I can not get our techs to enter QC into the computer.   If I had to guess they aren't even doing the QC.

I'm just fuming right now. That I can't get grown up techs to think.  Just THINK.  This isn't rocket surgery!

 

Should I take away computer PRN QC and take it back to paper?

I feel like I've followed all the steps to get them to cooperate.. Emails, verbal communication.   Nothing is working.

If you have doubts about there performing (or not performing) qc what is to keep them from still not performing it if you use paper vs electronics?  Some computer systems can be set up so that if QC is not performed at defined intervals you cannot generate results . . .

If you are serious about them not performing but just entering results:  a) you'd have to prove it somehow; b - you'd have to file biologic product deviations everytime you transfused a product that was done with circumspect QC; c) - discuss with your HR folks, might have to terminate at least one to send a message.

I had a student once that did not do qc, unfortunately for her I had replaced her reagents with food colored saline.  My staff saw her dereliction, though she continued to deny . . . even though she did A work, I wanted to fail her but her coordinator convinced me to just give her the minimal passing grade.

GOOD LUCK with this one!

Well I know the daily QC is getting done at least 5 days a week because I do it 

 

It's the as needed QC I can't get anyone to enter like Poly DAT.     They say they are doing it but they forget to put it into the computer.

8 minutes ago, amym1586 said:

It's the as needed QC I can't get anyone to enter like Poly DAT.     They say they are doing it but they forget to put it into the computer.

Recording it is part of the process.  One of our accrediting agencies (the MHRA) say that, if it is not signed, it wasn't done, and if it is not signed AND dated, it is graffiti.  Whereas, I think that they go well over the top a lot of the time (and few have the guts to challenge them), I happen to think that they are right about this (and it hurts me to say so, believe me)!!!!!!!!!!!!!

I agree with Malcolm - it is part of the process.  What is going to happen when you get inspected and don't have the requisite QC documented?  You will have to have a response - might as well figure it out now and insist on compliance before that happens.  Document, document, document all the aberrations and techs responsible.  Bring it up at their annual review (I'd bring it up every time I found it).  Sometimes  you just have to play hardball and let the chips fall where they may.  Even worse scenario is what if there is some type of patient error and no QC?  You don't want to go there - it's not the tech that gets sued, it's the supervisor and Medical Director.

Edited February 29, 20169 yr by David Saikin
needed to add more stuff

I second David above when he emphasizes that each time a violation of P&P happens the tech should be disciplined in some way, even if its only a verbal or written warning.  And you can't ignore QC protocols.  This is the kind of stuff regulators look for.

You might want to do some kind of in-service for the entire staff, as it is probably more prevalent than you realize.  While you are at it, remind them that undocumented QC is QC not done as far as an inspector is concerned.

Scott

 

Thanks for the advice !

Time for hardball.  I really don't mind it as much as I thought it would.  I get a lot more work done when people are mad at me! 

 

I'll start with a full on in service.  My boss said after that if they still miss it print it out and make them sign it.  Then he said he would get involved with a written warning, a verbal warning and you're gonna  wish you put in that QC warning.

Bear in mind also:

if testing was performed without documented QC, and that testing was used as pretransfusion/compatibility testing for a unit of blood that was issued from your department, it requires a mandatory report to the FDA as a biological product deviation.

amym1586,

Depending on your BBK computer system, you can create a polydat test that cannot be resulted without QC (make the QC results entry part of the test results entry).

17 minutes ago, Dansket said:

amym1586,

Depending on your BBK computer system, you can create a polydat test that cannot be resulted without QC (make the QC results entry part of the test results entry).

Currently, I don't think there's a way.   We have our fetal screen set up to put in the positive/negative/ patient at entry. But there's no way for Lot numbers and things like that.  So they are having to also go to the LIS and enter the Lot  number and QC.

I am curious, has any of your staff provided a rational reason for this dereliction of duties beyond, "I forgot".  While not condoning what they are doing maybe the current system is cumbersome and difficult or at least very inconvenient.  Another question, is it wide spread, say more than 3 staff members, or are there some that actually comply?  If it is the majority of the staff who are having problems, this might be an opportunity to get them involved in fixing a perceived problem.  Stress the need for the documentation and ask them to come up with a system that will ensure it getting done accurately and at the time of testing.  I found over the years that if the staff come up with solutions to problems they are much more likely to comply, and quite often came up with something much better than I could have.  On the other hand, their solutions are not always acceptable but should at least be considered and if rejected an explanation of why should be forth coming. 

There you go, a little more philosophical drivel! 

6 minutes ago, John C. Staley said:

There you go, a little more philosophical drivel! 

Certainly NOT drivel!

