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Bit of a rant....


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Auntie and others, we share your pain. If I may add to the list of pet peeves:   1. Starting weekly temperature discs on fridge/freezers on the wrong day and/or time. Then 5 days in a row 5 different

I think I will get away from the venting,(although venting can be very important to ones sanity at times) because although we have a few issues (generally minor, like not checking pending logs when th

it seems to me that there is a trend in healthcare in general, ofr less and less appriopriate oversight.  In the Lab, we have here a few managers, but there time is spent with HR duties and other admi

I am going to have to join in on DOGLOVERS comments....

 

I must first admit that I have also seen many of these different errors occur; whether they were intentional or simply over-looked by accident is another question altogether.  Observation during our robust competency testing has definitely brought a few raised brows on occasion.

 

That being said, I have to give some props to the great group of techs that I work with.  Everyone truly appreciates their job and puts a ton of effort into the quality of work and care that we provide every day.  I know that I am lucky to have about a dozen techs who are blood bank specialists (meaning they only work in the Transfusion Service and are not lab generalists), so that could impact the quality of staff that we are able to attract, train, and maintain as competent.  We have a few techs who have only been at it a couple of years as well as over half of the staff that are nearing 25 years or more, so I really don't feel that it is just about age/experience.  It is about finding the right type of person who will be a good fit for the type of work that is required in our field.

 

Auntie-D, I'm not sure whether or not you hold a position (such as a senior tech or supervisor) that can enforce standards, but it does not mean that you can not be a key driver in change.  Set a good example (which it sounds like you're already doing :rolleyes: ) and make sure your concerns are being heard by management.  All of these errors need to be reported so that appropriate follow-up can take place.  Hang in there, and try not to be discouraged!

 

Stephanie

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I'm discouraged :(

- same member of staff had set up a crossmatch again without a control being put up and also seems they don't ever put up immediate spin crossmatches :(

- not enough blood in stock for a 4 unit xm on a patient so just issued one unit. Then had the cheek to ask me why I hadn't put in an order for more blood. Pointed out, her patient, her blood, her responsibility. She ordered the additional 4 to come out on the afternoon delivery but didn't bother ordering any routine stock so now we have to wing it until the morning delivery or pay for transport...

- I came in at 12, said member of staff had done no authorising all day so as well as 6 haematology patients to crossmatch on my start I also had about 100 results to authorise

- same member of staff electronically issued normal blood on a patient requiring irradiated blood :(

Lots of incident logs for me to fill in today :(

I'm discouraged :(

- same member of staff had set up a crossmatch again without a control being put up and also seems they don't ever put up immediate spin crossmatches :(

- not enough blood in stock for a 4 unit xm on a patient so just issued one unit. Then had the cheek to ask me why I hadn't put in an order for more blood. Pointed out, her patient, her blood, her responsibility. She ordered the additional 4 to come out on the afternoon delivery but didn't bother ordering any routine stock so now we have to wing it until the morning delivery or pay for transport...

- I came in at 12, said member of staff had done no authorising all day so as well as 6 haematology patients to crossmatch on my start I also had about 100 results to authorise

- same member of staff electronically issued normal blood on a patient requiring irradiated blood :(

Lots of incident logs for me to fill in today :(

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Dr Pepper, I know its cold, I grew up in Farmington, NH. My Mom had a rule that said if it was below 0 she would give us a ride to school otherwise we walked. When I worked in Boston I parked over a half mile from work and would wear ski pants over scrubs on really cold days. The good part about retiring is that I won't have to shovel snow at 4 in the morning so I can go to work, it just can wait until daylight. By the way I have enjoyed bicycling thru Alfred. Pretty area. In the north you get cold and in the south you get too hot. There must be a perfect place somewhere.

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To DOGLOVER:  Best wishes for your retirement!!  I bet the per diem work will be very enjoyable when you know that you don't "have to" be there.

 

To Dr. Pepper:  Loved your list.  7 out of the 10 items on your list are also members of my "Top Ten" list of pet peeves.

 

Donna

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l'm glad i'm not the only one with pet peeves...

 

Double checked our stock and as we only had 2 units of O Neg left l figured it was best to order these... l can't believe someone would think that 2 units of O Neg is sufficient until 12pm the next day when the order would come :(

 

l just wish my line manager would take mistake seriously and do root cause rather than just incident logging it and walking on by :(

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l'm glad i'm not the only one with pet peeves...

