Hello All:

What quality control measures are employed in your laboratory, if any, to ensure that "miscellaneous" supplies are received from suppliers in working condition before they are put into use? By miscellaneous, I mean supplies that are not necessarily considered as "critical" as reagents, blood products, or equipment are.

We've recently had a couple of incidents in our laboratory that have inspired us to investigate the possibility of performing formal quality control on some of the supplies that we receive in the lab. One was that a supplier shipped some ringers lactate in a box that was supposed to be entirely 0.9% NaCl bags for our cell washer. (As the bags look identical, this went unnoticed until a tech attempted to use one of the ringer's lactate bags to deglyc a frozen unit - luckily it was outed as an incorrect bag before washing began.) Another is that we received a box of the sticky labels that we use to identify a unit as intended for a specific patient that turned out to not be adequately "sticky" and received several calls from nurses that the labels ripped right off of the units quite easily.

I'd love to hear what some other labs out there are doing!

I do inspect labels for accuracy, stickiness, correct color. Critical materials are inspected when received - I include component sets, saline, parts and misc stuff for the Echo, etc - but this is basic: packaging intact/sealed, correct item received, lot # and OD, does the product look 'normal', whatever seems appropriate for the item. We use a lab variance form to document issues relating to problems with supplies discovered after they are put into use. This would cover all supplies, including non-critical. Faulty/dirty/broken test tubes would be included under non-critical. The variance form has a box to check for vendor, instrument, supply, etc. and an area on the back of the form to document what the problem was and what was done to deal with the problem.

We are preparing to do a CAP re-inspection in a hospital that had a CMS validation inspection after their last CAP. One deficiency cited by CMS was lack of 'blood bank saline quality control'. Has anybody heard of such a thing? What do you suppose they want? Reportedly the CMS team (of 11) was there a whole week. This is a 180 bed hospital.

On some cubes of saline it is recommended (not mandated) that a DAT be performed daily to r/o contamination. There is a difference in the meaning of MUST vs SHOULD. If it is must - you gotta do it; should is up to you. I have found my BB saline to have a >100,000 colony count after 30 days. I have never qc'd saline, but I do qc my gel diluent. If my saline was contaminated I should get spurious reactions which would require further investigations. Never seen it.

I include saline in my daily QC for tube testing, but keep it simple. I use a paper form, each form is good for one week. Front side has the results of the testing performed daily. Back side has a listing of all reagents, including saline, with lot #s and outdates. Each day, each reagent gets a check mark if appearance and performance are OK or an X if they are not OK. Saline is supposed to be clear and colorless in appearance and when I use it to wash AHG tests, I should get the results anticipated for the reagents used in that tube. If an AHG reaction is not what it's supposed to be, it's probably because someone put the wrong reagent(s) in the tube and a repeat should fix it. If that doesn't work, then it may be a reagent problem, which would include the saline. Of course, we can't continue to perform testing if a reagent gets an X, so there shouldn't be one without documentation that an investigation occurred and perhaps a new lot of a reagent or reagents was opened, tested and found acceptable. There is a spot to document lot changes and comments which would include the new QC/troubleshooting/etc. If everything comes out OK that day, the saline box on the form gets a check mark. I've never had to give the saline an X.

I've been inspected by the state for CLIA validation following a CAP inspection and by CMS for validation after a Joint Commission inspection - both in the last 3 years. Passed both without any comment made about QC, so at least those inspectors didn't have a problem with my QC.

Edited January 19, 201213 yr by AMcCord

Thank you so much for your input and help!

Annadele

We do not use our saline cube past 30 days from the opening date.

We do not use our saline cube past 30 days from the opening date.

Same here.

We do not use our saline cube past 30 days from the opening date.

Ditto

thank you so much i had worked recently in quality control department i had some difficulties please any information you got paste ...

thank you