[Histonet] Re: Basis for Quality Work in a Histotech
My first recommendation would be to look at your process is there any way that you can error proof them? Make it more difficult to make the errors.When a lot of errors are occuring sometimes it is often due to how we do the job and not who does it. Sharon Genest Anatomic Pathology Process Improvement Saskatoon Health Region 306-655-8242 sharon.gen...@saskatoonhealthregion.ca his e-mail message may contain confidential and/or privileged information. It is intended only for the addressee. Any unauthorized disclosure is strictly prohibited. If you are not a named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e-mail from your system. E-mail transmissions cannot be guaranteed to be secure or error free as information could be intercepted, corrupted, destroyed, arrive late or incomplete, or contain viruses. The sender therefore does not accept any liability for errors or omissions in the contents of this message or any damages that arise as a result of e-mail transmissions. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Basis for Quality Work in a Histotech
I totally agree with you Rene. May I add as a supervisor of 6 in which all of them I trained all myself in an OJT situation. 1. Instill in them team work and pride in their profession 2. Reiterate to them that their unique skills are an important link in the health care chain. If they lack any of above it's your job to provide them with the knowledge, skill and understanding of their critical role in the health care chain. My belief is you will see a rise in quality with minimal mistakes. If they don’t improve after receiving all of the above they should look for another profession. Cheryl A. Miller HT(ASCP)cm Histology Supervisor, Hygiene Officer Physicians Laboratory Services 4840 F Street Omaha, NE. 68127-0999 402 731 4145 ext. 554 -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Rene J Buesa Sent: Saturday, December 15, 2012 10:38 AM To: Travis Troyer; histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Basis for Quality Work in a Histotech First I want you to excuse me, but I do not think that you are really qualified to supervise 2 histotechs if you need to ask for such quality guidance. You end by bemoaning about budget crunch and because of that it seems to me that your 2 histotechs are not receiving a decent salary and, as everybody knows, you are getting what you are paying for. With 10 years of experience you should know that the first step for quality of sections is quality of fixation and quality of processing. You have first to manage that aspect. Quality of sections comes after wards and there is no standard for mistakes and for what you are describing it seems that mistakes are frequent. By the way, if the pathologists are not pleased, they will not it take on the histotechs, but on you as a supervisor unable to provide them the quality they require. There is no such thing as instant reward for a good quality job; the histotech should not be treated as dogs receiving a cookie after a trick performed but there are 2 tools: you need to keep track of the mistakes → counsel the HT after a mistake → retrain them → keep a track of mistakes and there are verbal and written counselings and an annual evaluation, I am sure you know that. The ideal limit of mistakes is 0 but there is some acceptable mistakes limits, as long as they are few and far between. The pathologists are the ones who can tell you what they are willing to accept as mistakes limits. Ask them. It seems that if your 2 HTs do not improve, you should start looking for replacements, but they should be better paid, and if the mistakes continue at a high rate, you should put your 10 years experience to work and start doing some bench work René J. From: Travis Troyer ttro...@petersonlab.com To: histonet@lists.utsouthwestern.edu Sent: Friday, December 14, 2012 5:34 PM Subject: [Histonet] Basis for Quality Work in a Histotech This is a question for all of the lab supervisors. I am the supervisor of two histotechs. I am not doing techwork now, but have 10 years of experience. The pathologists are getting more and more upset at the lack of quality in the work and the mistakes that are happening. I was wondering if anyone had some ideas on what sort of a goal to set up and how to reward/punish for variations from that goal. For example, if the goal is three mistakes for the month, what is the best way to reward them for making that goal and what would be best if they had more mistakes in a given time frame. We are all feeling the budget crunch and the pathologists are trying to figure out a good solution. Thanks, Travis Troyer ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet PRIVILEGED / CONFIDENTIAL INFORMATION may be contained in this message. If you are not the addressee intended / indicated or agent responsible for delivering it to the addressee, you are hereby notified that you are in possession of confidential and privileged information. Any dissemination, distribution, or copying of this e-mail is strictly prohibited. If you have received this message in error, please notify the sender immediately and delete this email from your system. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Re: Basis for Quality Work in a Histotech
