

[Malcolm Needs ☆]

As I understand it, the AABB has said that if you do compatibility testing you are a transfusion service. If you are a transfusion service, there are a lot more questions that the inspector will ask: transfusion reaction workups, transfusion committees, physician oversight, transfusion criteria, etc. The lab which does compatibility testing must also report a transfusion-associated fatality to the FDA. A reference lab would be reluctant to take on those responsibilities for another hospital.

Sadly Marilyn, all of this does apply to us, which is probably why our inspections are so traumatic.

:(

[adiescast]

Hi adiescast

Are your reference laboratories located with your donation and testing facilities?

Steve Jeff

Are you referring to my facility or US facilities in general? My facility is a hospital transfusion service and does not draw any donors. We do reference work for other hospitals that are clients of our blood center, but we are not officially an immunohematology reference lab (no SCARF, unfortunately )

Most of the US immunohematology reference labs are in donor centers, but some of the large university hospitals also have reference labs along with their transfusion services. I guess the reference labs have sprung up where the resources were available. We tend to develop things rather randomly over here. :cool:

[Steven Jeff]

It is a general request really, just trying to get a handle on the differences between the two countries which you have gone some way to explain. The UK is very different with the likes of Rashmi and myself very much hospital based relying on the expertise and skills, dare I say it of reference laboratories like Malcolm's. However, the working relationships between the Hospital laboratories and the Transfsuion centre laboratories is very close and professional. In London and the south east corner of the UK (my local patch) we have the opportunity to meet each other at quarterly Technical Advisory Group meetings and discuss items of mutual interest. In other words we know each other very well and professionally we support each other. The threat of litigation does not appear to hang over our heads in the same way that it does elsewhere. That said mistakes though negligence by the BMS would not be acceptable.

Steve

:redface: