competency test

[nsfirm]

what is supposed to be tested?

just asked to give a test for the staff competency test, and just don't know where to start...

clue, anyone?

nova

[SMILLER]

Nova

As a matter of fact, we just had a Lab JCAHO inspection and found that regulations for competency documentation is way beyond what we would consider adequate. See this link for some details:

http://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFAQId=331&StandardsFAQChapterId=99

We are wondering if the JCAHO committee that came up with this stuff ever actually worked in a Lab!

Scott

[jayinsat]

Nova

As a matter of fact, we just had a Lab JCAHO inspection and found that regulations for competency documentation is way beyond what we would consider adequate. See this link for some details:

http://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFAQId=331&StandardsFAQChapterId=99

We are wondering if the JCAHO committee that came up with this stuff ever actually worked in a Lab!

Scott

This is one of those requirements that I believe is vital. When you work in a lab full of generalists who only rotate in Blood Bank once or twice a week, competency becomes important. This is especially so if the techs are not experienced.

An example of a good competency would be Emergency Release of blood and blood products. You could develop a test scenario where an emergency transfusion was required, visibly watch the tech go through the process of emergency releasing the right product, and properly documenting with whatever release you use and in your LIS. At my lab, we had a patient who needed emergency FFP due to coumadin overdose. The tech, not being strong in blood bank, thawed and emergency released 2 units of type O FFP. The tech never checked histories, was not aware of the patients blood type and erroneously believed O was the universal donor for all products. The patient who received the FFP was group B. The patient expired from unrelated multisystem organ failure that was pre-existing, however, this was an FDA reportable error non-the-less. An implace competency could have identified this flawed thinking and corrected it before a patient was adversly affected.

That is the purpose of a competency program anyway; to ensure techs are competent in tasks they are expected to perform, even the rare ones. I believe most tasks competencies should be measured by direct observance. Any process failures should be corrected on the spot, documented and filed.

There's my 2 cents.

[dgibaud]

If you're a CAP accredited lab not only do you have to apply the 6 fundamentals of competency testing, you must apply them accross all "systems" in place. That is, you need to measure the 6 fundamentals for crossmatching, antibody screening and ID's, ABO/Rh typings, elutions, etc etc. In chemistry, you can do competency testing on all tests performed on one instrument, but you also need to have the 6 fundamentals checked for each different instrument, or system, used in the performance of a techs' normal job. Needless to say this means much more documentation to get it all done.

[jeanne.wall]

Nova

As a matter of fact, we just had a Lab JCAHO inspection and found that regulations for competency documentation is way beyond what we would consider adequate. See this link for some details: ......

Scott

Scott - it looks like the CLIA requirements "spruced up" into Joint Commission talk. Jeanne

[KKidd]

To meet Joint Commision requirements we have a competency documentation form that is used in each department. It includes direct observations, supervisory reviews of the tech's work ,Direct observation of PM, proficiency testing, and written test.

Each year the techs get a written test that covers the Quality plan, computer operation, specimen /component handling, maintenance, patient testing and anything else I may have noticed. I am already working on 2013. When I notice a weakness, major change in protocol or we have an unusual situation, it is incorporated in the next year's competency.

Of course, there may be specific competencies during the year.

:sneeze: (the pollen is killing me!)

[SMILLER]

This is one of those requirements that I believe is vital. When you work in a lab full of generalists who only rotate in Blood Bank once or twice a week, competency becomes important. This is especially so if the techs are not experienced.

An example of a good competency would be Emergency Release of blood and blood products. You could develop a test scenario where an emergency transfusion was required, visibly watch the tech go through the process of emergency releasing the right product, and properly documenting with whatever release you use and in your LIS. At my lab, we had a patient who needed emergency FFP due to coumadin overdose. The tech, not being strong in blood bank, thawed and emergency released 2 units of type O FFP. The tech never checked histories, was not aware of the patients blood type and erroneously believed O was the universal donor for all products. The patient who received the FFP was group B. The patient expired from unrelated multisystem organ failure that was pre-existing, however, this was an FDA reportable error non-the-less. An implace competency could have identified this flawed thinking and corrected it before a patient was adversly affected.

That is the purpose of a competency program anyway; to ensure techs are competent in tasks they are expected to perform, even the rare ones. I believe most tasks competencies should be measured by direct observance. Any process failures should be corrected on the spot, documented and filed.

There's my 2 cents.

I get all that, but I really do not think that requiring an observer once a year to document that an associate: does QC related to releasing a FFP, does maintenance related to releasing a FFP, does a "blind" related to releasing FFP, performs a "test" related to releasing FFP, releases results related to releasing a FFP, and a written test related to releasing FFP: will not guarentee that an associate who does not work in Blood Bank often will be competent when they try to actually release a unit of FFP months down the line.