Travis, If it were me (and I've done this), I would go back to the bench and walk in their shoes to see what is really happening. Come in at the start of their shift and work right along side them. This way, you can see who/what/when is going on: How are the machines being maintained (how often/quality of maintenance .is the 95% really 95%, etc.) How is the processing schedule? Does it need tweeking? How is the embedding? Quality? Go ahead and embed some. How is the cutting? Quality/quantity? Go ahead and cut some. How is the routine staining? Maintenance good? Times good? How are the special stains? Are protocols being followed or does each cook have their own recipe they follow? How is your procedure manual(s) Does it need cleaning up? Does the special stain manual contain pictures of what a good stain should look like? Get my drift? Lots of things to think about. I would go on the bench for a week and see what really happens every day. It may be intimidating at first, but it will show your techs and your pathologists how much you care and this should help your approach when helping them improve their techniques. This may need to be done a few times, and each time, you will see improvements. I don't know of any techs who want to do bad work, they just may need guidance in getting there. Additionally, it will be helpful to track what infractions are going on and the frequency (we have a monthly tracking system and I report it at our QA meetings (mislabeled slides, mislabeled blocks, etc). Also, do you have a system in place to evaluate competency? This will be helpful when evaluation time comes around to approach them in areas of needed improvement. If you need help in developing a competency evaluation, the Michigan Society (www.mihisto.org) has a manual for supervisors that contains many different styles of evaluations that includes the different goals, measurements, assessment frequency, references and resources to help you develop an evaluation unique to your institution. Well worth the $5.00 investment. Supervising at times, can be a tough job, but I can tell you really care about the patient. The best of luck to you! Lynette Lynette Pavelich, HT(ASCP) Histology Supervisor Hurley Medical Center One Hurley Plaza Flint, MI 48503 ph: 810.262.9948 mobile: 810.444.7966 From: histonet-boun...@lists.utsouthwestern.edu [histonet-boun...@lists.utsouthwestern.edu] on behalf of Genest, Sharon SktnHR [sharon.gen...@saskatoonhealthregion.ca] Sent: Monday, December 17, 2012 7:55 AM To: 'histonet@lists.utsouthwestern.edu' Subject: [Histonet] Re: Basis for Quality Work in a Histotech My first recommendation would be to look at your process is there any way that you can error proof them? Make it more difficult to make the errors.When a lot of errors are occuring sometimes it is often due to how we do the job and not who does it. Sharon Genest Anatomic Pathology Process Improvement Saskatoon Health Region 306-655-8242 sharon.gen...@saskatoonhealthregion.ca his e-mail message may contain confidential and/or privileged information. It is intended only for the addressee. Any unauthorized disclosure is strictly prohibited. If you are not a named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e-mail from your system. E-mail transmissions cannot be guaranteed to be secure or error free as information could be intercepted, corrupted, destroyed, arrive late or incomplete, or contain viruses. The sender therefore does not accept any liability for errors or omissions in the contents of this message or any damages that arise as a result of e-mail transmissions. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] RELIA Special Job Alert for Supervisors and Managers 12-17-2012
Hello Histonetters!! I have several exciting opportunities for experienced Managers, and Supervisors in hospital and private lab environments in several locations in California. These are some of the premier employers in the United States. The positions are of course full time and permanent. My clients offer excellent compensation, benefits and relocation assistance. Here are my leadership positions: Pathology Supervisor - Fresno, CA Histology Supervisor - Los Angeles, CA Histology Manager - Los Angeles, CA I anticipate multiple management openings coming available nationwide after the holidays. If you are interested in looking into a change in another area of the country please let me know. That way I can keep you apprised of management opportunities in that area. Also if you would like more information or know of someone else who might be interested, please contact me at rel...@earthlink.net or 866-607-3542. I am available to discuss the opportunity at your convenience including after hours. Thanks-Pam There are a lot of recruiters out there right now trying to work with histology professionals and I appreciate your support and respect your needs. Remember I offer over 25 years of experience as a recruiter and for over 10 years I have dedicated my practice solely to placing histology professionals like you. Thank You! Happy Holidays !! Thank You! Pam Barker President/Senior Recruiting Specialist-Histology RELIA Solutions Specialists in Allied Healthcare Recruiting 5703 Red Bug Lake Road #330 Winter Springs, FL 32708-4969 Phone: (407)657-2027 Cell: (407)353-5070 FAX: (407)678-2788 E-mail: rel...@earthlink.net www.facebook.com http://www.facebook.com/PamBarkerRELIA /PamBarkerRELIA www.linkedin.com/in/reliasolutions www.twitter.com/pamatrelia ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Human bcell and Tcell Ab
