[Histonet] RE: Histonet Digest, Vol 24, Issue 15 labeling issues
Rice, Michael
Michael.Rice <@t> holy-cross.com
Thu Nov 10 13:44:30 CST 2005
In response to the question regarding an acceptable range for identification errors, there can be no range. It must be 100% correct. It has always been my habit to refuse specimens that are incorrectly labeled or otherwise lacking information. In the case of biopsies or other signicant cases where we do not want to lose control of the specimen, we insist that the person who was involved in the origin of the specimen come to pathology and identify the patient or correct the error. We do not process the specimen until all problems have been rectified. after a while when the people involved get tired of your calls and their having to come to the lab, they will hopefully change their ways. We recently had an ongoing problem with the OR sending specimens down without labeling the containers. I met with the nurse manager for the OR and went over the problem with her. She was able to identify the employee who was ignoring the step of labeling the specimens. That employee was counseled and was warned that her job was at risk. It has not happened again with that employee. Drastic steps have to be taken to avoid these errors as part of meeting JCAHO standards
Michael Rice CT.HT(ASCP)
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Subject: Histonet Digest, Vol 24, Issue 15
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Today's Topics:
1. Re: tonsils (Rene J Buesa)
2. RE: any suggestions? (Patsy Ruegg)
3. RE: any suggestions? (Pamela Marcum)
4. Process improvement monitors (John.Sheppard <@t> Health-Partners.org)
5. RE: tonsils (Monfils, Paul)
6. RE: (no subject) (O'Reilly, Siobhan)
7. reproducing microwave temperatures (Bernadette Weston)
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Message: 1
Date: Thu, 10 Nov 2005 08:19:49 -0800 (PST)
From: Rene J Buesa <rjbuesa <@t> yahoo.com>
Subject: Re: [Histonet] tonsils
To: Linda Blazek <BlazekL <@t> childrensdayton.org>,
histonet <@t> lists.utsouthwestern.edu
Message-ID: <20051110161949.42007.qmail <@t> web61216.mail.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1
We used to gross them only but the PA (usually at requests from the surgeon or the
medical practitioner) could ask for a microscopic evaluation sometimes as results
of a request by the insurance company!. In that case we used to process them and do
just H&E.
Essentially you will have to ask your pathologist what to do about them.
Rene J.
Linda Blazek <BlazekL <@t> childrensdayton.org> wrote:
I need some information on how other facilities are handling tonsils. Are they gross only and what criteria is used to have microscopic performed on them? Thanks for any info. - Linda
Linda Blazek, HT (ASCP)
Department of Pathology
Children's Medical Center
Dayton, Ohio 45404
(937) 641-3358
fax (937)641-5482
blazekl <@t> childrensdayton.org
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Message: 2
Date: Thu, 10 Nov 2005 09:23:37 -0700
From: "Patsy Ruegg" <pruegg <@t> ihctech.net>
Subject: RE: [Histonet] any suggestions?
To: "'Rene J Buesa'" <rjbuesa <@t> yahoo.com>, "'Till, Renee'"
<TillRenee <@t> uams.edu>, <histonet <@t> lists.utsouthwestern.edu>
Message-ID: <200511101623.jAAGNbxT021885 <@t> chip.viawest.net>
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Renee the IHC question asker. I too, like Gayle think that your question
was appropriate for this list and I thought that you gave a lot of
information. In my opinion yes he should be using goat serum block to match
up with his secondary host. There may also be a too close species with his
anti-rat primary on ms tissue causing non specific binding of ms serum IgG
just because ms and rat are so closely related. Frozen sections can be very
active with antigen since they don't go thru all the processing related to
ffpe tissue, so in my experience you need to carefully titer your IHC
antibody reagents often diluting much more than you would for ffpe tissue.
Also much of the endogenous issues, such as biotin, peroxidase and alk.phos.
