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KTUCK

Training new employees

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Just have a question regarding training new employees in the Blood Bank.

I have a new employee that I have been training and he has been caught in several lies. For example after several weeks in training, when performing daily QC the employee has verified results into the LIS, then after the fact I have found his QC tubes in the centrifuge. I have asked him how he put the results in if the tubes were in the centrifuge and he states that he put them back in there for me to read. I have told him that he does not need to do this. I have trained many people but am fairly new in this BB supervisor position, been in lab for 21 years.  Another example, he does not put his results in the LIS as he goes. When he does a tube type from a type and screen, he pulls the tubes out and lets them sit in the rack and then puts all the results in when the screen is down. I communicated to him that he needs to put the results in as he reads the tubes. He still does not listen to me. I do not trust him at all now and I am actually scared for the patient care. I have expressed this to my higher-ups, they just state he needs more time in BB.

What I'm trying to get at, its not an issue where he cannot do the work. I do not trust him doing the work. he reminds me of one of those people who likes to cut corners.

What am I supposed to do, I feel no one is listening to me.

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That's an awful situation!  I have had to retrain several techs who made mistakes.  How long do you usually train them?  I would document everything he does wrong.  Does your procedure state that you have to put your results in immediately?  Ours does, since that is what CAP requires.  What's worse is that your higher ups aren't alarmed by your observations.  If he is not following procedure, or changing his actions based on what you have communicated to him, I would not sign him off as being competent.

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I would agree with mollyredone, but would go further,

Not only do you need to record everything you say to him (and get him to counter-sign the record), you need to record everything you tell your own seniors, and get THEM to counter-sign what you have told them.  THIS PERSON IS DANGEROUS.  You, as a conscientious employee, should not have to take responsibility for this person, but, if the worst happens (and it well could), you want to make certain that you are not held responsible in law, but that the finger is pointed in the right direction.  If you get your own seniors to counter-sign your written concerns, you will, not only be protecting your own future, but will also cause them sleepless nights until they do something about the situation.

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One way to document the persons non compliance is through event management and training. 

Part of the training should require documented competency before they start submitting patient test results on their own and direct observation should be a part of that.  If this person cannot pass their competency then you have documented evidence.

If you know this person is not following SOP, you should be able to document such in your event management system.  Hopefully your SOPs also out line that concurrent documentation is required.

Based on the Fair and Just Culture of event management, this sounds like the Reckless behavior where the person is making these conscious choices and disregarding the risk involved.  This type of behavior should not be ignored and requires corrective action. 

Patient Safety and the "Just Culture."  A Primer for Health Care Executives Prepared by David Marx, JD 

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As you describe the events, these are not mistakes.  They appear to be wanton disregard for procedures and protocols.  Most facilities have a training period, usually 3 - 6 months wherein a new employee can be discharged without jumping through the usual hoops.  I suggest you use this escape route if it is available. 

Just out of curiosity what is this person's back ground and how well was it checked out?  

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Thank you all for responses. This person actually worked in a manufacturing plant before going to tech school. I contacted the place where he did his clinical rotations and they stated that they had the same problems and they wouldn't hire him because they couldn't trust him.

One day he performed a DAT. I had not shown him, he had not even watched me do one and he did it. This was after the fact that I told him, with witnesses present, that he is to not do absolutely nothing if he has not been shown.

He states that BB is his favorite department within the lab, and he is in school now to get his MLS. :(

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Document, document, document. I have had several employees who were hired by the evening shift and expected to work in blood bank (generalists) who were totally unsuitable to work in blood bank. Fortunately management listened. It helps to have a very involved Medical Director.

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We've had some struggles with employee performance (though not for lying recently, thank goodness!). After we discussed the issue  among section supervisors, we came up with a form that documents what the area of improvement needed is exactly, what is expected of the employee to correct the problem and when we will reevaluate for improvement. The employee has the opportunity to specify what he/she needs from us, in terms of education or retraining, to be successful. He/she them is asked to sign off on the plan. After the specified period of time, the employees performance is reevaluated and that is documented on the form in as much detail as needed. We state whether or not performance is satisfactory. That way we have all the details for HR, if it comes to that. For some of our employees, just putting them on notice that they aren't working up to standards by using the form has worked wonders. It may not work for your guy, but at least you've got it in writing.  Management can't say they weren't told. Scary situation. I agree with tricore - you have to document in great detail and definitely involve your Medical Director, if you can.

