Perhaps I am splitting hairs here, but it has come up for discussion; so.....

We perform Daily Reagent QC on our routine testing QC racks, every day on the day shift (usually first thing in the morning). With regard to QC of Reagents which are not part of the routine grid in our computer system (i.e. Poly AHG, C3 and PeG because we do not routinely use these reagents on a daily basis), I have been saying the same thing as for the Daily Reagent QC Rack; once daily. According the Technical Manual the frquency of QC should be Day of Use.

Our computer systrem (where we enter our QC results), gives the expiration of any of the QC'd racks as 2359 of the "following day." So a Rack QC'd today (05/27) would expire at 2359 05/28. Now the routine Daily Reagent QC racks are QC'd on the morning shift (so not only daily, but approx the same time each day). While we have that extra time as a function of the computer, I have always done QC of the routine racks each morning on the day shift. So now the question comes up with regard to the reagents that we only QC on the "day of use." Staff are tryiing to say then, for example, if Poly AHG was QC'd today at 0700, testing can continue to be performed without repeating the QC until 2350 of the following day.

How do all of you handle QC of reaents that you do not routinely use every day (i.e. rare antisera;

anti-C3; etc.)?

Thanks ahead of time for your input.

Brenda Hutson, CLS(ASCP)SBB

To avoid just such confusion, we go by calendar date. Yes it is possible to be forced to perform QC two times within a few minutes around midnight, but this is a very rare occurrence for our facility. I would think to err on the side of conservative would be the better choice. As a blood banker I prefer to be sure of my QC of process and reagents vs. skimping on them given the importance of the testing performed in our department (just my opinion).

I do the same thing you do Brenda, I QC the reagents each day of use. So yes it would be until 2359 of the same day.

I do the same thing you do Brenda, I QC the reagents each day of use. So yes it would be until 2359 of the same day.

I can't quite tell from your e-mail if we "do" perform it the same way. So if we QC a reagent (or Rack) today (05/27), that QC is actually good "in our computer system" until 05/28 @ 2359 (so approx. 40 hours later). For the Daily QC of the routine testing rack, we always do that every morning on the Day Shift (so that really has approx. 24 hours). But for Poly AHG, anti-C3 and PeG (reagents we only use as needed), we just QC them if we are going to use them. However, the expiration would then work the same way it does for our daily rack; if I QC Poly AHG anytime today (05/27), it will expire 05/28 @ 2359. So what I am saying I guess is that I feel more comfortable with not letting it go past 24 hours (so approx. the same time the next day) whereas some staff are now telling me that they are using the "computer expiration" for the "QC as needed" reagents.

I'm not sure that is what you are saying you do????

Thanks,

Brenda

Perhaps I am splitting hairs here, but it has come up for discussion; so.....

We perform Daily Reagent QC on our routine testing QC racks, every day on the day shift (usually first thing in the morning). With regard to QC of Reagents which are not part of the routine grid in our computer system (i.e. Poly AHG, C3 and PeG because we do not routinely use these reagents on a daily basis), I have been saying the same thing as for the Daily Reagent QC Rack; once daily. According the Technical Manual the frquency of QC should be Day of Use.

Our computer systrem (where we enter our QC results), gives the expiration of any of the QC'd racks as 2359 of the "following day." So a Rack QC'd today (05/27) would expire at 2359 05/28. Now the routine Daily Reagent QC racks are QC'd on the morning shift (so not only daily, but approx the same time each day). While we have that extra time as a function of the computer, I have always done QC of the routine racks each morning on the day shift. So now the question comes up with regard to the reagents that we only QC on the "day of use." Staff are tryiing to say then, for example, if Poly AHG was QC'd today at 0700, testing can continue to be performed without repeating the QC until 2350 of the following day.

How do all of you handle QC of reaents that you do not routinely use every day (i.e. rare antisera;

anti-C3; etc.)?

Thanks ahead of time for your input.

Brenda Hutson, CLS(ASCP)SBB

The place where I've set up the QC.....it is "each day of use per Tech"

Because they are rarely done most likely it would be once a day. It gives the techs who rarely rotate through blood bank confidence and you can use it as part of competency etc... Nobody has to keep track of who did it last and when. It will be easier also for the QC reviewer. It also solves some LIS problem...wherein the system won't let you proceed unless QC result has been entered. It sounds a little overkill...but if you find QC is being done on each shift then I think it should be part of daily QC.

The place where I've set up the QC.....it is "each day of use per Tech"

Because they are rarely done most likely it would be once a day. It gives the techs who rarely rotate through blood bank confidence and you can use it as part of competency etc... Nobody has to keep track of who did it last and when. It will be easier also for the QC reviewer. It also solves some LIS problem...wherein the system won't let you proceed unless QC result has been entered. It sounds a little overkill...but if you find QC is being done on each shift then I think it should be part of daily QC.

