WPCR  SfK<$[L(r frQqtJ/x];=r1tc?3 y4i A_@40qՂkILΪŚo!l=I1&T~@O Unrm9Adq&|ÌJkwQ@ӡ2_V^NTG`Ud]mp#X<1Ja'rАYNYL42únvrIymX:wq)rkhYL66 M֣ s"Gsz{3!nqvdmܳߝ!/Vܜw7 ߢ󖠘wOPYKVuqRjl5A*d!|fg'1.4} MR#U: %$*n:N 0( 0DUN#U.qU@Ew4 m #UH ^ ) ) ) ) ) ) ) B5 <6X9`("Courier 10cpiX#|x<6X9`("Courier 10cpiXx6X@8;X@($   )  _9 X^XXXA" ) xdE9W!A X #X^XX X^G# Xr*XXX^ X Xr*XV.QualityAssuranceintheBloodBanktt>T$MLAB2431  164  # ##X^X#(3$ !  (9 Z 6Times New Roman Regular<6X9`(Courier(G Z(Times New Roman a1 @UHhp LaserJet 1300 PCL 5e,,,,0*a} Z0Ultra Shadow RegularxH2  d !  _XHHX      eXX8^XXdd8   e_XV.0 @ Quality_ԀAssuranceintheBloodBank# Xr*X #  X  &( %X Xr*A.0  Overview~&$$ 0  1.0$$Goals.$$ 0  0$$ $$ 0  0$$a.0P $$SafetransfusionP $P $ 0  0$$b.0P $$Carefuladherenceto_SOPs_Ԁbytrainedpersonnel 6P $P $ 0  0$$c.0P $$Developcomprehensiveguidelinestobeincompliancewith_JCAHO_,FDA,_AABB_ԀandCAP>  P $P $ 0  2.0$$Terms $$ 0  0$$a.0P $$ Qualitycontrol isthemanagementofthetestingprocessitself.F P $P $ 0  0$$0P $$1)0 P $P $MonitoringofequipmentandinstrumentsR  $ $ 0  0$$0P $$2)0 P $P $Determiningthatreagentsarereactingappropriately.* $ $ 0  0$$b.0P $$ QualityAssurance includestheentireprocessofprovidingpatientcare,fromthetimethe  physicianordersthetestuntiltreatmentofpatientbasedonresultsoftest.^P $P $ 0  0$$0P $$1)0 P $P $Wereappropriatelabtestsorderedtodeterminetheneedfortransfusion.f $ $ 0  0$$0P $$2)0 P $P $Didthetransfusionserviceperformappropriatetestingofpatientspecimenand  preparationoftheappropriatecomponent $ $ 0  0$$0P $$3)0 P $P $Wasthetransfusionadministeredproperly.F $ $ 0  0$$0P $$4)0 P $P $Didthepatientobtaintheanticipatedbenefit.N $ $ 0  0$$c.0P $$ Utilizationreview istheprocessofmonitoringtheappropriatenessoftransfusion.P $P $ 0  0$$d.0P $$ Continuousqualityimprovement involvesreviewingtheprocessofprovidingpatientcare Z! withthegoalofreducingrework,wasteandinappropriatecare.6"P $P $ B.0  RecordKeeping>!$$$ 0  1.0$$Documentationiscriticalandmustinclude:" &$$ 0  0$$a.0P $$Qualitymonitoringstandardsbasedonregulatoryandaccreditingagencies$F"(P $P $ 0  0$$b.0P $$Writtenplananddocumentationoftestingandreviewmustbeavailabletoinspectors.v%#)P $P $ 0  0$$c.0P $$DesignformsforrecordingQCandqualityassessmentactivitiestoprovideanaudittrail.N&#*P $P $ 0  0$$d.0P $$Valuesobtained.&'$+P $P $ 0  0$$e.0P $$Conclusions.'%,P $P $ 0  0$$f.0P $$Correctiveactionstaken.(~&-P $P $  .f,4 C.0  ProcedureManualsX$$ 0  1.0$$_SOPs_Ԁarerequiredforalllaboratoryandadministrativeprocedures.$$ 0  2.0$$Proceduresforbloodbankslightlydifferentthanthoseforchemicalbasedassays.`$$ 0  3.0$$_NCCLS_Ԁhasrecommendedelementsofaproceduremanual.h$$ 0  4.0$$Administrativepoliciesandtechnicalproceduresshouldbemaintainedseparately. $$ B.0  QualityAssessmentofSuppliesandReagents p $$ 0  1.0$$Reagentsmaybemadeonsiteorpurchasedfromamanufacturer.x $$ 0  2.0$$Becauseofadditionalqualityassessmentrequirements,mostbloodbankspurchasereagents.