[Histonet] RE: Embedding process improvement and competencyassessment

Thu Aug 25 11:58:13 CDT 2011

That is unfortunate that people will resort to dishonesty, only cheating themselves in my humble opinion... According to NAACLS, since the discontinuation of the practical component of the HT exam( per Zoe)  it is the responsibility of the program directors to require practical blocks and slides in HT training programs.  Couldn't a histology supervisor or lead person create a similar process in their lab, if they wished to do so, for those who did not complete a formal program? Maybe something like a technincal proficiency from their procedures and competency standard that includes demonstration of manual execution and technical quality and mastery ?
I also think this plays in with quality control documentation and assessment, ( which could be considered as a MGMT function) i.e. documenting versus execution of  theory understanding and technical task(s) . Personally,  I know that I have always included this technical execution in the proficiency any time that I have been involved or responsible for assessment, training and evaluation, since there is theory and practical execution to be considered...but once the method and means are in place, it should be applicable in many situations with persons at different places in their learning, experience and training, in my opinion. 

I have seen this applied in several histology labs successfully, and included with the QMS and procedures. I know that having a histologist involved in this development process, could be crucial, as already pointed out in this discussion thread, but I think given the shortage of trained people, with the right attitude many high level managing activities could be supported or performed by an otherwise trained administrator .

Joelle Weaver MAOM, BA, (HTL) ASCP

> To: NHeath <@t> Lifespan.org
> From: JMacDonald <@t> mtsac.edu
> Date: Thu, 25 Aug 2011 07:57:46 -0700
> Subject: RE: [Histonet] RE: Embedding process improvement and competencyassessment
> CC: histonet <@t> lists.utsouthwestern.edu; histonet-bounces <@t> lists.utsouthwestern.edu; SDattili <@t> stormontvail.org
> 
> I fail to see the correlation of a non HT person supervising the Histology 
> lab and the lack of a practical exam for HT/HTL staff. One of the issues 
> that Shelley brought up was the staff lost or did not develop their 
> embedding skills. Submission of a practical exam is not proof of highly 
> developed embedding skills. For the HT exam there were 8 blocks that were 
> submitted (9 slides). I know of cases where the blocks were not even 
> embedded or cut by the applicant.
> 
> 
> 
> 
> "Heath, Nancy L." <NHeath <@t> Lifespan.org> 
> Sent by: histonet-bounces <@t> lists.utsouthwestern.edu
> 08/25/2011 07:11 AM
> 
> To
> "D'Attilio, Shelley" <SDattili <@t> stormontvail.org>, "Podawiltz, Thomas" 
> <tpodawiltz <@t> lrgh.org>, "Histonet Listserv (E-mail)" 
> <histonet <@t> lists.utsouthwestern.edu>
> cc
> 
> Subject
> RE: [Histonet] RE: Embedding process improvement and competencyassessment
> 
> 
> 
> 
> 
> 
> This is exactly why the powers that be should have NEVER gotten rid of
> the practical portion of the HT/HTL board certification! 
> 
> -----Original Message-----
> From: histonet-bounces <@t> lists.utsouthwestern.edu
> [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of
> D'Attilio, Shelley
> Sent: Thursday, August 25, 2011 9:45 AM
> To: Podawiltz, Thomas; Histonet Listserv (E-mail)
> Subject: [Histonet] RE: Embedding process improvement and
> competencyassessment
> 
> 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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