Are inhanced in frozens, or preserved more than in ffpe tissue. AB block,
fc receptor block, serum block before the primary and before the secondary
are all things I consider with frozen IHC, or I try to avoid the biotin
issue altogether by using a non biotin labeled polymer detection. Maybe
this person is inexperienced but we all started somewhere, so probably with
just a little help we can make a big difference for this person, that is
what we are here for, right?
Patsy
Patsy Ruegg, HT(ASCP)QIHC
IHCtech, LLC
Fitzsimmons BioScience Park
12635 Montview Blvd. Suite 216
Aurora, CO 80010
P-720-859-4060
F-720-859-4110
wk email pruegg <@t> ihctech.net
web site www.ihctech.net
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-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Rene J Buesa
Sent: Wednesday, November 09, 2005 2:28 PM
To: Till, Renee; histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] any suggestions?
With all due respect I think that your colleague's procedure is a royal
mess.
On the other hand it seems that he is not very willing to change his ways,
so the only thing I have to tell you (for him) is: good luck! He should be
the one doing the asking, and not you!
Rene J.
"Till, Renee" <TillRenee <@t> uams.edu> wrote:
Another tech who does not have much experience with histology came to me
with questions about his immunos. They are doing IHC with various cd markers
on frozen sections of mouse aorta. He has encountered particularly strong
background(or so he's been told, he thinks it is actual staining) with one
of the antibodies that was made in rat. He is using a goat anti-rat F(ab')2
from Jackson as the secondary. It is not absorbed against mouse. I have
asked all about his dilutions and incubations times, but he doesn't seem to
think that is the problem. I gave him an avidin/biotin block to try and see
if that helps. Any other ideas? I am not familiar with cd markers myself.
The only problem I could find just in talking to him was that he was
blocking with rabbit serum? I told him you normally match your block with
the host of the secondary, but would that make that big a difference as far
as background is concerned? Would the fact he is using frozen sections have
anything to do with it? Or could it just be the stain? I know they are doing
cd54, but I'm not sure if this is the one he is having a problem with.
I know this is not much informations, but I would still appreciate any input
Thanks,
Renee'
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Message: 3
Date: Thu, 10 Nov 2005 11:23:46 -0500
From: Pamela Marcum <pmarcum <@t> vet.upenn.edu>
Subject: RE: [Histonet] any suggestions?
To: "Hofecker, Jennifer L" <jennifer.l.hofecker <@t> Vanderbilt.Edu>,
"histonet" <histonet <@t> lists.utsouthwestern.edu>
Message-ID: <6.1.1.1.2.20051110112330.019a6c60 <@t> mail.vet.upenn.edu>
Content-Type: text/plain; charset="us-ascii"; format=flowed
Thanks, Jennifer. Pam
At 11:03 AM 11/10/2005, Hofecker, Jennifer L wrote:
>Well said Pam and Gayle!
>I know that every time I have a problem, my first thought is "ask
>histonet" not because I am lazy or because I can't look it up. I think
>first of histonet because of the diversity of our listmembers and their
>experience. Just because a publication lists the steps of a protocol,
>doesn't mean it will work. I would rather get my info from the ones who
>make these protocols work.
>On the other hand, every time I am about to post a query, I have to read
>it 6 times to make sure there isn't anything in the post that I will be
>chastised for. While I agree that we should not "post with reckless
>abandon", I do not think we should be terrified of backlash for asking how
>to do something we've never done before, especially if it affects patient
>care, whether directly or indirectly.
>
>Well, I am going to put on my bullet proof vest!
>Thanks for listening,
>Jennifer
>
>
>
>Jennifer Hofecker, HT (ASCP)
>Vanderbilt University Medical Center
>Division of Neuropathology
>(615) 343-0083
>(615) 343-7089 fax
>
>Thank You Gayle!! It is sometimes easy to forget not everyone has access
>to the Internet or a way to even place a message on HistoNet. We are
>attempting to assist people who are learning and while some may seem to be
>using HistoNet as way to avoid looking anything up the majority are asking
>questions that are not readily accessible or in an area like murine animal
>models that is more difficult. I have no problem with this and will answer
>most questions off line if it is a more esoteric question. I am surprised
>that the person with the issue about Rene's assistance for her friend is
>also the same Rene who has been asking all of us to contribute to Tricks of
>the Trade.