Hi Everybody! Can you guys weigh in on the best antibodies for Human B cell and Tcell staining in FFPE sections? We would like to have a fluorescent endpoint if that changes things. Thanks in advance! Hope everyone has a safe Holiday. Mike ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Basis for Quality Work in a Histotech
Travis, Histology has a very complex workflow AND requires artisan level workmanship to deliver a product. Those two together nearly guarantee mistakes, mostly minor, but sometimes literally life-threatening to patients. The goal is to instill a sense of Best Quality in the techs. A large part of achieving that attitude is to ensure the pathologists and administrators are behind the techs 100% and ALLOW the techs to do Best Quality - ie, accept that Best Quality will sometimes mean slower turnaround time. Does that aspect mean more people are needed? That's your call, but can be determined by workload accounting. The attitude should be that the SYSTEM makes the mistake, not the individual. It is not likely a person makes a mistake on purpose, but instead is it some aspect of the system that allows them to make a mistake (though shortcuts can be thought of as intentionally risking making mistakes on purpose, the purpose being to save time or effort). Workflows can be engineered to ensure some mistakes don't happen. Protocols must be followed to the letter by EVERYONE. No workarounds allowed (a workaround is an indication that there is something wrong in the system - the employee feels the need to take shortcuts. Why? BTW, Bill Gates said the most important word in his vocabulary is why. Why is something done the way it is? Why does a mistake happen at a certain point? ). In failure analysis a problem is approached by asking 5 levels of WHY? After asking WHY 5 times back down the workflow chain you usually find the root cause of a problem. If not, you keep asking why until the root cause is found. For instance, we worked out a slide labeling protocol at the microtome that, if followed, will ensure the tech does not make labeling errors. All participated in working this out and so have bought into the system. All new employees are trained in that system. That will eventually be followed by barcoding, but that is a year away at least. But our protocol has nearly eliminated labeling errors (we still get a few sneaking in here and there but as we catch them we try to figure out how to engineer them away). We also finally instituted the printing of cassettes directly from our LIS rather than using a stand-alone printer or hand-writing. That has almost totally eliminated cassette labeling errors - we used to have hundreds per month, mainly by residents putting in cassettes that they did not enter in our LIS, or making simple typo errors on a stand-alone cassette labeler, or hand-written cassettes. All these methods need to be investigated. Rewards are also very helpful. We give out Bear hugs that are $5 gift certificates to the campus store, cafeteria, various food vendors in the institution, etc. it's a small reward, but people actually appreciate it. We also have Star Awards of $50 gift cards for those times when someone does something more beyond the usual. The receiver chooses the card they want from about 2 dozen available (coffee shops, VISA, various stores, etc). Good luck with it! Tim Morken Supervisor, Electron Microscopy/Neuromuscular Special Studies Department of Pathology UC San Francisco Medical Center -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Rene J Buesa Sent: Saturday, December 15, 2012 8:38 AM To: Travis Troyer; histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Basis for Quality Work in a Histotech First I want you to excuse me, but I do not think that you are really qualified to supervise 2 histotechs if you need to ask for such quality guidance. You end by bemoaning about budget crunch and because of that it seems to me that your 2 histotechs are not receiving a decent salary and, as everybody knows, you are getting what you are paying for. With 10 years of experience you should know that the first step for quality of sections is quality of fixation and quality of processing. You have first to manage that aspect. Quality of sections comes after wards and there is no standard for mistakes and for what you are describing it seems that mistakes are frequent. By the way, if the pathologists are not pleased, they will not it take on the histotechs, but on you as a supervisor unable to provide them the quality they require. There is no such thing as instant reward for a good quality job; the histotech should not be treated as dogs receiving a cookie after a trick performed but there are 2 tools: you need to keep track of the mistakes → counsel the HT after a mistake → retrain them → keep a track of mistakes and there are verbal and written counselings and an annual evaluation, I am sure you know that. The ideal limit of mistakes is 0 but there is some acceptable mistakes limits, as long as they are few and far between. The pathologists are the ones who can tell you what they are willing to accept as mistakes limits. Ask them.