Just to clarify; the QC for antigen typing is usually done each time someone performs antigen typing (in that the LIS will always require them to enter the results for POS and NEG controls each time; a good practice in my mind anyway as it will help ensure you added the antisera).

However, the Poly, C3 and PeG are just specific grids set up to QC those individual reagents when used. So if someone has to use 1, they could always look in the testing results for that day and see if someone else already QC'd that reagent. But that is then where my question comes in; what if they QC Poly AHG at 11am today and get another order at 2pm tomorrow? I am saying I want them to perform the QC again tomorrow and they are saying that according to our LIS, the QC from today is good" until 2359 tomorrow night.

Brenda

The tech's day ends when they go home for that day. It did not matter whether AM tech performed it for that day a PM tech still have to perform the QC. And if it happens same tech comes in the next day...they would have to perform the QC. You can still set up your LIS to have the minimum QC per day (also set up LIS to allow your techs to enter QC results more than once per day) which meets the minimum standard BUT your techs have to follow your QC policy (i.e. frequency)... no ifs and buts about it. Nobody can say I don't have to perform QC because it was done 23 hours ago. These tests are rarely done that's why most techs are more comfortable performing the QC. Nobody have to worry about the hour and minutes the last QC was done, The only thing the daily and QC reviewer have to check was...if tech A performed the test, did tech A perform QC for that day. Other techs do not have to verify if someone else performed QC before using that particular reagent.

Edited May 27, 201015 yr by vilma_mt

The tech's day ends when they go home for that day. It did not matter whether AM tech performed it for that day a PM tech still have to perform the QC. And if it happens same tech comes in the next day...they would have to perform the QC. You can still set up your LIS to have the minimum QC per day (also set up LIS to allow your techs to enter QC results more than once per day) which meets the minimum standard BUT your techs have to follow your QC policy (i.e. frequency)... no ifs and buts about it. Nobody can say I don't have to perform QC because it was done 23 hours ago. These tests are rarely done that's why most techs are more comfortable performing the QC. Nobody have to worry about the hour and minutes the last QC was done, The only thing the daily and QC reviewer have to check was...if tech A performed the test, did tech A perform QC for that day. Other techs do not have to verify if someone else performed QC before using that particular reagent.

Yes, I did "clarify" that with them today via a read and sign document (that it must be done per calendar day "at a minimum." If someone on the pm shift today decides to go ahead and perform PeG QC (for instance) rather than check to see if someone on the Day Shift performed it, that is fine with me. My concern was more with regard to not performing it frequently enough (which is why I wanted to see what others out there are doing).

Thanks,

Brenda

Routine reagent rack qc'd each day of use. good til next day. rares are qc'd each day of use, not with each run - qc is good all day.

We always consider "day of use" to be a 24 hour period. In practice, however, we usually use a calendar day. So if I QC the anti-E on first shift 5/27/10, it can be used by second and third shift into 5/28/10. First shift would have to QC it again on 5/28/10 if they needed to use it.

Our routine racks are done each day in the morning and those "days" are 24 hour periods (approximately - we don't have computer documentation and we don't record the time it was done, so it could shift a couple hours either direction).

I agree; rare reagent antisera QC is "technically" good all day. The reasons most of my staff do it with each run are:

1. We don't do a LOT on a daily basis (may days without performing any); so easier to just do than look up in computer

2. Our computer system will require controls to be entered for every batch of typings you result; so would have to look up previous control results, write them down, then re-enter them for subsequent

I agree; rare reagent antisera QC is "technically" good all day. The reasons most of my staff do it with each run are:

1. We don't do a LOT on a daily basis (may days without performing any); so easier to just do than look up in computer

2. Our computer system will require controls to be entered for every batch of typings you result; so would have to look up previous control results, write them down, then re-enter them for subsequent

Oops...hit Return accidentally...

...testing

3. Since not done even daily (and Generalists rotating through Dept.) I like them to have the controls to compare against the patient.

So, the only issue for me is really in regard to Poly AHG, anti-C3 and PeG in that we do not run them with out Daily QC Rack because they are used infrequently. So, they each have their own grid for QC in the computer.

Brenda

Are you using Mediware's HCLL blood bank system? At my last hospital they used that and it was set up that way so the night shift didn't have to do QC at 12:01 am otherwise it wouldn't let them report out STATs until QC was done. At that hospital we did QC our reagents on the day of use [including PEG, C3 etc] as per the AABB stds and CAP stds.

For those always doing QC on day shift, consider this CLIA requirement:

"Over time, rotate control material testing among all operators who perform the test." 42 CFR 493.1256 (d) (7)

When doing inspections I often find blood banks that are not aware of this.

To meet the requirement we have a QC schedule that includes all 3 shifts.

we fulfill that CLIA requirement through proficiency testing of all operators on all shifts throughout the year.

We do it like adiescast.