MT vs MLT

[amym1586]

If you were a BloodBank supervisor with 80% MLTs... Would you change things vs if you were working with a staff of MTs? 

[pinktoptube]

Change things as in?

From my experience, a persons understanding, willing to learn, and pro-activeness is dependent on the person and not whether they are a MLT or MT.

[amym1586]

I'm coming from a hospital that only staffed MTs to a blood bank supervisor with mostly MLTs.  They make them call a pathologist for every platelet that gets issued, after 4 FFP have been issued and for every Cryo.   I was wonder if they were doing that to keep them in check or what ?  I'm just not used to that. 

[AMcCord]

With proper training and a thorough competency, there shouldn't be a need to restrict activities, with the possible exception of some specialized testing. Even then, with the right person, it could be possible for that person to perform a full test menu with an MT checking interpretations perhaps. I have about 50% MLTs and they function well for routine Blood Bank testing (which includes antibody ID). I strongly encourage them to ask questions if they have any concerns/doubts about what they are doing and they do.

Checking prior to issuing platelets, FFP and Cryo seems a bit excessive. Can you set a policy with pathologist approval for bench marks?  Example: If the platelet count is above 50,000 and the patient isn't on Plavix...check with pathologist. Etc.

[milesd3]

11 hours ago, amym1586 said:

I'm coming from a hospital that only staffed MTs to a blood bank supervisor with mostly MLTs.  They make them call a pathologist for every platelet that gets issued, after 4 FFP have been issued and for every Cryo.   I was wonder if they were doing that to keep them in check or what ?  I'm just not used to that. 

What pinktoptube said... MT's get one more semester of BB training in school but how many folks actually retain that extra bit of knowledge.  From my experience I find MT's and MLT's are both capable of doing the work and I cannot distinguish between the two looking at results.  The true training takes place on the job and the more hands on either gets the better a BB tech they become. 

Is this requirement for plts cryo etc just for the MLT or MT as well..?  If so I suppose the pathologist doesn't trust the MLT's judgment?  At our facility we rarely question the Dr's decisions to give plts because they are usually warrented.  we have in the past had OB Dr.s order plts to be onhand which usually means at the end of their life, we trhow them away.  Our in house Pathologist wouldn't stop this practice and it drove me insane.  He retired and our once a month pathologist isn't much better.

[Dr. Pepper]

19 hours ago, pinktoptube said:

Change things as in?

From my experience, a persons understanding, willing to learn, and pro-activeness is dependent on the person and not whether they are a MLT or MT.

Wholeheartedly agreed! Here's what I posted on a similar thread earlier this year:

"For decades we hired only MTs, but have had to hire a few MLTs over the last couple of years due to MT shortages. I find the quality of work varies not from the number of college courses they took but the innate ability, initiative and interest of the worker. We train equally and job responsibilities are equal (although the MTLs cannot do some things, like review results etc).

I had a MLT generalist on last weekend. He had a patient who got 4 units of blood the week before who now presented with anti-c and a positive DAT, weak mixed field. Pretty classic delayed reaction, except that the eluate reacted with all the panel cells. DAT was negative the week before. He dug into it and tested some more c-negative cells and found that there was also anti-Fya and -Jkb in the eluate (but not in the plasma yet). En route he tested the eluate with ficin-treated cells and PeG and ficin-treated some additional ones himself to help untangle the specificities. I did give him some phone coaching along the way, but it was an excellent job of blood banking. "Just" a MLT, but he really digs BB."

 

[Malcolm Needs ☆]

Over this side of the pond, an MT would be the equivalent of a HCPC Registered Biomedical Scientist.  BELIEVE ME when I say that I have come across some of these who have become our equivalent of your MT's, and not only stopped studying, but have regressed, and are a damned sight more dangerous than some people who work in transfusion, but have never taken such exams (our equivalent of your MLT's).

[goodchild]

Being a new blood bank supervisor can be a real trial by fire especially depending on how good of a ship your predecessors kept. (the following is not all inclusive and is definitely my opinion only)

You should review each blood bank procedure/policy/form. Are they in line with blood bank regulations and generally accepted practice standards? Does practice match policy? Are you well versed in your blood bank's accreditation manual? If not, become so and/or work closely with your quality assurance team. Are you well versed in the hospital accreditation manual to where it applies to blood bank? If not, same as before.

Get familiar with laboratory/hospital procedure/policies/protocols and how they intertwine with the blood bank. 

Develop a relationship with your medical director/sectional medical director. They will be a huge resource for getting things done.

If you use an LIS, review the entire blood bank dictionary (tests, products, antibodies, antigens, billing codes, etc). If you have CPOE, review every blood bank order.

Carefully review recent occurrence reports (nonconforming events, incident reports, sentinel events, whatever your institution calls them) for compliance/patient safety issues. If you don't have a good occurrence reporting system, work towards developing one. Promote a just culture.

Be prepared to revise basically anything and everything. Be prepared for resistance from your technologists, even if what you're doing is what the rest of the world has been doing for years and/or is a federal mandate.

