Competency Assessment Form Blood Bank - Testing Personnel First Name *Last Name *Date *Type of Assessment *Select One Type of AssessmentInitial6 MonthsAnnualObjectives To demonstrate knowledge and competency on pretransfusion testing system from preanalytical to to postanalytical phase To demonstrate knowledge and competency on the performance of Coombs Test and other immunohematology test to identify presence of specific antigens or antibodies To demonstrate skills in the handling of reagents/chemicals, sample specimens and other equipment related to the test procedure To demonstrate problem-solving skills on instrumentation, calibration and QC, and verification or validation of patient or blind sample results particularly on immunohematological discrepancies To be able to follow guidelines on blood bank procedures on receiving specimens, recording and labeling, receiving and storing blood units, reserving and releasing blood unit, maintenance and monitoring of equipment, blood transfusion reaction, donor selection and screening, donor bleeding and therapeutic phlebotomy, emergency processes, and other special or as needed immunohematological procedures Checklist on operation and regulation *1. Corrective process when error is committed in entering report into eHR2. Establishing Quality Control Plan for each test analyte as applicable3. Notification of critical value and documentation4. Checking and completing incomplete reports in the eHR5. Documentation of problem or occurrence if encountered6. Time frame storage requirement for patient’s reports, analytical studies i.e. QC, calibration and verification, operating procedures and other documentations7. Procedures for receiving proficiency test (PT) surveys, delegations, performance, reporting electronically, reviewing and evaluating the resultsKeep up to date with the Standard Operating Procedure (SOP)Checklist for Instrumentations and Blood Bank equipment (refrigerator, incubator, shaker, centrifuge, scopes and lenses, saline washer, and other related equipment) *1. Instrument's or equipment start-up procedure2. Process of calibration and QC as applicable3. Perform maintenance of instruments and associated equipmentSpecific Observation Guide1) Instrument's or equipment startup procedure Locate, turn on/off power switches Enumerate major system components/parts Water supply requirements as applicable Operating speed, temperature and humidity as applicable Alarm setting as applicable Knowledge of trouble-shooting process 2) Process of calibration and QC as applicable Demonstrate calibration verification of temperature (refrigeration and incubator) Calibration verification of speed (centrifuge) Demonstrate process of QC of reagents in blood bank as applicable Interpretation of QC result and corrective action based on design rule protocol Know what the quality control plan is 3) Perform maintenance of instruments and associated equipment Perform maintenance (Daily, Weekly or Scheduled) Show documentation of monitoring log and preventive maintenance Checklist for immunohematology procedures *1. Demonstrate process, logging, and documentation of receipt of reagents and blood units2. Demonstrate testing patient sample from pre-analytical to post-analytical phase3. Describe blood transfusion reaction work procedures4. Describe donors and therapeutic phlebotomy work process5. Show documentation and recording process6. Describe disposition of materials and sample specimenSpecific Observation Guide1) Demonstrate process, logging, and documentation of receipt of reagents and blood units Assessing the reagents or kits and blood units, recording lot/batch number and expiry date and proper storage Show records or documentation 2) Demonstrate testing patient sample from pre-analytical to post-analytical phase Receiving patient sample, logging/tracking, labeling, locating patient or donor/recipient previous records, assessing specimen stability and rejection criteria if any Enumerate materials needed for the test procedure Demonstrate actual procedure on ABO and Rh typing, antibody screening and specific antibody identification as applicable, complete cross-matching and Coombs test Demonstrate other blood bank procedure such as in pediatric transfusion (volume titration), emergency release of unscreened or incomplete screened blood units, and other non-routine or special procedure as applicable Demonstrate reading, interpretation of result, recording and documentation Enumerate limitations or factors that may interfere and may cause false test results Demonstrate the process of notification to the wards when the blood unit is ready Notification of critical results, flagging if any, and result reporting into eHR Demonstrate the process of releasing the blood unit for transfusion Demonstrate the process of receiving back blood unit from the wards (empty, used, or unopened unit) Recording and storing process of the reports 3) Describe blood transfusion reaction work procedures Receiving report and the blood unit from the ward when transfusion reaction occurs Procedure investigation of the transfusion reaction (forms, test, attestation) Notifying blood bank physician or laboratory director, American Red Cross or Federal Agency if applicable Storing process of the documentation 4) Describe donors and therapeutic phlebotomy work process Knowledge on selecting and screening donors procedure Demonstrate phlebotomy or blood collection for donors or patients Donor searching and communications Know what to do on emergency, notifying physician or referring action 5) Show documentation and recording process Recording critical results, specimen problem encountered, and any occurrences or incidents affecting standard patient care based on protocol 6) Describe disposition of materials and sample specimen Used pipette, tubes and stopper, expired or used reagents, empty bottles, slides Specimen sample and storing time frame Maintenance of non-consumable tools i.e. rack, timer, incubator, microscopes, etc.. Evaluation of previously analyzed specimens, internal blind testing samples, or external PT samples *- Performed and passed -Problem-Solving Knowledge and SkillsPlease take the assessment test to demonstrate knowledge and skills on problem-solving and come back here to post the result.Demonstrating knowledge and skills on problem-solving (Passing score is at least 80%) *Select TypeWritten ExamPractical ExamPercent (%) *Employee's AcknowledgementI acknowledged knowing and/or performing all above applicable listed checklists while being observed by my supervisor. I understood that failure to pass this competency assessment would result to remedial training and therefore, this would affect my performance on my position to carry out my duties and responsibilities as testing personnel. Typing my name below will constitute validity of this acknowledgment.Name of Employee *CLIA Assessment Elements1. Direct observation of routine patient test performance2. Monitoring the recording and reporting of test results, including critical values3. Review of intermediate test results, worksheets, QC records, PT results, and preventive maintenance records4. Direct observation of performance of instrument maintenance and function checks5. Evaluation of previously analyzed specimens, internal blind testing samples, or external PT samples6. Demonstrate problem-solving skills i.e. written exam, practical examCompetency Assessment ReportYes, demonstrates competency and meets standard.No, fails competency and needs remedial action.Name and Signature of Laboratory Director or Authorized Delegate *I hereby attest that I assessed and observed the employee above to the best of my knowledge. I further declare that the information and the competency assessment report provided is true and correct.Submit Form
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