Reviewing UKTLC Standards

[Rashmi]

Dear Colleagues,

Please note that the transfusion collaborative is in the process of updating the current Standards: https://www.shotuk.org/resources/current-resources/ which can be found at the bottom of the page.

UK Transfusion Laboratory Collaborative: minimum standards for staff qualifications, training, competency and the use of information technology in hospital transfusion laboratories 2014

If you have any suggestions for improvement/ inclusion please let me know. Changes to these standards will be discussed at the July 2018 SHOT meeting.

Many thanks!

[Rashmi]

Example of improvements could be:
1. Including the Transfusion Practitioner role- which is essential for lab interaction with the clinical areas.
2. Quality support for the Transfusion team at an appropriate level of understanding.
3. MLA support
4. BBM and Seniors to be able to demonstrate regular attendance at professional local meetings eg TADG
5. Capacity plans to include protected time for all staff to do serology competencies eg IPEx and BTLP TACT .

The TLC Standards are to help improve safety for your staff and patients, so please share your ideas on this forum.

Thank you.

[Simon Ennis]

Rashmi
I think there needs to be some raising of the profile of the BSQR to the senior execs within the hospital setting for TLC to really work. Until such times as it gets equal coverage as CQC they will not worry. As long as the service is within budget they will be happy, blaming bad training and errors on the BMS's not the system. As we heard today Inspections seem to be highlighting this decline since 2016. Some SHOT reports have even give mention that lack of response from senior management was a key factor in errors. How do we raise this problem?

[Rashmi]

Hi Simon,
Senior execs within our hospitals should by now be very aware of the BSQR via the BCR sign-off process. I believe there may be some changes being introduced shortly, and clarification that may help will soon follow on this Forum .

For the TLC Standards to work requires us all to strive towards meeting them ( and I agree it is a challenge ), in this way they continue to be regarded as industry standards, and supported by the inspecting bodies. This is the importance of stating your staffing requirements to safely run your service via your Capacity plan.
How we as individuals raise and escalate difficulties in maintaining safe practices and regulatory requirements to our senior managers is becoming an issue.
Can we address the following?

• We have written evidence of highlighting concerns to our line managers and escalating them through our quality systems/ processes so there is full visibility.
• We have a written response (documented in meeting minutes) to our concerns

• Do we have ‘black holes’ in the process of reporting via our multitude of ineffective meetings- with no feedback on how we are to manage the situation?
• Are these issues on the risk register- or are some BBMs not allowed to raise this on the register? (again, where is the evidence)
  

Someone once said to me that – you need to do what you can in your scope, and document what you can’t do, otherwise we will all be driven mad by thinking we are forever failing our patients and as importantly ,our staff.

If senior managers are blaming staff for making errors rather than considering system-wide issues I would refer them to the Francis Report and the Don Berwick reports- they obviously need educating , and the UKTLC would be very interested to be kept informed of which hospitals / Pathology labs that this is occurring. This culture is dangerous and to plead ignorance on their part is not an excuse when someone is harmed.

Thanks for posting, it's really important we all continue to discuss these things.

bw

[Chris Robbie]

Hi Simon

Early assessment of SAE reports for the MHRA chapter have actually shown fewer SAEs associated with resource and staffing issues. This would be at odds with the findings of the UKTLC surveys and MHRA inspection findings. It is likely that this is because the thoroughness of investigation and SABRE report writing is either not making the link between the actions of staff and the pressure they are under, or it is overlooking it as the reporter feels unable to put in any CAPA.

It is vital that when making an SAE report, if the problems are genuinely linked to staffing and workload problems, this is highlighted, even if the reporter is unable to address the problems. For example, if an error was due to a BMS rushing and forgetting a step, but they were working in a team of 2 when the minimum staffing level should be three, then say so. If you have requested a vacancy to be filled and either resource isn't available, or applicants not suitable, then say so. The more information that comes to us that reflects the actual situation, the more evidence we can provide to demonstrate this.

When I review SABRE reports, and add sub-categories, if I can see problems like this, not only will I be able to highlight it in future MHRA SHOT chapters, but I can also highlight it to MHRA Inspectorate. They can then make a decision whether this alters the BCR risk score sufficiently to decide whether further regulatory action is required.

[Simon Ennis]

Rashmi
Good response! I keep asking SHOT for some sort of feed back that might link Human Errors/Factors with numbers of e.g. locums?? SHOT reporting pages very helpful in discerning about the causes/systems failure, and this should be preached to the execs too!
BW

[Simon Ennis]

Chris
Is this as complex as I make it sound? (I agree with you BTW) but I wonder if reporters are worried that they will get into trouble or even trigger an inspection so the truth is not always out there, whereas the UKTLC is more introverted despite being made available to MHRA. Perhaps, thinking cap on, the UKTLC response should be part of the BCR staffing section?? In days gone by people used to associate workload with numbers of staff required, but for various reasons today this is more complex with automation etc....
kind regards

[Rashmi]

Hi Simon,
The MHRA has already responded to concerns- as evidenced by their last BCR question on adequate staffing levels. However, via various sources it was apparent that some BBMs were pressured into indicating that all was fine.

As I have mentioned at meetings, if anyone ever tries to coerce me to give information that I believe is false/inaccurate on the BCR (a legal document), then I will certainly not put my name on the declaration page. Something perhaps the regulators need to look into- does the BBM sign this as completing or is this out of their sight and control?

We need to stand up to this culture of fear and bullying if we want to see progress and improve safety in our labs, but , as BBMS we also have a responsibility to make sure the evidence to prove under resourcing is available. It is a balancing act and a recipe for overload , and the reason for better networking , talking on forums, sharing stuff, perhaps visit colleagues at other labs to find out how they manage their issues. I certainly could not have coped over the last few years without the incredible support of friends and colleagues

bw

[Rashmi]

Just to update you on the progress with revising the UKTLC Standards, 2014 - we are also looking to change the name

from:
UK Transfusion Laboratory Collaborative: minimum standards for staff qualifications, training, competency and the use of information technology in hospital transfusion laboratories2014

to something along the lines of:

Quality Standards for Transfusion Laboratories: Assuring Patient & Staff Safety

The TLC group would appreciate your comments on both the name and current content– so please post any ideas or suggestions to improve this. This is your chance to be involved and influence what goes in these revised standards before we complete the draft.

Many thanks!
Rashmi

[Simon Ennis]

Rashmi
Sounds Good. We need some tie in with the original re qualifications/experience and what is expected from e.g. MHRA of a person in day to day charge of running a hospital blood bank. I think there was a document linked with SABRE registration or am I getting old?? And then agreement on the structure below. Question; would transfusion practitioners (SPOTS) be expected to be part of the laboratory? Ours are soon to move to a different division but do the same, as you describe, important job linking between us and the wards. I look on the BBM role as being like a PUB with your name over the door as the registered (licensed) person.
happy Easter All
Simon