Owning Safety in the Autopsy Suite

The hospital security guard placed the deceased patient into the morgue refrigerator while chatting with his co-worker. They walked away without realizing the door did not close completely. Within the hour the automated temperature recording system sent an alert to the lab on the third floor.

The body had been unclaimed, and it stayed on the bottom shelf in the morgue. No one in the hospital wanted to take ownership of it. After a couple of months, fluids began to fill the shelf where the body was. The environmental services staff refused to clean up the mess since some staff were afraid.

The pathologist wanted to finish the autopsy quickly, so he started before the complete patient chart arrived. When the phone rang in the morgue, the physician on the other end of the phone said he believed the patient may have Creutzfeldt-Jakob Disease (CJD).

Managing safety in the autopsy suite can be difficult, but as these case studies show, it is important. One reason for the struggle is that clear ownership of the area is often not defined. Multiple internal departments and even external agencies may work in the morgue and autopsy suite. Pathologists, medical examiners, research physicians, security personnel, nurses, and organ procurement staff are just some of the various people that may perform tasks in the autopsy suite. This can create some unique and unwanted problems. The laboratory should take the lead in making sure all safety regulations are followed and that other users of the suite comply to avoid any unfortunate mishaps.

The morgue should be treated as a laboratory space, and it should be designed similarly to a BSL-3 laboratory space which includes an anteroom. Warning signs indicating the presence of biological and chemical materials should be placed on entry doors. Whenever work is performed in the area, proper personal protective equipment should be utilized. This PPE may include lab coats, gowns, gloves, respirators, and face protection. Make sure PPE is available in the area at all times. The autopsy space should be adequate, such that procedures may be performed effectively and that items such as knives and saws can be stored and used safely. Ventilation should be adequate (with a recommended minimum 12 air exchanges per hour), and the ambient temperature should be monitored as well.

While other personnel may access the morgue body storage refrigerator, it is often the lab or security departments who monitor the temperature. Since CAP inspectors set specific morgue refrigerator temperature ranges (1.1 to 4.4° Celsius), it can be important to communicate with the people who utilize the unit often. If placing or removing a body takes longer than expected, make sure there is adequate communication so that proper documentation of the temperature outages can be made. If a department other than the lab is responsible for temperature monitoring, make sure it is done correctly so there are no citations during an inspection.

Proper decontamination in the morgue is crucial. Instruments, tables, and counters must be disinfected to remove contamination of bloodborne pathogens. Use a chemical germicide for instrument and surface decontamination such as a 10-percent solution of sodium hypochlorite (or bleach). This intermediate-level disinfection will eliminate most bacteria (including Mycobacterium tuberculosis), and all fungi, and it inactivates viruses such as the hepatitis B virus. Rinsing with water or ethanol after disinfecting will help prevent the pitting of any stainless-steel surfaces.

Dealing with Creutzfeldt-Jakob Disease (CJD) in the autopsy suite requires special safety measures. Procedures should be posted in the area directing staff how to handle tissue and clean up in cases where patients are infected with CJD. The intact brain should be fixed in formaldehyde for one to two weeks before handling or cutting in order to reduce the prion activity. Non-disposable implements used with such patients should be immersed in 1N sodium hypochlorite (NaOH) for one hour before reuse. Surfaces on which autopsies occurred should also be immersed in NaOH for one hour for disinfection purposes.

Chemicals are stored and used in the autopsy suite, and standard safe lab practices should be used. Make sure staff is trained in proper the handling, labeling, and storage of chemicals as well as prepared to handle spills. Spill kits should be available and suitable to the chemicals used in the area. If formaldehyde is used, be sure an appropriate neutralizer is available for spill incidents.

As the most involved and best educated about its dangers, laboratory personnel should take the lead in making sure safety is a priority in the morgue, and educate all who may enter the area. Make sure communication is clear about who will use the suite and when- it’s never good to have someone walk in during an autopsy or organ removal. Use signage when necessary, and be willing to help in any unusual situations, because with a morgue, they definitely will arise. Work together as a team with all who utilize the area, and that ownership of safety will translate into safety for all.