Re: [Histonet] Basis for Quality Work in a Histotech
Tim, I'd be interested in more information in your labeling at the microtome that has all but eliminated errors. Would you share? Thank you, Sheila Haas Laboratory Manager MicroPath Laboratories, Inc. From: Morken, Timothy timothy.mor...@ucsfmedctr.org To: histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Sent: Monday, December 17, 2012 11:30 AM Subject: RE: [Histonet] Basis for Quality Work in a Histotech Travis, Histology has a very complex workflow AND requires artisan level workmanship to deliver a product. Those two together nearly guarantee mistakes, mostly minor, but sometimes literally life-threatening to patients. The goal is to instill a sense of Best Quality in the techs. A large part of achieving that attitude is to ensure the pathologists and administrators are behind the techs 100% and ALLOW the techs to do Best Quality - ie, accept that Best Quality will sometimes mean slower turnaround time. Does that aspect mean more people are needed? That's your call, but can be determined by workload accounting. The attitude should be that the SYSTEM makes the mistake, not the individual. It is not likely a person makes a mistake on purpose, but instead is it some aspect of the system that allows them to make a mistake (though shortcuts can be thought of as intentionally risking making mistakes on purpose, the purpose being to save time or effort). Workflows can be engineered to ensure some mistakes don't happen. Protocols must be followed to the letter by EVERYONE. No workarounds allowed (a workaround is an indication that there is something wrong in the system - the employee feels the need to take shortcuts. Why? BTW, Bill Gates said the most important word in his vocabulary is why. Why is something done the way it is? Why does a mistake happen at a certain point? ). In failure analysis a problem is approached by asking 5 levels of WHY? After asking WHY 5 times back down the workflow chain you usually find the root cause of a problem. If not, you keep asking why until the root cause is found. For instance, we worked out a slide labeling protocol at the microtome that, if followed, will ensure the tech does not make labeling errors. All participated in working this out and so have bought into the system. All new employees are trained in that system. That will eventually be followed by barcoding, but that is a year away at least. But our protocol has nearly eliminated labeling errors (we still get a few sneaking in here and there but as we catch them we try to figure out how to engineer them away). We also finally instituted the printing of cassettes directly from our LIS rather than using a stand-alone printer or hand-writing. That has almost totally eliminated cassette labeling errors - we used to have hundreds per month, mainly by residents putting in cassettes that they did not enter in our LIS, or making simple typo errors on a stand-alone cassette labeler, or hand-written cassettes. All these methods need to be investigated. Rewards are also very helpful. We give out Bear hugs that are $5 gift certificates to the campus store, cafeteria, various food vendors in the institution, etc. it's a small reward, but people actually appreciate it. We also have Star Awards of $50 gift cards for those times when someone does something more beyond the usual. The receiver chooses the card they want from about 2 dozen available (coffee shops, VISA, various stores, etc). Good luck with it! Tim Morken Supervisor, Electron Microscopy/Neuromuscular Special Studies Department of Pathology UC San Francisco Medical Center -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Rene J Buesa Sent: Saturday, December 15, 2012 8:38 AM To: Travis Troyer; histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Basis for Quality Work in a Histotech First I want you to excuse me, but I do not think that you are really qualified to supervise 2 histotechs if you need to ask for such quality guidance. You end by bemoaning about budget crunch and because of that it seems to me that your 2 histotechs are not receiving a decent salary and, as everybody knows, you are getting what you are paying for. With 10 years of experience you should know that the first step for quality of sections is quality of fixation and quality of processing. You have first to manage that aspect. Quality of sections comes after wards and there is no standard for mistakes and for what you are describing it seems that mistakes are frequent. By the way, if the pathologists are not pleased, they will not it take on the histotechs, but on you as a supervisor unable to provide them the quality they require. There is no such thing as instant reward for a good quality job; the histotech should not be treated as dogs receiving a cookie after a trick
RE: [Histonet] Basis for Quality Work in a Histotech