 

Double checked our stock and as we only had 2 units of O Neg left l figured it was best to order these... l can't believe someone would think that 2 units of O Neg is sufficient until 12pm the next day when the order would come :(

 

l just wish my line manager would take mistake seriously and do root cause rather than just incident logging it and walking on by :(

How about having a massive transfusion bleeder who is Oneg and not switching them, meanwhile the Oneg inventory is being depleted and someone wanting to set up the last two emergency Oneg units.

Or delaying an emergency request for blood due to not wanting to verify a straight forward textbook antibody.

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Oh I forgot the pan reactive one that they want 2 units for tomorrow for a chemo day patient. I had it all ready and packaged to go to the reference centre for them to crossmatch and this particular member of staff decides to do a 10 cell panel and enzyme too and empirically crossmatch 6 units with hope of getting 2 - all units pos, panel pan reactive. And surprise surprise there isn't enough sample left for the reference center to do it. So instead of coming in tomorrow for a transfusion the poor woman will be bled again and sent home and have to come in for a third time! Exactly the situation I wanted to avoid :(

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I'm curious, how many of the above mentioned problems are the result of generalists being forced to rotate through the blood bank/transfusion service?  I'll admit I did not read every one of the posts in detail but I think I did get the general gist of it.  My transfusion service was staffed with dedicated blood bankers 24/7.  I will not try to claim we never had problems but they were not common and seldom repeated with any regularity. 

 

I've mentioned it before but it's worth mentioning again.  As long as humans are involved in a process human errors will occur.  All you can hope to do is reduce repeat occurrences and minimize the impact.  I know this is not a popular philosophy among most blood bankers but it served me well for over 30 years.  :devilish: :crazy:

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Auntie-D, one of my absolte PET hates is receiving inadequate samples on patient's with an auto-antibody, especially as the User Guide and the back of the Request Form both have printed on them the MINIMUM sample volume required.

I sometimes think that people believe we can do the impossible (or, maybe, guess our results!!!!!!).

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My most commonly occurring pet peeves:

 

-- When techs who answer the phone spout off incorrect information -- such as "if we order these irradiated platelets for you routine you will have them this afternoon around 4 or 5" (our evening courier comes at 9 p.m. at the earliest!)

 

-- Ignoring patient samples, especially STATs, to do things like bring in inventory, review transfusion data, etc. :angry:

 

-- Not asking the right questions! I am fine with being called at home but last weekend had a tech call to ask what to do about an incompatible crossmatch (maybe... don't give the unit? :blink: Negative screen/panel -- plenty of stock available -- leave unit number and a note for supervisor...), but same tech didn't call about a questionable workup -- we almost missed a new antibody because they wanted to call it 'Echo junk'. If that Echo junk looks suspisciously like an anti-c, it might be an anti-c...

 

-- Leaving things in weird places in the fridge with no note/explanation. I get to be a detective 2-3 mornings a week because people just forget, I guess.

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I agree with John, generalists are a challenge.  But I am really proud of the generalists we have.  I really try to keep on top of problems every day.  And tell people what they did 'wrong' every time, don't let it go.  If you let it go, they get the impression it is ok.  For minor, annoying things, reminders.  After 2, then I get more serious with notes into their performance evaluation file, then comes counselings.  This gets there attention, if nothing else does.  If it is serious, then counseling right away.

 

Annoyances:

Forgot to add the stir balls to the indicator cells on the Echo analyzer.

 

More annoying:

Can't figure out my panel because I pulled the wrong antigram! (Echo panel)

 

Linda

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Yes, there are Techs. like that everywhere (and it seems to be becoming even more difficult to find experienced, knowledgeable staff with a good work ethic).  So, what I resorted to years ago (and about 3 Hospitals ago) is a little thing called "accountability."  You don't do your job (or don't do it correctly), and you get written up.  You get written up enough....and there will be consequences (and though it is extra work on my part, I manage to find ways to track almost every/any aspect of a task that is supposed to be done).  Once staff know you can track things back to them; and once they know there are ramifications....sadly, for "some" people, that is the only thing that will get them to do their jobs correctly.  And I can tell you this in all honesty (not at all meant as a reflection on me)....but when I have started at a new place (in-charge) and seen all of the above....and "forced" improvement (sometimes with kicking and screaming from some staff); I can say with all honesty that in every place I have left, the staff honestly thanked me at the end for "raising their standards."  They may have fought me all the way....but they could see the difference in their work performance after time and were actually proud of themselves.  That makes it worth it! :) 