>
>Pamela A Marcum
>Special Procedures Manager
>Bone Histology
>UPENN Vet School
>
>
>At 05:33 PM 11/9/2005, Gayle Callis wrote:
> >Rene,
> >
> >Sorry to disagree, and I certainly did not understand what YOU meant by
> >"changing his ways"? I couldn't see many changes here, other than some
> >refinement of his IHC method. Many people working with murine CD marker
> >IHC often need a little help with murine animal model IHC. Since our
> >lab works with murine CD marker IHC approx. 95% of the time, on frozen
> >sections etc per the inquiry, we are happy to sleuth problems. The
> >questions were valid ones for learning/refining of his techniques and
> >being a mousie person, I didn't have a problem with the inquiry.
> >
> >Some people (including a lot of experts in our field) do NOT want to be on
> >Histonet and second hand messaging certainly doesn't bother me as long as
> >more details are provided. I frequently ask questions on Histonet to
> >access information for others in my department - that's part of my job.
> >Your colleague is welcome to email privately if you or they wish.
> >
> >Gayle Callis
> >Research Histopathology Supervisor
> >Veterinary Molecular Biology
> >Montana State University - Bozeman
> >PO Box 173610
> >Bozeman MT 59717-3610
> >406 994-6367
> >406 994-4303 (FAX)
> >
> >
> >
> >
> >
> >
> >- At 02:28 PM 11/9/2005, you wrote:
> >>With all due respect I think that your colleague's procedure is a royal
> mess.
> >>On the other hand it seems that he is not very willing to change his
> >>ways, so the only thing I have to tell you (for him) is: good luck! He
> >>should be the one doing the asking, and not you!
> >>Rene J.
> >
> >Gayle Callis
> >Research Histopathology Supervisor
> >Veterinary Molecular Biology
> >Montana State University - Bozeman
> >PO Box 173610
> >Bozeman MT 59717-3610
> >406 994-6367
> >406 994-4303 (FAX)
> >
> >
> >
> >_______________________________________________
> >Histonet mailing list
> >Histonet <@t> lists.utsouthwestern.edu
> >http://lists.utsouthwestern.edu/mailman/listinfo/histonet
>
>
>
>_______________________________________________
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>Histonet <@t> lists.utsouthwestern.edu
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>
>
>_______________________________________________
>Histonet mailing list
>Histonet <@t> lists.utsouthwestern.edu
>http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Best Regards,
Pamela A Marcum
Manager, Histology Special Procedures
University of Pennsylvania
School of Veterinary Medicine
R.S. Reynolds Jr. CORL
New Bolton Center
382 West Street Road
Kennett Square, PA 19348
Phone - 610-925-6278
Fax - 610-925-8120
E-mail - pmarcum <@t> vet.upenn.edu
------------------------------
Message: 4
Date: Thu, 10 Nov 2005 11:56:13 -0500
From: John.Sheppard <@t> Health-Partners.org
Subject: [Histonet] Process improvement monitors
To: histonet <@t> lists.utsouthwestern.edu
Message-ID:
<OF445B593C.ACD02272-ON852570B5.0057A178-852570B5.005D09EC <@t> community.msft>
Content-Type: text/plain; charset=US-ASCII
Hello "Histonetters",
Once again I am on a "mission" for my medical director. I am hoping
to find out if anyone out there has been looking at quality management /
process improvement areas in histology / pathology labs in their community
hospitals.
We are currently reworking our P.I. program, and we are looking at
some of the most obvious errors we find. It seems to us that many mistakes
come to our lab from doctors offices, the O.R. and our birthing center.
