Hello all,

 

Reviewing our tech's competency assessment for 2013 thus far - and I have a few questions for all of you that I'm hoping you can help with:

 

1.  Regarding the 6 elements - we have direct observation checklists that account for 5 of the 6 of these.  However, we always struggle with the "assessment of test performance through previously analyzed specimens, internal blind sample testing, CAP specimen, etc..."  If a tech has completed a CAP survey for a testing procedure - this counts for that.  However, we have many more techs than CAP specimens.  Do you create blind samples for everyone for each procedure?  Seems like a HUGE job.

 

2.  Which brings me to this: What do you do to satisfy this element for the tests that you perform infrequently?  In our case in hematology/coags - I've got Kleihauer Betke stains and sperm screens I'm most concerned about (post-vasectomy only).  To create a "blind sample" for everyone to complete a Kleihauer would be extremely time consuming and expensive (we'd blow through tons of kits doing this).  And, I don't even want to get into the logistics of a sperm screen "blind sample" - how do you fake this one?  lol

 

Obviously, there are options and ways around these things - I'm just trying to get a feeling for what everyone else does.  Any help you could provide would be great.

 

Thanks,

 

Kristen

For Kleihauers we make up dummy ones from patient samples - add 1 drop of cord or baby blood to 9 drops of male whole blood, then take one drop of this mix and add to a further 9 drops of male whole blood. Using this basic ratio we adjust slightly to mimic a set volume bleed and then use this as part of competence assessment.

 

It's been a long time since I've done a male fertility test, so I'm afraid I'd be no help there...

Auntie D - so you do actually have every tech perform a Kleihauer?  Do you coordinate this by getting everyone together and using the same stain?  I'm just thinking of the logistics of having 20 techs across 3 shifts perform this - we would use up at least several kits doing this.  Seems like a lot for a test we perform maybe once every few months...

Every tech that does not perform a proficiency sample (CAP or NYS) would get an unknown. And yes, you will use more reagents. We were going to bring additional tests in this year and decided against it strictly from the competency issue.

Auntie D - so you do actually have every tech perform a Kleihauer?  Do you coordinate this by getting everyone together and using the same stain?  I'm just thinking of the logistics of having 20 techs across 3 shifts perform this - we would use up at least several kits doing this.  Seems like a lot for a test we perform maybe once every few months...

 

Yes every tech has to prove competency. We are a medium sized lab in the UK, with about 20 BMSs and we do about half a dozen Kleihauers a day.

 

I don't understand how you would use up several kits though - it takes about 2ml of stain per person doing it so even if 20 people do it, it is still less than one bottle of reagent.

 

When we get our national EQA in (the one that we report to the 'big bods' in grubbyment then we rotate who does it so that everyone does one a year.

 

So basically we have an internal competence and an external one that are staggered so that everyone does one every 6 months.

 

I believe for every test we do that is infrequent, competencies are essential for both guaranteeing the quality of the test, but also to give people the confidence that they are doing their job well. If we get a positive malaria screen we get everyone in the lab to speicate it and do a percentage parisitaemia if necessary - this then gets logged in their training folder.

 

We have a fairly robust training system and anyone who doesn't have up-to-date competencies is hounded to get them done lol

Thanks everyone for all the replies!  It is interesting to see what everyone else does to handle some of this...

 

Can anyone tell me what kit/reagent you use to perform Kleihauers?  We use the Simmler kit - which is why I'm thinking we would go through alot of kits to complete a competency for everyone. 

 

Also something I'm wondering - does everyone / every shift do Kleihauers in your lab?  There was a suggestion to only have day shift perform these, but I know there is a question of stats - which can come in at any time...  Then again, we do have 72 hours to administer Rhophylac... thoughts???

Kholshoe-

 

Not sure if this will be helpful or not but we (Hemo bioscience) have a line of Educational Reagents (simulated patient plasma) traditionally used in MT/CLS programs that I know have been purchased in the past for that very component of competency assessment. If you'd like any info on those, please let me know!

 

Good luck with your Competency Assessment!  I am attending a webinar on CLIA and its latest changes next week mainly out of curiosity. Quite the process! Whoa!

 

Adele

On 11/25/2013 at 1:07 PM, Auntie-D said:

For Kleihauers we make up dummy ones from patient samples - add 1 drop of cord or baby blood to 9 drops of male whole blood, then take one drop of this mix and add to a further 9 drops of male whole blood. Using this basic ratio we adjust slightly to mimic a set volume bleed and then use this as part of competence assessment.

 

It's been a long time since I've done a male fertility test, so I'm afraid I'd be no help there...

can I ask you your reason for selecting Male whole blood?

I am thinking to use RH Positive CORD with RH Negative whole blood so I can use the specimen for Fetal bleed and K-B Stain.

Everyone please give your input...

At my other job, one tech made the slides, but every tech was responsible for reading them and calculating results.

We have made up special written tests for those techs that don't have a chance for a CAP and for some of our more expensive or extensive testing (P2Y12, bone marrows, and semen analysis). The questions are put in such a way that the tech is forced to pull the procedure and actually go through it to come up with the answers.

On 12/20/2015 at 7:24 PM, Eagle Eye said:

can I ask you your reason for selecting Male whole blood?

If you select a female they may be pregnant and have foetal cells in the blood - thus making your negative control positive. I suppose for a dummy one it doesn't really matter but we just use our premade pos and neg controls for competencies and that's how we make them.

Thank you