 

Scungio 1

Dan Scungio, MT(ASCP), SLS, CQA (ASQ) has over 25 years experience as a certified medical technologist. Today he is the Laboratory Safety Officer for Sentara Healthcare, a system of seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. He is also known as Dan the Lab Safety Man, a lab safety consultant, educator, and trainer.

Groupthink and the Abilene Paradox

Everyone makes decisions and everyone makes decisions in groups. But we all have been part of groups that felt anything but productive: the end result was subpar, the process took a lot longer than if you had done it yourself, and the endless arguments and indecision caused you and everyone else on the team a lot of stress.

So how can we ensure that an effective group decision-making process is in place? How can we be certain that the decision we make as a group are the right ones?

Groupthink is when group members’ desire for harmony and unanimity overrides their motivation to realistically consider alternative courses of action. Not considering alternatives can have severe consequences as this additional information could have altered an idea or process to make it more effective. An example of Groupthink is with the company Theranos, where the entire board went along with Holmes’ ideas without looking for alternative solutions. Needless to say, they would have benefitted from those alternative options. Groupthink occurs because members of a group do not feel comfortable sharing their dissenting opinions due to high group cohesiveness, stressful situations, and a feeling that the group will always be successful.

The Abilene Paradox complements the Groupthink concept: with Groupthink it is a few members of a group that do not speak up, while with the Abilene Paradox the majority (or the entire group) remains silent. Furthermore, with Groupthink even the dissenting (and silent) member will usually feel good about the final decision, while with the Abilene Paradox members feel resentment. The reasons the Paradox occurs revolve around fears of separation and reprimand. The results are group projects that never go anywhere or fail, and separation from the group.

The good news is that both situations can be avoided by one main thing: creating an open environment in which dissenting opinions are encouraged, listened to, and incorporated. So next time you are in a group or meeting, pay attention to the number of dissenting opinions stated and how people respond to them. Reflect on how you respond to those opinions and if there is something you can do to increase the openness in your team or department.

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-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.


 

In pursuit of efficiency and continuous improvement, the pathologists, residents and technical staff at Makerere University, meet every Wednesday. They are also joined by colleagues from the Mulago National Referral Hospital under the Ministry of Health of Uganda.  The purpose of this meeting is to make decisions that pertain to teaching, operation of the histopathology service, and conducting research.

Since 2003, I have attended several of these meetings. However, the realization and achievement of goals has been poor and nearly zero in some instances. No prior agenda is sent out. During the meetings, counter-productive decisions are made. The generation of ideas, alternatives and creativity has dwindled meeting after meeting. Attendance and contribution to meetings are viewed as a waste of time and effort. This has led to low motivation, and attendance has hit an all-time low.

There is always somebody to blame for the failure in teaching, the inefficient biopsy service and the low research productivity at the end of each year. In the last team building workshop, the Mulago team did not show up despite an earlier commitment and receiving an invitation three weeks to time. In the first workshop, the executive director of Mulago did not show up even when he was scheduled to speak! We have had a share of failed projects and ventures; the FNA clinic and teaching of Cytotechnology have not gone well, establishment of the “pay for service” laboratory is struggling and embedding QA and QC systems in the histopathology laboratory has been a total failure. Lately, we lost the bid to the ASCP Cancer Diagnostics for the Africa telepathology project.

In summary, the department seems to be stuck in thick mud! What is in play here?  It is the groupthink and Abilene paradox; the making of irrational decisions and failure to manage group agreement respectively.  This is an expected natural occurrence in decision making involving groups.

The motivation for being on the ASCP leadership academy is my passion for change through leadership. That is what drives me. I love effective participation and being part of productive teams.