Would also love to hear! $$ for bar coding too far away! Lynette Lynette Pavelich, HT(ASCP) Histology Supervisor Hurley Medical Center One Hurley Plaza Flint, MI 48503 ph: 810.262.9948 mobile: 810.444.7966 From: histonet-boun...@lists.utsouthwestern.edu [histonet-boun...@lists.utsouthwestern.edu] on behalf of Sheila Haas [micropathl...@yahoo.com] Sent: Monday, December 17, 2012 11:57 AM To: Morken, Timothy; histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Basis for Quality Work in a Histotech Tim, I'd be interested in more information in your labeling at the microtome that has all but eliminated errors. Would you share? Thank you, Sheila Haas Laboratory Manager MicroPath Laboratories, Inc. From: Morken, Timothy timothy.mor...@ucsfmedctr.org To: histonet@lists.utsouthwestern.edu histonet@lists.utsouthwestern.edu Sent: Monday, December 17, 2012 11:30 AM Subject: RE: [Histonet] Basis for Quality Work in a Histotech Travis, Histology has a very complex workflow AND requires artisan level workmanship to deliver a product. Those two together nearly guarantee mistakes, mostly minor, but sometimes literally life-threatening to patients. The goal is to instill a sense of Best Quality in the techs. A large part of achieving that attitude is to ensure the pathologists and administrators are behind the techs 100% and ALLOW the techs to do Best Quality - ie, accept that Best Quality will sometimes mean slower turnaround time. Does that aspect mean more people are needed? That's your call, but can be determined by workload accounting. The attitude should be that the SYSTEM makes the mistake, not the individual. It is not likely a person makes a mistake on purpose, but instead is it some aspect of the system that allows them to make a mistake (though shortcuts can be thought of as intentionally risking making mistakes on purpose, the purpose being to save time or effort). Workflows can be engineered to ensure some mistakes don't happen. Protocols must be followed to the letter by EVERYONE. No workarounds allowed (a workaround is an indication that there is something wrong in the system - the employee feels the need to take shortcuts. Why? BTW, Bill Gates said the most important word in his vocabulary is why. Why is something done the way it is? Why does a mistake happen at a certain point? ). In failure analysis a problem is approached by asking 5 levels of WHY? After asking WHY 5 times back down the workflow chain you usually find the root cause of a problem. If not, you keep asking why until the root cause is found. For instance, we worked out a slide labeling protocol at the microtome that, if followed, will ensure the tech does not make labeling errors. All participated in working this out and so have bought into the system. All new employees are trained in that system. That will eventually be followed by barcoding, but that is a year away at least. But our protocol has nearly eliminated labeling errors (we still get a few sneaking in here and there but as we catch them we try to figure out how to engineer them away). We also finally instituted the printing of cassettes directly from our LIS rather than using a stand-alone printer or hand-writing. That has almost totally eliminated cassette labeling errors - we used to have hundreds per month, mainly by residents putting in cassettes that they did not enter in our LIS, or making simple typo errors on a stand-alone cassette labeler, or hand-written cassettes. All these methods need to be investigated. Rewards are also very helpful. We give out Bear hugs that are $5 gift certificates to the campus store, cafeteria, various food vendors in the institution, etc. it's a small reward, but people actually appreciate it. We also have Star Awards of $50 gift cards for those times when someone does something more beyond the usual. The receiver chooses the card they want from about 2 dozen available (coffee shops, VISA, various stores, etc). Good luck with it! Tim Morken Supervisor, Electron Microscopy/Neuromuscular Special Studies Department of Pathology UC San Francisco Medical Center -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Rene J Buesa Sent: Saturday, December 15, 2012 8:38 AM To: Travis Troyer; histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] Basis for Quality Work in a Histotech First I want you to excuse me, but I do not think that you are really qualified to supervise 2 histotechs if you need to ask for such quality guidance. You end by bemoaning about budget crunch and because of that it seems to me that your 2 histotechs are not receiving a decent salary and, as everybody knows, you are getting what you are paying for. With 10 years of experience you should know that the first step for quality of sections is
RE: [Histonet] Basis for Quality Work in a Histotech
Here is our slide labeling procedure. It is simple, but we insist it be followed. This will be modified once barcoding is instituted to use scanning ID of slides vs block. We also instituted block ID beads at the embedding center. That has helped tremendously to identify people that may need embedding retraining. One other thing I should mention. People in the lab should be told to trust their inner voice. We had several labeling errors that on investigation were suspected or ignored by a tech in the chain or events. In one case the sectioning tech pulled the wrong block from the file, labeled the slides with that block number and sent it to the IHC group. An IHC tech took the slide and noticed the number was wrong but ASSUMED the sectioning tech had made an error, so corrected the number to match the request on her log. The mistake was only caught by the pathologist who noticed the IHC slide did not match the HE slide from the proper block. I tell my techs: Trust your instincts. If something seems wrong - for whatever reason - STOP!!! Investigate the issue. You will save time, effort, and maybe lives. I also tell my techs not no pathologist will remember how fast you were, just how many mistakes you made. Tim Morken +++ Slide Labeling Procedure at the Microtome Slide labeling at the cutting station is the most important part of the process used to identify slides. A mistake at this point will cause a mix-up in slides or cases and could lead to improper diagnosis and treatment for patients. Because this is such an important step the following procedure must be followed exactly. Deviation may cause mislabeling. Deviation from the procedure may be cause for reprimand and termination. Important points: 1. Label slides for one block at a time. 2. Do not pre-label slides before cutting sections from a block, or for any other blocks. 