1 hour ago, amym1586 said:

Currently, I don't think there's a way.   We have our fetal screen set up to put in the positive/negative/ patient at entry. But there's no way for Lot numbers and things like that.  So they are having to also go to the LIS and enter the Lot  number and QC.

Are you sure?  A test name, a lot number and an expiration date is not much different than a test result!

1 hour ago, John C. Staley said:

I am curious, has any of your staff provided a rational reason for this dereliction of duties beyond, "I forgot".  While not condoning what they are doing maybe the current system is cumbersome and difficult or at least very inconvenient.  Another question, is it wide spread, say more than 3 staff members, or are there some that actually comply?  If it is the majority of the staff who are having problems, this might be an opportunity to get them involved in fixing a perceived problem.  Stress the need for the documentation and ask them to come up with a system that will ensure it getting done accurately and at the time of testing.  I found over the years that if the staff come up with solutions to problems they are much more likely to comply, and quite often came up with something much better than I could have.  On the other hand, their solutions are not always acceptable but should at least be considered and if rejected an explanation of why should be forth coming. 

There you go, a little more philosophical drivel! 

To leapfrog off of John, from a quality perspective: "human error" should be considered a contributing factor and never your final conclusion of the investigation of a nonconforming event.

3 hours ago, John C. Staley said:

I am curious, has any of your staff provided a rational reason for this dereliction of duties beyond, "I forgot".  While not condoning what they are doing maybe the current system is cumbersome and difficult or at least very inconvenient.  Another question, is it wide spread, say more than 3 staff members, or are there some that actually comply?  If it is the majority of the staff who are having problems, this might be an opportunity to get them involved in fixing a perceived problem.  Stress the need for the documentation and ask them to come up with a system that will ensure it getting done accurately and at the time of testing.  I found over the years that if the staff come up with solutions to problems they are much more likely to comply, and quite often came up with something much better than I could have.  On the other hand, their solutions are not always acceptable but should at least be considered and if rejected an explanation of why should be forth coming. 

There you go, a little more philosophical drivel! 

That's a great idea.   When our previous supervisor left a few months ago (putting me in charge) he said that the as needed QC was something he wasn't focused on and suggested I try to get more involved in it.  So Im guessing they've all be very lax about doing over the last few years.  

3 hours ago, Dansket said:

Are you sure?  A test name, a lot number and an expiration date is not much different than a test result!

I'll definitely ask.  We are getting ready for an upgrade on the system. So I'll bring it up to see if it's an option. 

On 3/1/2016 at 2:36 PM, Dansket said:

Are you sure?  A test name, a lot number and an expiration date is not much different than a test result!

I added tests to result QC results, Lot # and Expiration date to our FHB battery, as well as our KB.  They are free text fields.  This way these are all documented at result entry and are filed with the specimen results.

Cool. Since we are gearing up for an upgrade from Version 3.8 to 3.11    Quite a big jump and I never got trained on the guts of this BB system they are going to ask to have someone from a build team come and help us.  So I'm definitely going to see if I can incorporate QC !

I would document continuous non compliance and go with progressive discipline. Luckily we do not have this problem but my tech knows that if they missed QC or they had failed QC....My director will make sure that we repeat every specimen gets repeated related to that particular QC. 

Do that....make them repeat all tests which were performed that day. You might need to show that to inspector as if you do not have QC results and no corrective action....you will be in ....

 

On our previous computer system we had the option to write in the lot number and expiration date of the antisera when we were antigen typing. But it was really cumbersome and time consuming. It was also hard to tell if someone had done QC on a particular antisera for the day and if we didn't know we would have to repeat it. So, we went back to writing on paper and it seemed to work better for us. We can flip open the book and tell at a glance if we need to do QC on JkB antisera no matter what shift you are working. The computer is a great aid but not always the best answer.

 

 

1 minute ago, DebbieL said:

On our previous computer system we had the option to write in the lot number and expiration date of the antisera when we were antigen typing. But it was really cumbersome and time consuming. It was also hard to tell if someone had done QC on a particular antisera for the day and if we didn't know we would have to repeat it. So, we went back to writing on paper and it seemed to work better for us. We can flip open the book and tell at a glance if we need to do QC on JkB antisera no matter what shift you are working. The computer is a great aid but not always the best answer.

 

 

As much as I love to go paperless/electronic, this is how we do it also.

I think with your upgrade coming you have the opportunity to educate, have the techs show competency and then make it part of SOP.  First time you have a non-conformance you start the "verbal warning" process. If it continues ti goes to a written counseling. 

Bet ya once someone gets counseled for this things will start to turn around.  No one wants a counseling on their record, I guarantee it.