Following the completion of the two courses, I now clearly understand what has been happening in my department. I look back and easily recognize the symptoms of groupthink; the illusion of unanimity, self-censorship, mind guards, and shared stereotypes.

Recognition of the problem is half way to the solution. Techniques to avoid the problem are now known to me. The style of meetings in the department needs to be changed. The chair should avoid being too directive in order to ensure an open climate during discussions.  The chair should also assign a member the role of a critical evaluator and once in a while open up the meetings to important outsiders.

All the decisions to do the above had to be agreed upon by members during the weekly meetings. I now recognize and understand the play of the Abilene paradox here; that some members said “yes” when indeed they meant to say “no.” I look back and recognize action anxiety, fear of separation, real risk, negative fantasy, perceived risk and confusion of risk and certainty.

Looking at the 15 reasons as to why one ends on the road to Abilene, I can surely identify with each of them. This, I am sure, is shared by each of the staff members.

We need to avoid the trip to Abilene by making changes in the conduct of meetings. We should plan before the meetings, invite the right people, clearly state the decisions to be made, plan enough time for discussion, and set a climate of openness. During the meetings, vital questions should be asked. It takes a lot to plan but in the end, the returns are long term and a good on time invested.

What can be done differently now? Sharing the new knowledge learned during the course is the first step. The second step is to put into practice the techniques to avoid the group think and endless trips to Abilene. These must eventually become the new culture of practice and eventually spread across other university departments.

RL

-Robert Lukande is trained as an anatomical pathologist and is currently employed at the College of Health Sciences, Makerere University, Kampala Uganda. He is a teacher, research and consultant, and is passionate about changing the lives of others through leadership. He’s the current president of APESCA and is acting chair of the Department of Pathology.

Does Price Transparency Improve Lab Utilization?

Physicians often have poor awareness of costs. For that reason, many believe that providing cost information to physicians would increase awareness that, in turn, could improve laboratory utilization. For example, costs of lab tests could be displayed as a field in the computerized provider order entry system. Interventions of this type are attractive because they are relatively inexpensive to implement and do not disrupt workflow with popups. Further, unlike other interventions, cost display is sustainable. Some interventions require constant training and followup whereas cost display is a one-time intervention. For these reasons, organizations are experimenting to see the effect of cost display on laboratory utilization.

Does cost display reduce lab utilization? Studies have shown wide variation in impact. Most studies have focused on orders for laboratory testing and imaging; however, a few studies have looked a pharmaceuticals.  A recent systematic review concluded that cost display is associated with a modest reduction in laboratory utilization.(1) The review included twelve studies on lab utilization and all of these showed improvement.(2-13) However, a more recent study by Sedrak et al. found that cost-display had no impact on utilization.(14) Similarly, two imaging studies found that cost-display had no effect on orders.(4, 15). There was a wide variation in impact: test utilization reduction ranged from 0% to over 30% in some cases. Overall, it appears that cost display tends to reduce utilization; however, it sometimes has no effect as shown in the Sedrak study. So far, cost display has never been associated with an increase in utilization. We have experimented with cost display at University of Utah and, like the Sedrak study, found no effect.

Why is there such a range of effects? Can we predict which organizations are likely to benefit? The short answer is that nobody knows.  The twelve studies on lab utilization where conducted in a wide range of settings (community, academic and pediatric hospitals), included different numbers of tests, or had other differences that could affect results. The way in which costs are displayed also varies. Some sites use the Medicare Maximum Allowable Reimbursement Rate, some use a series of dollar signs to indicate cost categories, and others use charges. It is not clear whether these differences matter.

There are a number of factors that might affect the impact of cost display. For example, cost display might have less impact at an institution that has an effective utilization management program in place because there is less opportunity for improvement. Or, the number of tests with costs displayed may have an impact. For example, some studies have displayed costs for a relatively few number of tests whereas other studies showed costs for a large number of tests.  Cost display for a few tests may send a different signal to providers than providing costs for all tests. Also, we don’t know how long the intervention works. Is there an initial effect that wears off? If so, how long does it last? These questions will need to be resolved by future studies.