Edited December 29, 2015 by goodchild
Typo/etc

[mcgouc]

I have had MLTs who were better at antibody identification than some SBB's I have hired.   Experience & individuality mean so much in Blood Bank.    However, in this blood management era,  pathologists should be involved in the transfusion of all blood components.  I would have greatly appreciated our Pathologist interfacing with the physicians when we lowered the hemoglobin level for red cell transfusions.  One tech in the department working on several patients should not be the person involved in multiple phone calls with the nurses & physicians as to whether the patient meets the hospital's criteria to give the component.  

[tbostock]

The trend at least in NY State is to have only MTs in the Blood Bank because we do high complexity testing.  However, in my years of experience, I've had MLTs that were great Blood Bankers and MTs that are terrible at it so it really depends if someone has critical thinking skills and attention to detail or not.

Edited December 29, 2015 by tbostock

[goodchild]

Oh and in regard to MT vs MLT; they're both qualified to do high complexity testing. An MLT with two years of experience in a particular field is qualified to be a general supervisor for the department. Research the history/intent behind policies that don't make sense to you.

[SMILLER]

I would also agree with those who think that appropriate training and documentation of competency is more to the point than whether one has a MT, MLT or SBB after their name.

 

Scott

[David Saikin]

The best BB tech I ever worked with was an MLT.  I learned a lot of the nuances of serology from her.  As intimated in many of the posts above - it is the person not the degree which determines how they progress in the BB.  I have worked with SBBs who scared the crap out of me with their decision making processes, or technical (dis)abilities.  Right now my staff is about 50/50 MT/MLT.  They all do the same work and I expect the same standard of performance from all - but esp my MLTs 'cuz they were all my BB students for their clinical internships.

[Likewine99]

I too have worked with MLTs that were top notch Blood Bankers and MTs that weren't worth what they paid for their education.  And...... there were a couple of SBBs who absolutely couldn't make a decision re: what antibodies a pt had or fell apart in a trauma situation.

In this time of staffing shortages it is vitally important to hire the best fit for the job.  We absolutely have to provide the best blood products for our patients as timely as possible.

It's the "person" not the credentials that make a good BBer.  And I'll bet it's the same in the other areas of the lab.

 

[tbostock]

On Tuesday, December 29, 2015 at 4:25 PM, goodchild said:

Oh and in regard to MT vs MLT; they're both qualified to do high complexity testing. An MLT with two years of experience in a particular field is qualified to be a general supervisor for the department. Research the history/intent behind policies that don't make sense to you.

Yes, an MLT can work in BB as long as there is always a bachelor's level tech directly observing them.  NY State made it a little stricter than the CLIA requirements.

[goodchild]

48 minutes ago, tbostock said:

Yes, an MLT can work in BB as long as there is always a bachelor's level tech directly observing them.  NY State made it a little stricter than the CLIA requirements.

NY State requires MLTs to be directly observed at all times by a bachelor's degree tech when doing high complexity testing? How has that impacted the ability to maintain staffing in blood banks/laboratories? Especially considering that many labs employ generalists who cover BB on evening/overnight shifts.

I'm only going to elaborate because qualification of testing personnel is a hot button item right now with CAP, TJC, AABB. And regionally, this has been a hot button issue with personnel/staffing.

The minimum educational qualifications for testing personnel in high complexity environments (not including those grandfathered by pre-92/95 clauses) are

• license from state (if required by that state)
• 60 credit hours from an accredited institution that includes 24 semester hours of science courses (of which at least six must be bio and six must be chem)
• laboratory training (either a clinical laboratory program [MLT] or 3 months training in the specialty relating to the high complexity testing)

An MLT (with their licensure, per state guidelines) would be eligible to work independently in blood bank once they completed training.

[amym1586]

Thanks for your feedback!

I hope no one took that as me "dissing" an MLT.  There are MLTs here that have been working for as long as I've been alive.  And I believe no matter how much you study BB it's really the experience that counts.    

I was just curious if their standards here were based on the fact that we do have majority of MLT's working here. They keep a short leash on some things and other things don't check at all.    I think they need some updating and rearranging. I just hope I have the guts to do it. 

[David Saikin]

You are a blood banker - you have the guts.  Just present the changes you are requesting in a logical, professional way.  I always found the biggest hurdle was the staff and "we've always done it this way" mentality.  If you explain your "why's" it may make change go smoother.

[John C. Staley]

2 hours ago, David Saikin said:

You are a blood banker - you have the guts.  Just present the changes you are requesting in a logical, professional way.  I always found the biggest hurdle was the staff and "we've always done it this way" mentality.  If you explain your "why's" it may make change go smoother.

I would like to add one note to what David said.  Pick your battles wisely.  Step back every once in awhile and ask yourself; "is this fight going to be worth the effort?"  Some are, some are not.  Start with a few "no brainers" and set a pattern of winning the battles.  That makes the next ones a little easier. As David noted above, I have found, over the years, the most important question you can ask is "Why?".  If they can not tell you why it is probably a good battle to take on.

[Likewine99]

To add to what John said about battles....  If you can find a tech in the BB that is interested in changing things and can get them on your "side", it might help solidify changes if one of the rank and file is your ally.

I bet ya, half of the staff want things to change and the other half don't.  If you can find the half that is willing to change, get them to help you drive the change, it might make things easier.  Good luck