[Histonet] Documenting control tissue source?

Thomas Jasper tjasper <@t> copc.net
Fri Aug 15 11:41:42 CDT 2008

Hey Tom,

Keeping some patient accession numbers for tapping the control source
later on could be handy.  But, I've never heard of it as a mandatory
policy or a regulatory compliance issue.  Besides, new control tissue,
from your patient source can be obtained by an LIS search. 
To flip this around, from a regulatory standpoint...it's possible that
HIPAA could take a dim view re: patient privacy.  I mean we work with
patient numbers all the time, but if it's not necessary (for controls)
why go there?  It's possible that someone (the inspector) may have been
trying to "mold" your service into their vision of what labs ought to
be, as opposed to just inspecting you and making objective evaluations
based on regs.  I've seen this more than once with CAP inspectors (I
realize this was JCAHO).  Someone may have been blowing smoke up
your...here.  Where you shown any documentation to this effect?  I don't
think you're doing anything wrong.  And for her to tell you that most
histo labs do this was a bit presumptuous.

Tom J.

Thomas Jasper HT (ASCP) BAS
Histology Supervisor
Central Oregon Regional Pathology Services
Bend, OR 97701
tjasper <@t> copc.net

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Tom
Sent: Friday, August 15, 2008 4:12 AM
To: histonet <@t> pathology.swmed.edu
Subject: [Histonet] Documenting control tissue source?

We are finishing up our JCAHO inspection today.  The inspector asked
about our control tissues and where we documented the source.  We get
nearly all of our controls from patient samples and she said that most
histo labs mark their control blocks with the source case number.  They
then keep records of the control source used when staining new cases.  I
can see no logical reason to keep this info.  You use a control
appropriate for the element being stained.  Why does it matter where the
control came from?  Am I wrong?  Do you do this?  


Tom McNemar, HT(ASCP)
Histology Co-ordinator
Licking Memorial Health Systems
(740) 348-4163
(740) 348-4166
tmcnemar <@t> lmhealth.org

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