In the meantime, should you provide cost feedback at your institution? It is hard to predict what will happen but most evidence suggests that you will see some improvement in utilization. It is not expensive to implement and some organizations have seen a significant impact. At worst, the evidence suggests that you will see no effect on testing behavior.  On balance, cost-display seems like a low-risk intervention.

 

References

  1. Silvestri MT, Bongiovanni TR, Glover JG, Gross CP. Impact of price display on provider ordering: A systematic review. Journal of Hospital Medicine 2016;11:65-76.
  1. Fang DZ, Sran G, Gessner D, et al. Cost and turn-around time display decreases inpatient ordering of reference laboratory tests: A time series. BMJ Quality and Safety 2014;23:994-1000.
  1. Nougon G, Muschart X, Gérard V, et al. Does offering pricing information to resident physicians in the emergency department potentially reduce laboratory and radiology costs? European Journal of Emergency Medicine 2015;22:247-52.
  1. Durand DJ, Feldman LS, Lewin JS, Brotman DJ. Provider cost transparency alone has no impact on inpatient imaging utilization. Journal of the American College of Radiology 2013;10:108-13.
  1. Feldman LS, Shihab HM, Thiemann D, et al. Impact of providing fee data on laboratory test ordering: A controlled clinical trial. JAMA Internal Medicine 2013;173:903-8.
  1. Horn DM, Koplan KE, Senese MD, Orav EJ, Sequist TD. The impact of cost displays on primary care physician laboratory test ordering. J Gen Intern Med 2014;29:708-14.
  1. Ellemdin S, Rheeder P, Soma P. Providing clinicians with information on laboratory test costs leads to reduction in hospital expenditure. South African Medical Journal 2011;101:746-8.
  1. Schilling UM. Cutting costs: The impact of price lists on the cost development at the emergency department. European Journal of Emergency Medicine 2010;17:337-9.
  1. Seguin P, Bleichner J, Grolier J, Guillou Y, Mallédant Y. Effects of price information on test ordering in an intensive care unit. Intensive Care Medicine 2002;28:332-5.
  1. Hampers LC, Cha S, Gutglass DJ, Krug SE, Binns HJ. The effect of price information on test-ordering behavior and patient outcomes in a pediatric emergency department. Pediatrics 1999;103:877-82.
  1. Bates DW, Kuperman GJ, Jha A, et al. Does the computerized display of charges affect inpatient ancillary test utilization? Arch Intern Med 1997;157:2501-8.
  1. Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med 1990;322:1499-504.
  1. Everett GD, Deblois CS, Chang PF. Effect of Cost Education, Cost Audits, and Faculty Chart Review on the Use of Laboratory Services. Arch Intern Med 1983;143:942-4.
  1. Sedrak MS, Myers JS, Small DS, et al. Effect of a Price Transparency Intervention in the Electronic Health Record on Clinician Ordering of Inpatient Laboratory Tests: The PRICE Randomized Clinical Trial. JAMA Internal Medicine 2017.
  1. Chien AT, Ganeshan S, Schuster MA, et al. The effect of price information on the ordering of images and procedures. Pediatrics 2017;139.

 

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-Robert Schmidt, MD, PhD, MBA, MS is a clinical pathologist who specializes in the economic evaluation of medical tests. He is currently an Associate Professor at the University of Utah where he is Medical Director of the clinical laboratory at the Huntsman Cancer Institute and Director of the Center for Effective Medical Testing at ARUP Laboratories.

Conflict Resolution and Prevention

When it comes to the herb cilantro, people either love it or they hate it because it tastes like soap. Conflict is much the same way: either you see it as constructive or destructive. In my case, I used to think cilantro tasted like soap and it would ruin any food it came near. When I became a teenager, my taste buds changed. Now I will eat an entire bunch of cilantro on top of a taco or khao tom. Similarly, I used to feel conflict was a destructive force, and now I sometimes even look forward to a conflict (assuming it’s handled effectively) because it is an essential stage of team development.