These errors come in the form of incomplete or no requisition,
discrepancies between specimen labels and requisitions, and no or
incomplete label on specimens. These are the issues that are of particular
interest to my director. We are trying to establish a reasonable range to
strive for. Ideally we would like to have all specimens labelled correctly
with the correct reqistion and full clinical history / diagnosis coming in
to our lab, but realistically we are not sure if that is possible.
If anyone has reviewed these monitors and does not mind sharing their
information, we would greatly appreciate using it for comparitive data
purposes. We have been monitoring this for a couple of years and we do not
have a sky high rate, but it is higher than we believe it should be.
Thanks again
John Sheppard HT(ASCP)
P.S. If anyone has ideas on how to improve this performance, short
of firing nuses everytime they mess up please let me know ? (this is a
joke)
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Message: 5
Date: Thu, 10 Nov 2005 12:18:36 -0500
From: "Monfils, Paul" <PMonfils <@t> Lifespan.org>
Subject: RE: [Histonet] tonsils
To: "'histonet <@t> lists.utsouthwestern.edu'"
<histonet <@t> lists.utsouthwestern.edu>
Message-ID:
<09C945920A6B654199F7A58A1D7D1FDE01717610 <@t> lsexch.lsmaster.lifespan.org>
Content-Type: text/plain; charset="iso-8859-1"
Years ago, when I worked in a clinical histology lab (I am now in research),
we processed and sectioned all tonsils. Since no serious pathology had ever
been discovered in any of the thousands of subadult tonsils we had
processed, the department was considering a "gross only" policy for tonsils
from patients under 16 years of age. Don't you know, that very month they
found an undiagnosed lymphoma in the tonsils of a 12 year old girl. We
continued processing all tonsils. As I said, that was quite a few years
ago, and they may have changed the policy since then.
> ----------
> From: histonet-bounces <@t> lists.utsouthwestern.edu on behalf of Linda
> Blazek
> Sent: Thursday, November 10, 2005 7:54 AM
> To: histonet <@t> lists.utsouthwestern.edu
> Subject: [Histonet] tonsils
>
> I need some information on how other facilities are handling tonsils. Are
> they gross only and what criteria is used to have microscopic performed on
> them? Thanks for any info. - Linda
>
>
> Linda Blazek, HT (ASCP)
> Department of Pathology
> Children's Medical Center
> Dayton, Ohio 45404
> (937) 641-3358
> fax (937)641-5482
> blazekl <@t> childrensdayton.org
>
>
> _______________________________________________
> Histonet mailing list
> Histonet <@t> lists.utsouthwestern.edu
> http://lists.utsouthwestern.edu/mailman/listinfo/histonet
>
>
------------------------------
Message: 6
Date: Thu, 10 Nov 2005 12:20:00 -0500
From: "O'Reilly, Siobhan" <Siobhan.O'Reilly <@t> nyumc.org>
Subject: RE: [Histonet] (no subject)
To: Histonet <@t> lists.utsouthwestern.edu
Message-ID:
<4BCB18390D553D41A3FFEB77D5A3BA97012DB631 <@t> excnyuebw2k63.nyumc.org>
Content-Type: text/plain; charset=iso-8859-1
Please remove mine as well.
-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu]On Behalf Of
drosini <@t> comcast.net
Sent: Thursday, November 10, 2005 6:54 AM
To: Histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] (no subject)
please take my name off the histonet list
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Message: 7
Date: Thu, 10 Nov 2005 12:48:12 -0500
From: "Bernadette Weston" <bernaweston <@t> hotmail.com>
Subject: [Histonet] reproducing microwave temperatures
To: histonet <@t> lists.utsouthwestern.edu
Message-ID: <BAY103-F2D396BB396122B4DC6ADFA1660 <@t> phx.gbl>
Content-Type: text/plain; format=flowed
A few years back I attended a convention taht did a workshop on how to check
your microwave for reproducible tempertures. I remember having a worksheet
for that seminar, does anyone have a method they like to share for this
monitoring?
Bernadette Weston HT
Barberton Citizens Hospital
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