Another problem I have encountered is people who are just trained "how" to do something (or "what" to do); not the "why" or theory behind it.  I always teach by principles because my philosophy is that if someone understands why they do things the way they do, they are much less likely to forget steps; to recognize when something is not right; and to be able to trouble-shoot problems when they do encounter them.  People that are just taught "what" to do, are errors waiting to happen (and will not understand when you try to correct them, because they were never taught that way in the first place).  But again, there are 2 types of workers; those who may have been taught that way but have the motivation to want to understand what they are doing and to do a good job; and are willing to learn and understand what they were never taught; and those who just want a paycheck.

 

And unfortunately, they don't teach work ethic much anymore.....do they? :wacko: 

 

Brenda Hutson, CLS(ASCP)SBB

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Yes, come back to the Great White North. :D  :D

I think I will get away from the venting,(although venting can be very important to ones sanity at times) because although we have a few issues (generally minor, like not checking pending logs when they are supposed to and acting on them) for the most part my techs are very responsible and really take their jobs to heart. They all really care and I am so thankful to have worked with this group for the last 12+ years. I will be retiring Jan 3 and its been a great group to work with. I will still PRN a few shifts here and there but not as manager. I will still check in on BB Talk. Will have time to visit and spoil my little grandbaby. Hopefully get to move back to New England (New Hampshire or Maine), depends on the housing market. Anyway, Merry Christmas and Happy New Year to all of you. Thanks so much for this website, it is a great thing.

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Oh Linda, I feel your pain. Check *everything*, patient ID #, Lot #'s, etc twice if not three times.

 

Beth

I agree with John, generalists are a challenge.  But I am really proud of the generalists we have.  I really try to keep on top of problems every day.  And tell people what they did 'wrong' every time, don't let it go.  If you let it go, they get the impression it is ok.  For minor, annoying things, reminders.  After 2, then I get more serious with notes into their performance evaluation file, then comes counselings.  This gets there attention, if nothing else does.  If it is serious, then counseling right away.

 

Annoyances:

Forgot to add the stir balls to the indicator cells on the Echo analyzer.

 

More annoying:

Can't figure out my panel because I pulled the wrong antigram! (Echo panel)

 

Linda

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Management and accountability go together.  If you document errors and the director just shrugs his shoulders, the techs know they can slide by with inferior work.  Neither our Director nor Assistant Director were ever supervisors over other techs.  They sit in offices down the hall from the lab and write, what I am sure, are outstanding reports.  There is no on-site technical laboratory management.  Recently, a replacement Hematology position (this Hemo tech is also trained in BB to cover for me when I am off)  was advertised for 0600 to 1430 with the tech working in BB from 0600 to 0630 to help me do the morning work before going to Hematology.  I had asked for help in the mornings for years because I am by myself over 80% of the days I work and I often arrive at 0600 to multiple same day of surgery patients, reviewing all work (including antibody identifications), maintenance, temperatures, QC, etc.  In addition, third shift only works on STAT patients leaving all early morning work for me.  The new tech came at 0630 and went straight to Hematology.  The Director took 9 months to inform me (after multiple questions as to why she was not coming at 0600) that it made the new tech happier to come at 0630 and he didn't see any reason to make her unhappy.   Then this tech made multiple errors on a day when she had to cover BB while I was having a medical procedure.  The new tech stated she is not in there enough in the mornings to know what to do. (This tech had made multiple previous errors where the Director's response was a shrug.)  This day,  the  Director  informed me "I believe she is a good tech but as you know it can get stressful in your department and having the knowledge and forethought to resolve some issues can be difficult for someone who works limited hours in blood bank."  DuH!!!   

 

That said, I honestly believe the second and third shift techs (all generalists)  know I hold them accountable when they work in BB and they work hard to meet the standards in the BB.  However, these same techs may be late for work over and over, or just not show up for work, because they know there will be no repercussions from laboratory management.    