The Thomas-Kilmann Conflict Mode Instrument (TKI) gives you insights into how you prefer to manage conflict, whether that is through:

  • Competing
  • Collaborating
  • Compromising
  • Avoiding
  • Accommodating

Knowing what your go to method is for handling conflict allows you to actively increase your skills in the other conflict modes and applying each mode when the situation requires it. Having more than one or two management skills will allow you to respond to different types of conflict effectively and nip unnecessary conflict in the bud.

 

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-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.

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Do you know that we have a comfort zone when we are handling conflicts? The Conflict Management course conducted by ASCP’s Leadership Academy offers an assessment of your conflict management style using the Thomas-Kilmann Conflict Mode Instrument (TKI). This assessment is eye-opening and helped me gain a better appreciation of my management style.

I scored high on “accommodating skills” on the TKI, meaning that when in conflict, I tend to be reasonable and accommodating with others, creating goodwill in the process. This method is particularly helpful for managers who inherit a new department through restructuring and aim to preserve harmony and avoid disruption to the work process. It is also helpful for building social credits to be use in the future for more important tasks that need larger buy-ins. As companies in the healthcare and diagnostic testing sectors evolve and adapt to the new regulatory and fiscal environment, departments within companies will continue to be restructured to ensure efficiency and relevancy. In my current position as a manager, I find these skills to be immensely useful, particularly as I’m recently given oversight responsibilities of new departments. The skills are helpful to ensure seamless transition while continuing to provide patients with unsurpassed diagnostic insights and innovation.

The course also asks us to look at our blind spots. I find that I tend to spend too little time discussing issues in depth and hashing out personal differences. “Collaborating mode” encourages us to work through issues, think outside the box, and to create a win-win solution. I’m learning to set aside time to proactively reach out to others with varying views and to understand their thoughts and evaluate their viabilities and applications. This gives me an opportunity for integrative solutions to merge insights from people with different perspectives on a problem and gain commitment from various stakeholders.

The ASCP Leadership program and the TKI gave me important revelations into my conflict management comfort styles and provided insights into my blind spots. While my favorite conflict behaviors are results of both my personal predispositions and the requirements of my work situations, I try to utilize other management styles based on the specifics of the situation. I have no doubt that the leadership program has augmented my management tool box. Now I have different tools at my disposal, whether it be “kill your enemies with kindness” (accommodating), “two heads are better than one” (collaborating), “Leave well enough alone” (avoiding), “might makes right” (competing), or “split the difference” (compromising), to approach future conflicts.

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-Paul Chiou, MPH, SCT (ASCP) CM is a supervisor of Cytology and FISH at Miraca Life Sciences. Paul is a CAP inspector and an active member of the laboratory community having served on various professional committees over the years.

Utilization Management – Where Have We Been and Where Are We Now?

Healthcare organizations are under increasing pressure to increase value. It is well known that a significant portion of laboratory testing is unnecessary. As a result, many organizations have started laboratory utilization management programs (LUMP) to reduce the waste associated with laboratory orders. Each month, I’ll address a series of topics related utilization management.

Conceptually, LUM is not difficult. It is much like any other improvement process such as Deming’s PDSA cycle (Plan Do Study Act) or the DMAIC (define, measure, analyze, improve, and control) cycle used by Six-Sigma. In the context of LUM, one must identify opportunities for improvement, design and implement an intervention, and study the results. Most organizations are familiar with these approaches and utilization management is nothing more than directing these improvement methodologies to laboratory testing.