If someone is not proficient in an area, I agree that observation and/or testing is needed to ensure they are competent when they need to be. This is something that management needs to be aware of, but no amount of documentation, by itself, is going to guarentee anything. I think this may be another case where a massive amount of documantation may give a false sense of security. We shouldn't be so superficial with competencies.

These blanket requirements for comeptencies are draconian. Managers will be spending a hige amount of time documenting that the regs are followed, when they should be more concerned with how associates are doing in each area on a regular basis.

At least, that's what I think. We will, of course, comply with the regs as written.

[jayinsat]

I get all that, but I really do not think that requiring an observer once a year to document that an associate: does QC related to releasing a FFP, does maintenance related to releasing a FFP, does a "blind" related to releasing FFP, performs a "test" related to releasing FFP, releases results related to releasing a FFP, and a written test related to releasing FFP: will not guarentee that an associate who does not work in Blood Bank often will be competent when they try to actually release a unit of FFP months down the line.

If someone is not proficient in an area, I agree that observation and/or testing is needed to ensure they are competent when they need to be. This is something that management needs to be aware of, but no amount of documentation, by itself, is going to guarentee anything. I think this may be another case where a massive amount of documantation may give a false sense of security. We shouldn't be so superficial with competencies.

These blanket requirements for comeptencies are draconian. Managers will be spending a hige amount of time documenting that the regs are followed, when they should be more concerned with how associates are doing in each area on a regular basis.

At least, that's what I think. We will, of course, comply with the regs as written.

I certainly don't disagree with you. Seems like an overcomplication of what should be a simple evaluation tool.

[Eagle Eye]

I agree with you regarding requiring competancy for all techs working in blood bank.

In addition to requiring competancy, you can always look to your process to see if you can streamline or improve your process. I do not know if you have the computer system or all is on paper. If you are computarized you can set up your tables as such that system will not allow you to dispense O FFP to patients are not non O. Same way you system should only allow AB FFP to patient who doesn't have prior record. AB FFP can be issued to all blood type.

[Malcolm Needs ☆]

Apologies, but I'm not sure that I entirely agree with your reasoning here aakupaku.

Giving group O FFP to a non-group O receipient can be a life-saver in extremis, and so should be allowed by your computer (albeit, there should be many warnings before it is allowed); giving red cells of an incompatible ABO group would be a killer, and should never be allowed.

[jayinsat]

I agree with you regarding requiring competancy for all techs working in blood bank.

In addition to requiring competancy, you can always look to your process to see if you can streamline or improve your process. I do not know if you have the computer system or all is on paper. If you are computarized you can set up your tables as such that system will not allow you to dispense O FFP to patients are not non O. Same way you system should only allow AB FFP to patient who doesn't have prior record. AB FFP can be issued to all blood type.

Our LIS (MEDITECH) is set up that way. In fact, that's how the error was caught by me the next day! The tech emergency issued the FFP on the emergency release paperwork manually. By the time he got around to doing it in the computer, the unit was completely transfused. The warnings he received is what made him realize his error. I quized a few other techs and found out they erroneously believed you give group O FFP in emergency release situations.:cries:

That's my issue. This tech only works every other weekend. We never see him unless he comes in for annual eval or TB testing once or twice/year. I am not the super but I'm the one who catches all the errors. I don't make the decisions. I have asked several times for regular competencies and continuing education but am always told it's "overkill" :mad::mad:

Enough venting. My point is I think it's important to somehow evaluate and verify competency. Not to satisfy regulators but to ensure our patients are safe. If we approach it that way, I believe we will satisfy our regulators.

[Eagle Eye]

Our system stops tech from issuing O FFP to non O patient. We have a policy(if possible with approval) that you can give A FFP to AB patient in emergency/or for the patient without blood type and there is no time to thaw AB FFP. And this transaction is done manually and we hardly need to use this once a year or less. Our docs are trained to make sure they draw and send specimen to us ASAP. So patient's blood type is available right away. I do not see a case where we would need to use O FFP.......Disaster situations are different!!!!!!!

Apologies, but I'm not sure that I entirely agree with your reasoning here aakupaku.

Giving group O FFP to a non-group O receipient can be a life-saver in extremis, and so should be allowed by your computer (albeit, there should be many warnings before it is allowed); giving red cells of an incompatible ABO group would be a killer, and should never be allowed.

[Eagle Eye]

How about you post a simple chart on freezer showing group type compatibility chart!!!!

[Eagle Eye]

Malcom on this one we have to agree on our disagreement!!!!!!!:tongue:

Apologies, but I'm not sure that I entirely agree with your reasoning here aakupaku.

Giving group O FFP to a non-group O receipient can be a life-saver in extremis, and so should be allowed by your computer (albeit, there should be many warnings before it is allowed); giving red cells of an incompatible ABO group would be a killer, and should never be allowed.

