Man did that bring back some memories. Bill and I worked together in the same Navy lab and he is correct if a block was embedded wrong you would get it in either the back of the head or between the shoulders. They stopped throwing them at me the day I throw the block back at the microtomist and hit him in the head. We were a tough crew that saw a lot, did a lot, partied together a lot, but never lost the fact that we were there for patient care and treated all the specimens and bodies as if they came from a love one. When it came time for Bill and I to become the trainers we were brutal in how to embed, section and all other aspects of histology, I mean we only wanted perfection.
Tom Podawiltz HT (ASCP) Histology Section Head/Laboratory Safety Officer. LRGHealthcare Laconia, NH 03246 603-524-3211 ext: 3220 -----Original Message----- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of O'Donnell, Bill Sent: Thursday, August 25, 2011 1:57 PM To: Heath, Nancy L.; Jennifer MacDonald Cc: Histonet Listserv (E-mail); histonet-boun...@lists.utsouthwestern.edu; D'Attilio, Shelley Subject: RE: [Histonet] RE: Embedding process improvementand competencyassessment Just to throw a somewhat funny situation into the mix. I learned my embedding skills in the Navy. The basic method for learning all tasks was 1. explain it, 2. demonstrate it, 3. do it. Each microtomist was responsible for taking a good look at the block before cutting it. If the embedding was not spot-on, the block was always returned for reembedding. The method of return was to throw it at the back of my head. They rarely missed. Very quickly, I got tired of being hit in the head and my embedding improved. Can't do that kind of stuff now, even in the military. Who knew that histology used to be a contact sport? We've gotten sooooo soft! As to the other situation, as a histology supervisor, I was over cytology in one of the labs I worked at. I doubt that I was much of a manager to them as I knew next to nothing about their work. However, I took the time to learn some aspects, and then just pretty much left them alone. (It was a mutual respect, they pretty much left me alone too.) They did a fine job of making me look good. I trusted them, and they didn't do anything to betray that trust. Because of that, I would simply sign-off on the occasional request. Evals were pretty easy as I simply interviewed the pathologists, checked attendance and moved on. That being said, I wouldn't want to have to do it again. They deserved better, but we made it work, since it wasn't going to change. Have a great day! William (Bill) O'Donnell, HT (ASCP) QIHC Senior Histologist Good Samaritan Hospital 10 East 31st Street Kearney, NE 68847 Check out my podcast at DeaconCast.Net SERENITY is not freedom from the storm, but peace amid the storm. Cultivate it in PRAYER! -----Original Message----- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Heath, Nancy L. Sent: Thursday, August 25, 2011 11:39 AM To: Jennifer MacDonald Cc: Histonet Listserv (E-mail); histonet-boun...@lists.utsouthwestern.edu; D'Attilio,Shelley Subject: RE: [Histonet] RE: Embedding process improvementand competencyassessment Regardless of wether there were 8 blocks or eighteen blocks taking the practical taught me to be precise with all of the hands on aspects of Histology. Shame on the older techs from the "practical days" of not keeping on top of their game with embedding. My comment was geared more towards the newbies coming out of histo schools who can pass the exam with flying colors but sit them in front of an embedding center or microtome and they are all thumbs! As far as a manager, I myself would rather have someone who has experience with histology over seeing my work. Just once again the lack of respect of having the HT/HTL behind your name. ________________________________ From: Jennifer MacDonald [mailto:jmacdon...@mtsac.edu] Sent: Thursday, August 25, 2011 10:58 AM To: Heath, Nancy L. Cc: Histonet Listserv (E-mail); histonet-boun...@lists.utsouthwestern.edu; D'Attilio, Shelley; Podawiltz, Thomas 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." <nhe...@lifespan.org> Sent by: histonet-boun...@lists.utsouthwestern.edu 08/25/2011 07:11 AM To "D'Attilio, Shelley" <sdatt...@stormontvail.org>, "Podawiltz, Thomas" <tpodawi...@lrgh.org>, "Histonet Listserv (E-mail)" <histonet@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-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@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 ________________________________________ NEED A DOCTOR? 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