The success of a LUMP depends on the proper organization of the program. Top management support is very important. At my hospital, the LUMP was driven by an initiative called Value Driven Outcomes which was started by the Dean of the Medical School, Vivian Lee.(1) This program affected all parts of the organization – including the lab. We formed a LUM committee that was chaired by the Chair of Internal Medicine and included high-level representatives from Information Technology, Pathology, Finance, and education. The high-level support made it possible to overcome resistance and move quickly. I speak to many clinicians and managers across the country who are involved in LUM. Almost invariably, those who have top-level support are more satisfied with their progress. In contrast, those who approach LUM from the bottom up are less satisfied. They make progress, but the path is more difficult.

Identifying opportunities for improvement is the most challenging part of UM Opportunities are usually identified by comparing performance against a guideline. Unfortunately, the number of tests (~2500) far outnumbers the availability of guidelines (~200).

Benchmarking is alternate approach that can be applied to almost any test. In benchmarking, one compares testing patterns across a number of organizations and looks for outliers(2). The presumption, which is not necessarily true, is that unusual order patterns are associated with unusual order patterns and that tests with unusual order patterns are most likely high-yield targets.

There are several good sources of guidelines. The Choosing Wisely campaign provides a good list of tests that are obsolete. A forthcoming CLSI document on utilization has a chapter that provides a long list of targets. Repeat testing is also a common target and several recent guidelines have been published on testing intervals. (3-5)

Although there remains much to be discovered with respect to guidelines, interventions are fairly static. I haven’t seen much new since the 1990’s. A recent review categorized interventions as education, audit and feedback, system-based, or penalty/reward.(6) All of these seem to work, but there is a lot of variation across studies – even within one intervention. A forthcoming CDC study will add to this literature.

Overall, the bottleneck in LUMPs are finding guidelines and doing the analysis to determine whether an opportunity exists. National organizations such as CLSI do a great service by compiling this information.

That is the overview. Next time, I’ll pick a more specific topic.

 

  1. Kawamoto K, Martin CJ, Williams K, et al. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes. Journal of the American Medical Informatics Association 2014:amiajnl-2013-002511.
  1. Signorelli H, Straseski JA, Genzen JR, et al. Benchmarking to Identify Practice Variation in Test Ordering: A Potential Tool for Utilization Management. Laboratory medicine 2015;46:356-64.
  1. Janssens PMW, Wasser G. Managing laboratory test ordering through test frequency filtering. Clinical Chemistry and Laboratory Medicine 2013;51:1207-15.
  1. Orth M, Aufenanger J, Hoffmann G, et al. Recommendations for the frequency of ordering laboratory testing. LaboratoriumsMedizin 2015;38.
  1. Lang T. National Minimum Re‐testing Interval Project: A final report detailing consensus recommendations for minimum re‐testing intervals for use in Clinical Biochemistry. https://www.rcpath.org/asset/BBCD0EB4-E250-4A09-80EC5E7139AB4FB8/. 3013. Accessed: May 30 2017.
  1. Kobewka DM, Ronksley PE, McKay JA, Forster AJ, Van Walraven C. Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: A systematic review. Clinical Chemistry and Laboratory Medicine 2015;53:157-83.

 

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-Robert Schmidt, MD, PhD, MBA, MS is a clinical pathologist who specializes in the economic evaluation of medical tests. He is currently an Associate Professor at the University of Utah where he is Medical Director of the clinical laboratory at the Huntsman Cancer Institute and Director of the Center for Effective Medical Testing at ARUP Laboratories.

 

 

 

Safety Success in the Anatomic Pathology Laboratory

The pathologist walked into the histology laboratory every morning to say hello to the staff. As he did so, he drank from his cup of coffee.

The gross room was very small, and the eyewash station was placed on the faucet in the only sink in the room. One foot above the sink were the sharp ends of all of the cutting tools that hung on the wall. That was also the hand washing sink.

The morgue was the only space in the hospital where chemical waste could be stored before being picked up. The waste containers were not dated, and a funnel was left in the opening of one of them.

