[Histonet] RE: Embedding process improvement and competencyassessment

Thu Aug 25 13:19:43 CDT 2011

Ditto Joe! & I did it twice! Once for HT, then again for HTL!!!

Paula K. Pierce, HTL(ASCP)HT
President
Excalibur Pathology, Inc.
8901 S. Santa Fe
Oklahoma City, OK 73139
405-759-3953 Lab
405-759-7513 Fax
www.excaliburpathology.com

________________________________
From: "Galbraith, Joe" <joseph-galbraith <@t> uiowa.edu>
To: Bea DeBrosse-Serra <BDeBrosse-Serra <@t> isisph.com>; Jennifer MacDonald 
<JMacDonald <@t> mtsac.edu>; "Heath, Nancy L." <NHeath <@t> Lifespan.org>
Cc: Histonet Listserv (E-mail) <histonet <@t> lists.utsouthwestern.edu>; 
"histonet-bounces <@t> lists.utsouthwestern.edu" 
<histonet-bounces <@t> lists.utsouthwestern.edu>; "D'Attilio, Shelley" 
<SDattili <@t> stormontvail.org>
Sent: Thu, August 25, 2011 1:07:26 PM
Subject: RE: [Histonet] RE: Embedding process improvement and 
competencyassessment

How disgusting to hear about cheating.  I recall that someone was supposed to 
sign off as a witness that the applicant had done the work themselves.  I spent 
months acquiring tissue, processing, embedding, cutting and staining a set of 
blocks and slides and was rewarded with a high score for the effort.  It was 
something I could be proud of.  As I recall we had to submit 25 or so slides 
back then only some of which were graded and the grading was really strict (but 
did vary with the grader).

Joe Galbraith HTL (and also MT by the way)
University of Iowa

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu 
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Bea 
DeBrosse-Serra
Sent: Thursday, August 25, 2011 12:14 PM
To: 'Jennifer MacDonald'; Heath, Nancy L.
Cc: Histonet Listserv (E-mail); histonet-bounces <@t> lists.utsouthwestern.edu; 
D'Attilio, Shelley
Subject: RE: [Histonet] RE: Embedding process improvement and 
competencyassessment

I heard of a lot of cheating as well. People paid others to do the blocks and 
staining. How good does it do? In the end, these people are cheating themselves. 
Very sad!

Beatrice DeBrosse-Serra HT(ASCP)QIHC
Isis Pharmaceuticals
Antisense Drug Discovery
1896 Rutherford Road
Carlsbad, CA 92008
760-603-2371

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu 
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Jennifer 
MacDonald
Sent: Thursday, August 25, 2011 7:58 AM
To: Heath, Nancy L.
Cc: Histonet Listserv (E-mail); histonet-bounces <@t> lists.utsouthwestern.edu; 
D'Attilio, Shelley
Subject: RE: [Histonet] RE: Embedding process improvement and 
competencyassessment

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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