Quality Structure

[kaz5485]

My lab is exploring differing quality structures in hospital labs.  I would be interested in knowing if your labs have a quality dept. in the lab, and if so, how many people are dedicated to the dept?  Does it consist of Transfusion Medicine as well as other lab areas?

 

Thanks!

[pinktoptube]

We have a quality department that consists of 2 personnel. They cover all areas of the lab, mostly just tracking sample cancellations, follow-up on documented safety/error events, tracking equipment, and I'm not sure what else. I still do all the Transfusion Stats, Audits, tracking, etc...

[AMcCord]

I am responsible for quality issues in Blood Bank. Same with the leads in our other lab sections - they are responsible for their section. We report to lab management and the medical director.

Lab reports to hospital quality. Quality issues from every part of the organization that directly affect patient safety are reported as they arise at a 'Safety Huddle' every morning which is presided over by the CEO or a VP. Hospital quality is always present. Those issues get immediate attention. As an example - if we do a transfusion reaction workup, that gets reported the next morning at huddle and if there were any correctable issues related to that event, they are part of the report. So if something occurs, like nursing service didn't follow protocol and used Ringer's lactate instead of saline (Note - that does not happen here!), or didn't report the reaction in a timely fashion or didn't re-verify patient ID as part of the response to the reaction, or if lab didn't use antigen negative units, etc etc - that is reported and a response to that is expected very quickly to fix the problem.

[SMILLER]

Simular to Mr. McCord above.  Also, like most other hospitals, our regular QA committee, which gets reports from each divison, meets monthly to assess ongoing monitors.  Then there are other committees we report to sometimes, like Transfusion and Trauma.

 

Scott

[Cliff]

I'm afraid to say.  I'm a compliance person for a large blood bank / donor center.  I have two people that work in just compliance.  We also have lab compliance and two other compliance people that work there.

[AMcCord]

On 8/8/2016 at 11:02 AM, SMILLER said:

Simular to Mr. McCord above.  Also, like most other hospitals, our regular QA committee, which gets reports from each divison, meets monthly to assess ongoing monitors.  Then there are other committees we report to sometimes, like Transfusion and Trauma.

 

Scott

Also part of our quality structure. I am on Transfusion Committee - the blood bank Medical Director is the chair. I attend Trauma Committee meetings for the lab, which can be a very helpful thing in nipping blood bank emergency release/mass transfusion problems in the bud and building relationships with other departments.

Edited August 11, 2016 by AMcCord

[goodchild]

On ‎8‎/‎2‎/‎2016 at 9:56 AM, AMcCord said:

I am responsible for quality issues in Blood Bank. Same with the leads in our other lab sections - they are responsible for their section. We report to lab management and the medical director.

Lab reports to hospital quality. Quality issues from every part of the organization that directly affect patient safety are reported as they arise at a 'Safety Huddle' every morning which is presided over by the CEO or a VP. Hospital quality is always present. Those issues get immediate attention. As an example - if we do a transfusion reaction workup, that gets reported the next morning at huddle and if there were any correctable issues related to that event, they are part of the report. So if something occurs, like nursing service didn't follow protocol and used Ringer's lactate instead of saline (Note - that does not happen here!), or didn't report the reaction in a timely fashion or didn't re-verify patient ID as part of the response to the reaction, or if lab didn't use antigen negative units, etc etc - that is reported and a response to that is expected very quickly to fix the problem.

We do something extremely similar to your daily executive safety huddle.

We previously had two individuals for laboratory quality/compliance, one for all lab and the other for blood bank specifically. Now we just have the one individual who covers the whole lab.

[PBM RN]

I am a Clinical Blood Management Coordinator/TSO and an RN. My position is in Quality and Patient Safety. We also have a patient safety person designated to the Lab/Blood Bank and newly joining me is a Performance Improvement coordinator who will be .3 for PBM. We have an event reporting System that lab participates in using as well and I work with PS and Lab on any blood related issues. The Lab Directors delegate other issues to their  Supervisors. We have an educator assigned to the lab which assists us as needed. We also have Daily Safety huddles and Lab leadership attends these along with our QPS Director and local VP leadership. We have a Transfusion Committee where we report patient safety issues and also to QPC Council.  Lab also reports to the QPS Council and then to leadership annually.

Let me know if I can answer any questions.

 

Anne

 

Edited January 2, 2017 by amburkey