It can be difficult to oversee safety for a clinical laboratory, but often the people responsible for it have a clinical lab background, so the understanding of the regulations is clear. However, if you are responsible for the anatomic pathology (AP) areas as well, you may need to broaden the scope of your safety learning. Each of the lab safety situations mentioned above are real, and detecting and resolving those and other issues is important. Knowing the regulations for histology, cytology, and the morgue settings is a good place to start. Next, spend some time in those areas, and learn the processes that occur every day. Ask questions and look at procedures.

Bio-safety regulations in the AP lab are no different than for clinical laboratory staff. Many specimens, body parts and cadavers may be handled, and Standard Precautions should be used. That includes the use of gloves, lab coats, and face protection.

Chemical hygiene is also important in the AP lab, and since these areas tend to utilize many more chemicals than others, the management of them can seem daunting. Be sure to keep an updated chemical inventory which designates carcinogens, reproductive toxins and acute toxins. Ensure all staff have access to Safety Data Sheets (SDS) and that they have been trained to properly store chemicals. That means strong acids and bases should be stored near the floor, and they should never be stored together. Other incompatible chemicals should be separated as well. Ensure that proper spill supplies are available, and that staff can clean up various types of chemical spills. Conducting spill drills is a great way to keep staff ready for the real event.

Exposure monitoring should occur depending on what chemicals are used in the area. Managing chemical safety also includes ensuring proper labeling of all chemical containers. Primary container should have current Globally Harmonized System (GHS) compliant labels, and secondary containers also need adequate labeling. Secondary containers may be labeled using a GHS format or NFPA and HMIS conventions may be used.

Chemical or Hazardous waste handling must also be monitored closely in AP areas. If chemical waste is stored in the lab in a Satellite Accumulation Area, the containers should not be dated, and they should be stored at or near the point of waste generation. Central Accumulation Areas are areas where waste is stored before it is removed from the site. In these areas, containers must be dated, and a log should be kept for weekly checks of the areas. Weekly checks include looking for container leaks, dates on containers, and making sure containers remain closed. All chemical waste containers must remain closed unless someone is actively working with them. Never leave an open hazardous waste container open or with a funnel in it while unattended.

Special safety consideration should be given to tissue cutting in the histology area. Microtome and cryostat use presents specific sharps dangers because of the large sharp blades in use. If a blade guard is included with the equipment, train staff to always engage it before placing hands near the blade. Use magnet-tipped implements to remove the blades and rubber-tipped forceps to install new ones. Follow manufacturer guidelines for cryostat decontamination, but avoid using formaldehyde fumes for that purpose.

If laboratory staff is exposed to formaldehyde concentrations greater than 0.1 parts per million in their routine work, there is a safety training program that is required by OSHA. This formaldehyde training needs to be administered at the time of initial job assignment and whenever a new exposure to formaldehyde is introduced into the work area. The training must also be repeated annually.

As a lab safety officer, I learned over time how to work with and coach pathologists for safety. There is no more coffee consumed in the lab. The cramped gross room was remodeled to improve safety. Understanding the issues and reporting them was the key to getting this done. It took a difficult inspection by the EPA to teach me how to properly handle chemical waste. Today the representative from the state is my best reference, and she is willing to come to the labs and help us with waste regulation compliance. If your background is clinical, don’t ignore the special considerations in the anatomic pathology areas. Use your resources to learn what happens there, and understand the regulations so that employees in every area of the lab can work safely.

 

Scungio 1

Dan Scungio, MT(ASCP), SLS, CQA (ASQ) has over 25 years experience as a certified medical technologist. Today he is the Laboratory Safety Officer for Sentara Healthcare, a system of seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. He is also known as Dan the Lab Safety Man, a lab safety consultant, educator, and trainer.

