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AMER
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Dear all.

 

I have suggestion,why we don't have two diffrent supjects,one for the AABB and the other one for CAP and every one can write his experience on those inspections ( Deficiency and the recomendation) as kind of education material to all blood banker or the people who work in Transfusion Medicine Services.

 

Thanks alot

Amer

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A nice idea but I think that there are too many variables in inspections, whether AABB or CAP. 

 

First off, the AABB assessment is pretty subjective and is based not only on the assessor's training but also on their experience, their bias (yes), and their interpretation of the standards.  You would end up writing a long dissertation about why your received non-conformances, your agreement/disagreement with the report, how you justified what you felt shouldn't have been cited, AABB's response, etc., etc.  I know when I did assessments (retired from I&A last year), I looked primarily at the Quality Plan and its implementation and usefulness.  Yes, I still looked at reagents, spoke with the techs, and verified mandated policies/procedures but . . . when i received the packet for an assessment I get to see what the previous event had reported.  Some folks are into the minutiae (which I found to be a major waste of time/effort). 

 

Second:  CAP has a checklist - yes or no.  There are many shades to yes and no and a great many inspectors can't see the forest for the trees, and some have limited Blood Bank experience.  Granted, the CAP is also educational for both parties, but I have found that a great deal of effort is wasted on back and forth with CAP on issues which the on-site inspectors did not/would not understand.  While my BB has always had minimal non-confomances, the entire lab has usually had 60-75% of the cited non-conformances removed by CAP central.  Are you going to document all the back and forth, your opinion of the inspection team/your inspector, how your responded?  Seems like a lot of time spent.

 

Or are you just going to say my inspection was great (and why), good (and why), sucked (and why).  I think you can do this under the ACCREDTATION forum by making a comment or asking a specific question about a standard. 

 

Oh and let's nor forget the FDA!

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The two weirdest things I was ever cited for:

 

Not logging the expiration date of non-sterile gauze (I had no idea such a thing even expired...)

 

Inspector found 1 balance tube in the entire lab that was expired.  We were cited that it was expired and it did not say the words "BALANCE TUBE ONLY" on it.

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The two weirdest things I was ever cited for:

 

Not logging the expiration date of non-sterile gauze (I had no idea such a thing even expired...)

 

Inspector found 1 balance tube in the entire lab that was expired.  We were cited that it was expired and it did not say the words "BALANCE TUBE ONLY" on it.

I like this topic:  THE WEIRDESTTHINGS I WAS EVER CITED FOR

 

For me that was not having my facility ID on my ab panel sheets.  I knew I was in for it when the inspector started off saying she knew she'd have to dig to find something "in Dave's lab!"  This was in the day when the inspector sent the report to the AABB Area Chair and he/she decided what was actually citable.  I called my area chair and told him  1. that I couldn't believe he cited me for this and 2. I wanted to inspect his blood bank (aganist the rules). 

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I got a strong 'recommendation' for the lack of facility ID on my ab panel sheets from a CAP inspector who used to be an AABB inspector.

 

I was cited for not having a through enough SOP for a water bath - outside of keeping it full of water, clean, the temp set/checked, and what we use it for.........how much more do you need to know???

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The two weirdest things I was ever cited for:

 

Not logging the expiration date of non-sterile gauze (I had no idea such a thing even expired...)

 

Inspector found 1 balance tube in the entire lab that was expired.  We were cited that it was expired and it did not say the words "BALANCE TUBE ONLY" on it.

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Terri, David, & Ann - All of those citations are amazing! I hope I never get that inspector!

I'm under the impression that The Joint Commission and CAP are changing their focus more towards the processes and outcomes (rather than the minute details such as those citations mentioned above.) So it will be interesting to see how our inspections go the next couple of years.

Donna

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