Opportunites for Improvement.docx

Edited by AMcCord

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WELL I HAVE DOCUMENTATION OF EVERYTHING AND IT JUST DOESNT SEEM TO PHASE MANAGEMENT. THEY WANT TO EXTEND HIS 60 DAY PROBATION PERIOD UNTIL he gets signed off in BB

WHICH I DO NOT WANT TO SIGN HIM OFF AS COMPETENT.

So here is another scenario. After an email was sent out to everyone that he is can now only do TSC's, he performs a CORD blood on the Provue and verifies the results out. He is asked why he performed the CORD blood and states that a midnight shift tech watched him do everything.

But I still said in the email, only TSC's. So my management doesn't think this is a big deal, along as someone watched him. My point being, he still did not listen to me.

Am I just freaking out for no reason, or should I just let it go...??? I don't know what to do

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Scary times when management will not hear our cries whether it be a dangerously short staffed lab or dangerous staff that are putting patient safety at risk. Is there anyone else that can also account for these happenings and go with you to have a talk with HR along side your superiors?  Power in numbers. 

Edited by Gnapplec

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9 hours ago, KTUCK said:

WELL I HAVE DOCUMENTATION OF EVERYTHING AND IT JUST DOESNT SEEM TO PHASE MANAGEMENT. THEY WANT TO EXTEND HIS 60 DAY PROBATION PERIOD UNTIL he gets signed off in BB

WHICH I DO NOT WANT TO SIGN HIM OFF AS COMPETENT.

So here is another scenario. After an email was sent out to everyone that he is can now only do TSC's, he performs a CORD blood on the Provue and verifies the results out. He is asked why he performed the CORD blood and states that a midnight shift tech watched him do everything.

But I still said in the email, only TSC's. So my management doesn't think this is a big deal, along as someone watched him. My point being, he still did not listen to me.

Am I just freaking out for no reason, or should I just let it go...??? I don't know what to do

If the midnight shift tech did allow him to do this, then there should be signed and dated documentary evidence from this midnight shift tech that they did indeed watch him do everything, and then, if it were me in charge, the midnight shift tech would have to explain to me, in words of one syllable why they had disobeyed my instructions in my email.

I agree entirely with the posts above that you MUST take this to HR, and take others with you if you possibly can.

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You are to be commended for going the extra mile to ensure safe patient care.

Like others here, i would suggest at this point that you put all of this stuff into a document (impassionately written of course).  End with your concerns about patient safety, corporate compliance, etc.  Be sure to list all of the management people you have alerted with dates.  Then send the email it to all management and administrators above the BB and Lab (including directors and V.P.s)   You should have a corporate compliance officer you need to send a copy to as well.

Hopefully some responsible person will realize that they can no longer ignore a disaster waiting to happen, as you will have created proof that all responsible parties were alerted.  

Scott

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As everyone else said, document, document, document.  This person is a huge risk to patient safety which should send up red flags to everyone and it's also a risk to your hospital to have someone of this caliber in your lab.

Do you have an HR counseling policy, I've used it to document unsatisfactory technical performance or a violation of organizational values and mission.  Start with a verbal warning/discussion.  "No you may not do a DAT test without having your competency signed off".  After the verbal (document this) then take it to a level I (or whatever your HR calls it), refusing to follow policy and procedure, unsafe patient care, tie this to something in the counseling framework.  Get input from HR with this.

At the time of the Level I, reiterate that if this behavior is observed  again this will take the counseling to a Level II.  At this point the tech may need to go on a "highly structured performance improvement plan" which I've seen done in conjunction with the employee.  Goals are set, timeframe for touch base meetings set, feed back sessions on progress.  You are giving them the benefit of the doubt and this is fair to the employee in question.

Usually if the performance improvement goals aren't met, bye bye, adios, das veydanya.  You can't do this alone, you need upper management and HR involvement because this could become quite unpleasant for everyone involved.  Especially a patient.  

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