Everything DiSC Workplace

As part of my work as a leadership coach and consultant, I’ve had the good fortunate to participate in several life- and work-transforming certification programs and courses. Everything DiSC Workplace stands out from the others because of its simple yet transformative power. For me personally it has given me direct insights into how I can adapt my behavior to become more effective with people who behave similar to me and with those who behave differently. Understanding the four different personality types of the Everything DiSC Workplace model allows me to get better results, be more productive as an employee, and it gives insights into my own workplace preferences. As a result of this course, I’ve learned how to tailor my approach to the situation and the people involved. Should I be more direct or soften my language? Should I focus on building rapport or present a lot of data to get my point across? Here at ASCP, Everything DiSC Workplace is one of our fundamental courses that every employee takes.

Everything DiSC Workplace focuses on people’s behavioral patterns and preferences while at work. The model distinguishes between four main styles:

  • D for Dominance
  • i for Influence
  • S for Steadiness
  • C for Conscientiousness

All styles are equally valuable and useful. In fact, all people use all four styles, but everyone has a preference of one or two styles.  Typically speaking, those with a preference for the D style would describe themselves as active and questioning. Those with the i-Style are more active and accepting. The S style relates to people who are accepting but thoughtful, and those with the C Style are thoughtful and questioning.

There are behaviors, motivators, stressors, and priorities associated with each style. Understanding your own preferences and your strengths and growth opportunities is a great foundation for your leadership development.

 

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-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.

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I thoroughly enjoyed the Everything DiSC Workplace. It was an assessment that I hadn’t done before and I found it to be very accurate in describing my behaviors and attitudes. I have gained quite a few insights about myself, the people I work with, and even the leaders that I report to.

I am a C DiSC style, the conscientious style, the one who likes to take the time to consider all the facts and make an objective decision. Great, right? Well, I don’t always remember to be personable. So, when I look over a project, I can be rather blunt. My input can come across as corrections or criticisms. This is something I need to watch out for as a C. In the past I have tried to explain that there were no bad feelings on my part; no dislike or intention to belittle. Those who were upset by my manner often continued to react in the same way. Now I have learned to never lead with a correction or change, but to stop and consider what someone has done first. If what they have done will work, even if it is not what I would have done, I thank them for taking care of it and doing such a great job. If it won’t work I still thank them first, but I may ask a few leading questions as well. Perhaps we can come up with some improvements together. I seem to have a much better rapport with my coworkers now and they seem to be more willing to add their own suggestions.

As I look around my workplace, I can see the styles that many of my coworkers prefer.

A D-style that I know gets argumentative when I dismiss her ideas without explanation, yet doesn’t allow me time for the full explanation. There have been many disagreements between us. I have learned that if I acknowledge her ideas first and then add a few bullet points, it turns out that we are often actually working towards the same goals.

If I need to sell an idea to everyone, I know an “i” that I can go to. Once she gets excited about it and starts bouncing ideas off everyone, things take off from there. It is an awesome talent. It is also one that doesn’t usually work on me. This is another situation where I have learned to appreciate her ideas first and then, considerately, discuss them in more detail. I want to encourage her spirit but not dampen it if I happen to disagree.

I see the S-styles as the backbone of my lab. As I get all wound up about sudden changes, they take it all in stride. That is my C-style again, wanting to think it through before making the change. The S’s have been through a lot of changes though, and calmly accept most of them. A little appreciation goes a long way with these guys. If they feel compelled to complain about a change, it’s time to listen.

Interestingly, I have also started paying close attention to how my leaders talk to me. I have one who talks to me about big changes, explains the situation, listens to my thoughts, and gives me time to think about it. I don’t necessarily get my way, but when I go into her office ready to fight to prevent a change, I generally come back out supporting it and eager to help. It’s a C thing. Make me feel like I’m a part of what’s happening and I’m fine.

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-Stacey Robinson, MS, MLS(ASCP)CMSHCM,QCYMCM is a graduate of the Clinical Laboratory Science program at the University of Texas Health Science Center in San Antonio and holds a Masters in Science in Biotechnology from Johns Hopkins University. She currently serves as the Vice Chair of the Hematology Exam Committee for ASCP.