 

 

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Yes, there are Techs. like that everywhere (and it seems to be becoming even more difficult to find experienced, knowledgeable staff with a good work ethic).  So, what I resorted to years ago (and about 3 Hospitals ago) is a little thing called "accountability."  You don't do your job (or don't do it correctly), and you get written up.  You get written up enough....and there will be consequences (and though it is extra work on my part, I manage to find ways to track almost every/any aspect of a task that is supposed to be done).  Once staff know you can track things back to them; and once they know there are ramifications....sadly, for "some" people, that is the only thing that will get them to do their jobs correctly.  And I can tell you this in all honesty (not at all meant as a reflection on me)....but when I have started at a new place (in-charge) and seen all of the above....and "forced" improvement (sometimes with kicking and screaming from some staff); I can say with all honesty that in every place I have left, the staff honestly thanked me at the end for "raising their standards."  They may have fought me all the way....but they could see the difference in their work performance after time and were actually proud of themselves.  That makes it worth it! :) 

Another problem I have encountered is people who are just trained "how" to do something (or "what" to do); not the "why" or theory behind it.  I always teach by principles because my philosophy is that if someone understands why they do things the way they do, they are much less likely to forget steps; to recognize when something is not right; and to be able to trouble-shoot problems when they do encounter them.  People that are just taught "what" to do, are errors waiting to happen (and will not understand when you try to correct them, because they were never taught that way in the first place).  But again, there are 2 types of workers; those who may have been taught that way but have the motivation to want to understand what they are doing and to do a good job; and are willing to learn and understand what they were never taught; and those who just want a paycheck.

 

And unfortunately, they don't teach work ethic much anymore.....do they? :wacko: 

 

Brenda Hutson, CLS(ASCP)SBB

Thank you for putting my feelings into words! I do a lot of educating, and these are not new techs. Small hospitals usually have generalists and many do not really want to work in blood bank. And they don't like change (unfortuantely relearning to do something the right way after many years of doing it the wrong way is looked upon simply as change).

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  • 2 weeks later...

Had to add my two cents!

 

I recently had to leave a large university hospital because of the lack of work ethic.  I worked day shift so all of us were dedicated blood bankers.  I've only been in the field for 5 years and loved the challenge I found in the BB, but I couldn't put up with the negligence anymore.  Issues that were reported to management and HR multiple times were completely ignored and a coworker who spent most of every day on personal phone calls was promoted.  I've seen this same person blatantly decide they don't want to perform an antibody ID (and discuss it with the manager) so they skip it.  Even though it met all of the rules to running a new ID.  So frustrating.  Anyways, I left the lab and am pretty sad about it.  I just couldn't sit around watching the quality go down the drain anymore.  I didn't feel comfortable working in a place that I wouldn't want my own lab work performed.  

 

Good Luck to all of you!  I hope you don't get as discouraged as I did.

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Had to add my two cents!

 

I recently had to leave a large university hospital because of the lack of work ethic.  I worked day shift so all of us were dedicated blood bankers.  I've only been in the field for 5 years and loved the challenge I found in the BB, but I couldn't put up with the negligence anymore.  Issues that were reported to management and HR multiple times were completely ignored and a coworker who spent most of every day on personal phone calls was promoted.  I've seen this same person blatantly decide they don't want to perform an antibody ID (and discuss it with the manager) so they skip it.  Even though it met all of the rules to running a new ID.  So frustrating.  Anyways, I left the lab and am pretty sad about it.  I just couldn't sit around watching the quality go down the drain anymore.  I didn't feel comfortable working in a place that I wouldn't want my own lab work performed.  

 

Good Luck to all of you!  I hope you don't get as discouraged as I did.

You made me think back on my Peace Corps days in West Africa in the 70s. My job was supposed to be teaching blood bank at a large university hospital - I gave one lecture in one year, and that was pinch-hitting for someone who was sick. I had a couple hours notice to prepare an hour-long lecture - in French! Even within the infrastructural limits of the country hospital, they could have done a much better job, but my racist doctor boss didn't want to hear about it. He just wanted another white guy working the bench. My point is that it's discouraging, frustrating and humbling to knock your head against the wall and realize finally that you cannot change things, as much as they should be changed, and you have the choice of accepting it or walking. I chose to walk, and worked my second year with my wife, a cytotech, and learned (somewhat) diagnostic cytology of body fluids in French, not a particularly useful skill for an American blood banker, but I was much happier there. You chose to walk as well, Cherrilee, and that takes wisdom and courage. I hope you have found another lab with higher standards that you're more comfortable with - I would like to think that that's the norm, not the exception. Shame on the old place for not having anyone to listen to you. By the way, CAP and AABB have anonymous hotlines one can call; I imagine your state dept of health does as well.

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