[Histonet] RE: Embedding process improvement and competency assessment

[D'Attilio, Shelley]

Hi Tom,
Thank you for your kind words.  I am off the bench almost completely.  I can work in the gross room in a pinch and my counting skills are excellent, so I can always file slides and block if an emergency arises:)  I occasionally cover a bench in Chemistry as well, but my staff is all pretty glad that I mostly stay in my office.  

Thanks so much for the embedding information.  The main problem we are tackling at the moment is tissue orientation.  I have written a pretty detailed embedding procedure that is being reviewed by the new histology supervisor.  Our plan is to refresh the training of everyone on staff in conjunction with this procedure, then add specific embedding competencies to our checklist.  I will make sure that the procedure incorporates the first 6 elements that you listed below.

Currently we have a QA sheet that is given to the pathologist with each batch of slides.  Pathologists provide us with feedback on the slide quality by filling out the form.  Slides with sub-standard quality--whether in orientation, cutting, staining, whatever--our reviewed by every histotech in the lab with an aim to education and improvement of performance.  We have a form called the "Slide Quality Review Form" that details the quality issue.  Techs are directed to review the slides and comment.  Difficult cases or those where people disagree are discussed in our department meetings.  

One of our difficulties over the years has been how the work was divided between the histotechs.  One histotech loved to embed and was very good at it, so he did most of the embedding.  He eventually moved to an overnight shift, which resulted in him embedding even more than he was.  Consequently, other staff people either lost their skills or never fully developed them.  It was introduction of rapid processing that really brought this issue to the forefront, since different people were embedding at different times of the day.

Unfortunately, I let my NSH membership lapse this year for budgetary reasons.  I have purchased quite a few resources over the years from NSH, and even attended the NSH annual meeting a few years ago when it was in Phoenix.  I will reconsider my decision to drop my membership.  

For those on the list, here is Tom's response to my question:

Hi Shelley, 

I would suggest you join NSH, they have all kinds of reference material for this type of work. 

Please tell me you are off the bench, you have a lot to monitor and if you are working the bench on top of your management duties my prayers go out to you. 

Embedding: 

1. Proper size of mold in relation to specimen size. 
2. Proper orientation of tissue, example 5 skin biopsies, dermis must face the same direction, and be at an angle to the blade so when you cut the section cuts smoothly and doesn't roll up. 
3. Multiple pieces all on the same plane. If one piece is deeper than the others you must re-embed, or you will cut through the other pieces before you reach it. 
4. Make sure that the embedding unit is wipe down between each case as are the forceps, this will avoid tissue floaters. 
5. Never open more than one cassette at a time. 
6. Verify that the piece count on the work sheet matches what is in the cassette when it is opened.
7. Never hound the staff about speed, accuracy is more important, speed comes with experience. If its embedded wrong, it will be cut wrong and this will effect diagnosis. 
8. What do you do for QA on the slides?I have a work sheet that the Pathologist fills out each day about the slides, which is the end product of embedding. 

I hope my tips help you and feel free to contact me if you need anything.  

Tom Podawiltz, HT (ASCP)
Histology Section Head/Laboratory Safety Officer
LRGHealthcare
603-524-3211 ext: 3220
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