( $$ 0  3.0$$ Thefollowingreagentsmustbetestedeachdayofuse:  $$ 0  0$$a.0P $$_antihuman_Ԁglobulinserum2P $P $ 0  0$$b.0P $$bloodgroupingantiserumsb P $P $ 0  0$$c.0P $$_lectins_:P $P $ 0  0$$d.0P $$antibodyscreeningcellsP $P $ 0  0$$e.0P $$reversegroupingcellsP $P $ 0  0$$f.0P $$enzymesjP $P $ 0  4.0$$Fordonorcollectionfacilitiesthe followingmustbetestedwitheachrun :r$$ 0  0$$a.0P $$hepatitistestingreagents$P $P $ 0  0$$b.0P $$HIVtestingreagentsP $P $ 0  0$$c.0P $$_HTLV_ԄI/IIreagents|P $P $ 0  0$$d.0P $$ALTtestingreagentsTP $P $ 0  0$$e.0P $$syphilisserologyreagents.,P $P $ 0  5.0$$Whenreagentsandsuppliesarereceivedeachofthefollowingmustbedocumentedduringthelogin 4! process: "$$ 0  0$$a.0P $$dateofreceipt#P $P $ 0  0$$b.0P $$manufacturer d$P $P $ 0  0$$c.0P $$lotnumber!<%P $P $ 0  0$$d.0P $$expirationdatel" &P $P $ 0  0$$e.0P $$reviewofmanufacturer'scircularforchangesD# 'P $P $ 0  0$$f.0P $$leakingordamagedcontainers$!(P $P $ 0  6.0$$ Beforebeingplacedinusereagentsaretestedforsensitivityandspecificity. %t#*$$ 0  7.0$$ Dailytestingisrequired toensurethereagenthasnotlostpotencyorreactivity.~'&%,$$ 0  0$$a.0P $$CanuseaformandprocedurecreatedinhouseorutilizeQCkitprovidedbyamanufacturer.0)&.P $P $ 0  0$$b.0P $$Lotnumbersandexpirationdateofallreagentstestedmustbeontheform.*'/P $P $ 0  0$$c.0P $$Gradedreactionsrecorded.*(0P $P $ 0  0$$d.0P $$SpecialtypingseraneedonlybeQCdwhenused.+`)1P $P $ 0  8.0$$Finaldispositionofdamagedorunsatisfactoryreagentsmustbedocumented.h-+3$$  @.+4 _C.0  EquipmentX$$ 0  1.0$$Documentationmustbemadeofroutinemaintenance,repairsandtestingperformedoninstruments  fromdateofreceipttodateinstrumentispermanentlyremovedfromservice.$$ 0  2.0$$ Temperaturemonitoring iscriticalforrefrigerators,freezers,incubatorsand_waterbaths_.8$$ 0  0$$a.0P $$Mustbemanuallyrecordeddaily.DP $P $ 0  0$$b.0P $$Refrigeratorsandfreezersmusthaveadevicetorecordthetemperature24hoursaday.  P $P $ 0  0$$c.0P $$Whentemperatureisoutofrangemusthavedocumentationofreasonorcorrectiveaction  L  taken.| $ P $P $ 0  0$$d.0P $$Alarmsonrefrigeratorsandfreezersmustbetestedperiodicallytomakesuretheywillsound ,  attheappropriatetemperature. P $P $ D.0  Components\$$ 0  1.0$$Eachstepofthepreparationofcomponentsmustbedocumented.d $$ 0  2.0$$Periodicallyaunitissacrificedtotestforpotency,efficacyandpurity.$$ 0  0$$a.0P $$Atleastfourcomponentsaretestedmonth.P $P $ 0  0$$b.0P $$Threeofthefourmustmeetminimumrequirements.lP $P $ E.0  Personnelt$$ 0  1.0$$Personnelwhoperformtestsandpreparecomponentsmusthaveadequateeducationandtraining.$$$ 0  2.0$$Mustdefinetasksperformedandlevelsofcompetenceneeded.|$$ 0  3.0$$Musthaveajobdescriptionwhichshouldincludethefollowing:,$$ 0  0$$a.0P $$Title4!P $P $ 0  0$$b.0P $$Briefdescriptionofgeneralfunctionsandresponsibilities. "P $P $ 0  0$$c.0P $$Descriptionofspecificduties.#P $P $ 0  0$$d.0P $$Supervision d$P $P $ 0  0$$e.0P $$Qualifications!<%P $P $ 0  0$$f.0P $$Specialfactorsl" &P $P $ 0  0$$g.0P $$Seepage548forMTjobdescriptionD# 'P $P $ 0  4.0$$Oncejobisdefinedcan%  Ԁthendeterminelevelofeducationandtrainingrequired.