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Kathyang

Competency on Couriers

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        I was cited by our AABB Assessor for not having a competency on the people who come down to pick up blood for both AABB and CAP. I was wondering if anyone else completes a competency. Also if you do could you share a competency checklist with me? I was going to challenge the CAP nonconformance since that talks specifically about testing personnel. The people who come from the floor are doing no testing. I have been working in Blood Bank for 35+ years and never heard of this or got cited for this before.

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Just out of curiosity, who are your couriers and what, exactly to they do?  Are they involved in any part of the process of making sure the blood products is for the right person or do you just hand them a bag of blood and tell them where it needs to go?  I really liked when we moved into a new building and transporting blood products via pneumatic tube system removed this problem.

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  They come down to pick up the blood for the nurses. Sometimes they are nurses but most of the time they are either ward secretaries or patient techs (not hanging the blood). They bring the pick-up form from the floor and take it back up to the nurse who needs to hang the blood. They use 2 nurses to hang the blood.

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I implemented training for the couriers.  It was a PPT that their boss gave them to read and sign off on.   Basically, go directly to department promptly, avoid hot or cold temps, give to responsible person. 

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This is an interesting topic. Disclaimer: I am not intimately familiar with the complexities of the regulations.

Obviously, couriers are not involved in testing and are therefore not technically subject to the CLIA regs. On the other hand, they are involved in the quality chain from lab. to patient. I don't know if this is overseen by AABB/CAP, but more probably it's under the "Joint Commission" umbrella.

I suppose one could argue that a facility should require competency/training for persons delivering blood to the hospital - other driver/couriers, even FEDEX drivers, if that's how you get your inventory.

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18 minutes ago, R1R2 said:

I implemented training for the couriers.  It was a PPT that their boss gave them to read and sign off on.   Basically, go directly to department promptly, avoid hot or cold temps, give to responsible person. 

Is this a one-time thing or is there annual refresher training, a.k.a. competency ?

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9 minutes ago, R1R2 said:

I think upon hire.   Not really a competency, more like training.

 

That sounds like a reasonable approach, if the process is actually required by regulation. Kathyang's original post mentioned "competency", but it's possible we're talking about the same thing.

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I was asked about the courier training a couple of inspections ago.  She asked what training they received.  I told her I wasn't sure because they were nursing personnel and they were trained by nursing.  That's all the further that conversation went.  I can't think of a standard covering that, so if you can let us know what one he cited, that would be appreciated.

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4 hours ago, BankerGirl said:

I was asked about the courier training a couple of inspections ago.  She asked what training they received.  I told her I wasn't sure because they were nursing personnel and they were trained by nursing.  That's all the further that conversation went.  I can't think of a standard covering that, so if you can let us know what one he cited, that would be appreciated.

Annual training for nursing staff.

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I feel slightly worried about nurses training nurses, as some have suggested above happens.  This may be either me misreading the posts, or, possibly, posters not being crystal clear.

The reason I say this is that, if the training is not reinforced by the person who wrote the training, it could be that a situation arises where there are "Chinese whispers" (with profuse apologies to the likes of my good friend Yan Xia, and others from the Far East for the latent racism of the term) arising, where there are subtle differences from one trainer to a trainee, and then that trainee also introduces subtle differences, and so on, and so forth, until what is being passed on to the trainee by the trainer, bears very little similarity to the original Standard Operating Procedure.

I am quite happy to be "shot down in flames", if I have got completely the "wrong end of the stick".

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2 hours ago, TreeMoss said:

Annual training for nursing staff.

Who's responsible for training and tracking, etc. - nursing or the Blood Bank ? How does one know that the body that turns up to collect the blood has been trained ?

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14 minutes ago, exlimey said:

Who's responsible for training and tracking, etc. - nursing or the Blood Bank ? How does one know that the body that turns up to collect the blood has been trained ?

That is almost exactly what I meant exlimey.  One or other should take FULL responsibility, and given that it is blood, it should be the Blood Bank.

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I was advised by one assessor to have an information sheet like the one mentioned above for the couriers (nurses, patient care techs, anyone who pick up blood) to read and sign.  We gave them a sticky dot for the name badge and if they didn't have that, they had to read and sign the form. We required the form to be read yearly and they got a different colored sticky dot each time.  It would be difficult to perform true competencies without following the courier to the floor to make sure they delivered the blood properly.

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I would think you have a good argument against both.  The AABB standard references the CFR which is also related to testing.  (42CFR 493.1235 and 42 CFR 493.1451 (b)(8)(9))

from the CAP Lab General 55500 References

Department of Health and Human Services, Centers for Medicare and Medicaid Services. Clinical laboratory improvement

amendments of 1988; final rule. Fed Register. 2003(Oct 1):1065-66 [42CFR493.1451(b)], 1053-54 [42CFR493.1413], 1992 (Feb 28)

7184 [42CFR493.1713]

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The AABB standard (2.1.3) also seems to be a general competency requirement for testing personnel.  When you got your final inspection report from AABB, was this citation still on it?

Scott

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We have training for the folks that courier blood initial and an annual module with some key questions. In my years, I have seen folks carry blood to the cafeteria and put it on their food tray, stick it in a pocket and go take a smoke break, leave it on a nursing station counter and not notify the proper people..... They are also required to know how to perform a read back check and why this is so important.

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42 CFR 493.1235 and 493.1451 refers to " personnel requirements that must be met by laboratories performing moderate complexity testing, PPM, high complexity testing or any combination of these tests"  and the 6 required elements.  Nothing about people who only carry products from the lab to the patient.  I think, perhaps, this was a misunderstanding of competency requirements by the assessor and I would challenge the citation.

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Perhaps there was confusion between training and competency.  CAP requires training: TRM.40900, Blood/Tissue Sign-Out 

The procedure for signing blood and tissue out of the laboratory provides adequate protection for the potential recipient.

NOTE:  A person authorized by the transfusion medicine service must perform a clerical and visual inspection of each component immediately before it is issued. Transporters of blood components and tissue must be trained in prompt delivery. Training may consist of instruction at the time the procedure is dispensed.

Evidence of Compliance:

Written  procedures for the issue of blood components and tissue AND

Written policy for the instruction of transporters on the proper handling of the product

 

 

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We would sign out blood to transporters.  They were trained to handle blood products appropriately and in a timely manner, i.e., blood had a priority over all other transport calls, and was always immediately delivered.  This was documented formal training - 1980s at a University affiliated hospital.

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