[Malcolm Needs ☆]

Okay aakupaku, but what are you going to give in extremis (and I do mean in extremis) if you only have group O FFP left in your freezer - you surely have to give something?

[Eagle Eye]

OK fine Malcom agree!!!!!!!!!!!! BUT...........

How often that will happen??? Thats when the inventory management comes in place....I am not talking about disaster situation!!! I am at level I trauma center, we had a case where we almost ran out AB FFP (only 10 left) and the bleeder was AB...and yes I was panicking.....and patient bacame stable and we had (thank GOD!!!!) enough time to get more AB FFP. But we had enough A, B FFP in stock...and we were trying to get more AB FFP.....That's when our medical director takes decision.....

[RL0121]

An example of a good competency would be Emergency Release of blood and blood products. You could develop a test scenario where an emergency transfusion was required, visibly watch the tech go through the process of emergency releasing the right product, and properly documenting with whatever release you use and in your LIS. At my lab, we had a patient who needed emergency FFP due to coumadin overdose. The tech, not being strong in blood bank, thawed and emergency released 2 units of type O FFP. The tech never checked histories, was not aware of the patients blood type and erroneously believed O was the universal donor for all products. The patient who received the FFP was group B. The patient expired from unrelated multisystem organ failure that was pre-existing, however, this was an FDA reportable error non-the-less. An implace competency could have identified this flawed thinking and corrected it before a patient was adversly affected.

That is the purpose of a competency program anyway; to ensure techs are competent in tasks they are expected to perform, even the rare ones. I believe most tasks competencies should be measured by direct observance. Any process failures should be corrected on the spot, documented and filed.

I'm in the process of developing a competency testing/evaluation for the Emergency Release of Blood Products. This is supposed to be a 6 month goal I need to accomplish. I have to perform a mock drill for all our BB'ers and evaluate all of them as to how they respond to the situation. We don't do this often and I want them to be comfortable if they have to deal with the real situation. Do you have any scenarios and evaluation tool I can use that you would like to share? or anyone? Thanks.

[Malcolm Needs ☆]

OK fine Malcom agree!!!!!!!!!!!! BUT...........

How often that will happen??? Thats when the inventory management comes in place....I am not talking about disaster situation!!! I am at level I trauma center, we had a case where we almost ran out AB FFP (only 10 left) and the bleeder was AB...and yes I was panicking.....and patient bacame stable and we had (thank GOD!!!!) enough time to get more AB FFP. But we had enough A, B FFP in stock...and we were trying to get more AB FFP.....That's when our medical director takes decision.....

Now there I would agree with you - it would occur once in a blue moon - if that often, but, if your computer system makes it absolutely impossible for you to issue group O FFP in such an unlikely situation (as opposed to extremely difficult), you, and more to the point, the patient, would be in deep trouble.

That's all I'm saying - it should not be impossible - just very difficult.

[jayinsat]

How about you post a simple chart on freezer showing group type compatibility chart!!!!

We have a chart. People don't look at charts, SOP's or other reference material when they are in a panic with a nurse asking for uncrossmatched blood. They tend to go with what they know (or don't know). That's my issue. All the safeguards were in place but they circumvented them. The computer was not used, it was issued on paper. The chart is on 3 walls and the freezer door where they pulled the FFP from. Didn't see it!

That's why we must measure competency and correct errant thought and behavior.

[Eagle Eye]

We have 0% tolerance for not issuing unit in computer system (unless system is down). It took as almost >1 year & several error reports to get to where we are now. We had only one case in last two year where the tech did not use computer to issue blood. No patient harm but we still take it very seriously and take disclipanary actions so it doesn't happen again and we will regret it.

I inform my staff that the computer flags are there for a reason. and computer system is there for a reason!!!

[jayinsat]

We have 0% tolerance for not issuing unit in computer system (unless system is down). It took as almost >1 year & several error reports to get to where we are now. We had only one case in last two year where the tech did not use computer to issue blood. No patient harm but we still take it very seriously and take disclipanary actions so it doesn't happen again and we will regret it.

I inform my staff that the computer flags are there for a reason. and computer system is there for a reason!!!

If I were in charge, that's how it would be here as well.

[marvy1]

A little off topic...but with the given scenario of a coumadin overdose, we would have not issued FFP but gave Octaplex or Beriplex or some other Prothrombin Complex Concentrate. Extremely effective at bringing the INR down for coumadin od patients.

[Mabel Adams]

I would like to resurrect this thread and see if anyone would share a competency record document that meets Joint Commission requirements, makes you feel like you can tell if your workers are competent but is as efficient as possible in accomplishing all of this without an outrageous time committment.

Our AABB assessor suggested that we had more items on our competency form than necessary, implying that we can lump antibody screen, ID and maybe DAT into "antibody detection" but she isn't able to "tell us what to do" so she didn't give me any specifics. Any good examples out there?