$")$$ 0  5.0$$Potentialemployeesareinterviewedanditwillbedeterminediftheyarequalifiedbasedonthejob &L$+ description.|'$%,$$ 0  6.0$$Musthaveawrittentrainingprogramandassessmenttodeterminecompetencyoftheemployee.,)&.$$ 0  0$$a.0P $$Observationoftheemployeeduringjobperformance.*(0P $P $ 0  0$$b.0P $$Checklisttodocumentemployeesprogress.+\)1P $P $ 0  0$$c.0P $$Proceduresandpolicieschangefrequentlysotrainingisanongoingprocess.,4*2P $P $  <.+4 0  7.0$$Competencycanbeassessedbyproficiencytesting.X$$ 0  0$$a.0P $$Observingemployeeperformingassignedtasks.P $P $ 0  0$$b.0P $$Reviewingdocumentation.`P $P $ 0  0$$c.0P $$Assigningexternalproficiencytestingsamplesonarotatingbasis.hP $P $ 0  0$$ $$ 0  0$$d.0P $$Paperandpenciltesting. P $P $ 0  0$$e.0P $$Proficiencytestingisusedbyaccreditingandregulatoryagenciestoassesslaboratory  p  competency. H P $P $ F.0  QualityAssessmentandUtilizationReviewP $$ 0  1.0$$Mostfacilitiesusethe10stepprocessoutlinedby_JCAHO_. $$ 0  0$$a.0P $$AssignresponsibilityXP $P $ 0  0$$b.0P $$Delineatethescopeofcare0P $P $ 0  0$$c.0P $$Identifythemostimportantaspectofcare`P $P $ 0  0$$d.0P $$Identifyindicators8P $P $ 0  0$$e.0P $$EstablishthresholdsP $P $ 0  0$$f.0P $$CollectandorganizedataP $P $ 0  0$$g.0P $$EvaluatedatahP $P $ 0  0$$h.0P $$Takecorrectiveaction@P $P $ 0  0$$_i_.0P $$AssessactionsanddocumentimprovementpP $P $ 0  0$$j.0P $$Communicate.HP $P $ 0  2.0$$TransfusionCommittee$$ 0  0$$a.0P $$Medicalstaffresponsibleforassessingadequacyoftransfusionservicesandproperuseof P bloodcomponents.(P $P $ 0  0$$b.0P $$Reviewsusageofallcomponentsforappropriateness.X P $P $ 0  0$$c.0P $$Reviewsrecordsofalltransfusionreactions.0!P $P $ 0  0$$d.0P $$Reviewsorderpractices."P $P $ 0  3.0$$QualityAssessmentPlan `$$$ 0  0$$a.0P $$coordinationofqualityassessmentactivities.h" &P $P $ 0  0$$b.0P $$Selectappropriatequalityassessmentindicators.@# 'P $P $ 0  0$$c.0P $$Indicatorsareareliablemeasureofthequalityofserviceprovided.$!(P $P $ 0  0$$d.0P $$Indicatorsselectedtomonitorhighvolumeorhighriskactivities.$")P $P $ G.0  UtilizationReview&H$+$$ 0  1.0$$Requiredby_JCAHO_P(%-$$ 0  2.0$$Usedtoassessthebloodorderingandtransfusionpracticesofthemedicalstaff.()&.$$ 0  3.0$$_Crossmatch:transfusion_Ԁratio*'/$$ 0  0$$a.0P $$Numberofunits_crossmatched_Ԁdividedbytheactualnumbertransfused.*(0P $P $ 0  0$$b.0P $$Usedasanindicatorthattoomuchbloodisbeingrequestedtobeonhold.+X)1P $P $ 0  0$$c.0P $$Couldresultinhighoutdateorwaste.,0*2P $P $ 0  4.0$$Numberofautologoustransfusion.8.+4$$ _ԇ0  5.0$$Numberofemergencyreleases.X$$ 0  6.0$$Calculatestatisticsbyphysician.$$ 0  7.0$$Reviewofrecordstodetermineiftransfusionwasjustified.`$$ 0  8.0$$Auditcriteriafortransfusionmustbedefined:h$$ 0  0$$a.0P $$Hematocritlessthan24% P $P $ 0  0$$b.0P $$Hemoglobinoflessthan8gm/dL  P $P $ 0  0$$c.0P $$Symptomsduetoanemia p P $P $ 0  0$$d.0P $$Recentestimatedbloodlossofgreaterthan10%oftotalbloodvolume. H P $P $ 0  0$$e.0P $$Ifauditrevealsunjustifiedtransfusionphysicianisnotifiedandaskedtorespond.x P $P $    xu.v % &(x<vv xu.TheEnd# xu.vvx<H## &( %v xu.G#