Quality school: an innovative approach to laboratory quality practices training.

The quality management program in the Division of Transfusion Medicine at our institution had evolved to the point that the program generally was perceived to be the sole responsibility of our Quality Unit (which was administratively independent of day-to-day operations). It became clear that this administrative model was counterproductive to our new goal of instilling a responsibility for quality into every work level of our division. Such a culture change requires a considerable, organized educational effort. Quality School was established to meet these particular educational needs. The details of the modular structure of the courses and the initial results of their implementation are described. This Quality School approach was developed specifically for transfusion medicine, but the principles could be applied to any clinical laboratory.

Ordering blood for the wrong patient--getting inside the minds of ordering physicians.

OBJECTIVE: To assess the impact on ordering errors when physicians stopped handwriting patient identifiers on requests for blood transfusion. MATERIAL AND METHODS: Physicians, frustrated by the amount of time required to complete paper forms to order blood, asked if the requirement for handwritten patient identifiers, which were in addition to such information "stamped" on blood requests, could be eliminated. We acquiesced to the request, modified the blood ordering forms accordingly, and continued to monitor ordering errors. RESULTS: After elimination of the handwritten identifiers in 1997, ordering errors increased from an annual rate of 1 in 10,000 to 6 in 10,000 blood requests by late 1999. We alerted the clinicians by newsletter, and the rate decreased somewhat (3 in 10,000 requests). However, the error rate did not decrease to its previous level of 1 in 10,000 requests until mid-2001, about 2 1/2 years after reinstitution of the requirement for handwritten patient identifiers. CONCLUSION: An obligatory second entry of demographic identifiers on a blood order requires ordering physicians to carefully consider the identity of the patient receiving a transfusion and reduces the likelihood of transfusion of an unintended recipient. Error management tools, such as a predetermined method for planning, reviewing, and documenting all changes, facilitate detection of trends and responses to corrective actions.

Evolution of quality management: integration of quality assurance functions into operations, or "quality is everyone's responsibility".

The management of quality in the Division of Transfusion Medicine at our institution has undergone a lengthy, sometimes painful but always progressive evolution over nearly four decades. Initially, it consisted of one laboratory technologist who was assigned the task of performing certain basic QC checks on a predetermined list of laboratory, collection, and processing steps. This technologist reported directly to the medical director. The tasks gradually grew in volume and complexity so that a four-person quality unit was established, administratively quite separate from the operations and accountable only to the Medical Director. The next stage in the evolutionary process was more revolutionary in scope because it involved a comprehensive cultural shift toward the concept of "quality is everyone's responsibility." The evolutionary process in our institution to date and the planning and organization involved in the direction and management of the evolution itself are described.