3. Work with one block at a time as much as possible. If the block must be re-soaked before completing the slide count then the block must be isolated from the other blocks to prevent a mix-up. 4. The stainer tech will compare stained slides to the blocks to ensure they are correct. Sectioning Procedure 1) Pick up the next page of the processing log and the blocks that are on that page. 2) Verify that the blocks picked up are on the processing log. a. Put the blocks in order according to the processing log. b. Put a check mark “” next to the block line on the log to indicate the block is present in the group. c. Note any problems with the blocks 1. Put an “X” mark next to any problem blocks and note the problem. a. Add-ons b. Missing c. Reprocessing needed d. Re-embedding and reason e. other 3) Face-trim the blocks and put them on ice (if necessary) in order as shown on the processing log. 4) Pick up the first block on the log. a. Do not pre-label slides for this or any other block 5) Place the block in the microtome and cut sections according to a. requests on the processing log and established sectioning requirements b. “Tissue Sectioning Standards” of the Sectioning section of the Histology Laboratory manual 6) Pick up the proper number of sections on the appropriate slides. 7) Label the slides a. Write the Accession number and Part letter/number of the block on the microtome. b. Label slides with your initials (legibly) c. Label initial slide in the group with the cassette color and page number (this slide is first in the rack and faces forward for the Stainer person to see) d. NOTE: If the block must be re-soaked to complete the slide count, then isolate the block on the ice tray by putting it at the back of the tray facing backwards. This will indicate that some slides have been cut previously. 8) Place the slides for HE in the HE staining rack a. Write the color and page number of the processing log on the first slide of the rack. b. Place slides in the rack beginning at the front of the rack and working backward. c. Place designated “unstained” slides in separate rack(s) for use later (IPOX, Specials, etc). d. Discard any unused slides with sections on them. 9) Take the block from the microtome and put it in the cardboard filing box. 10) Clean the surface of the water with a Kimwipe or paper towel. Be sure there are no tissue fragments floating on the water bath. 11) Cross off that case on the processing log with a diagonal line through the entire case. 12) When the HE slide rack is filled take it to the 60C oven a. Hand-write a label with the cassette color and page# as well as the time the slides will come out of the oven (10 min from current time). b. Place the label on the front end of the slide rack (end with first slide). c. Put the slides in the oven with the label
RE: [Histonet] Re: Basis for Quality Work in a Histotech
I agree with most everything said here. I'd like to add that I ask my staff to visualize the patient getting accurate results in a timely fashion. In that order of importance. We really work for the patient, not the Pathologist or the company. If I don't tell them the good stuff, I can never address the bad. Another mistake is using fear to motivate. In other words, I've messed up 2 times this month one more and I'm out of a job. There has to be little risk for mistakes. And an environment of working together to change should help people with Histological pride. Here's how I do it. I call a meeting. I describe the problem, and give the person who did it, an out. An out is an admission by me that the system needs tweaking. Blame is not going to get us the information we need. I say we, because my job is to exclude the ridiculous ideas, and choose the first one to try. It is a mistake for me to assume I have the answer. They do, the people doing the work. Now I observe and LISTEN. And as a group we agree on how to move forward. Sure they'll suggest stupid things, and I brush them aside. But if they make the rule, they will most likely follow it. Yes, you're right this is very Pollyanna of me and I know there are people we just can not reach. Problem people need extra prodding sometimes. But there comes a point when we just have to let them go. Documentation will help you move them on to another job that better suits their skill-set. Good reading is the American Samurai by William Lareauhttp://www.amazon.com/William-Lareau/e/B001KIQWZS/ref=ntt_athr_dp_pel_1 Bruce Gapinsk HT (ASCP) Chief Histologist Marin Medical Laboratories PathGroup SF Important Notice: This e-mail is intended for the use of the person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient, any disclosure, copying, distribution, or use of the contents of this message is strictly prohibited. If you have received this e-mail in error, please destroy this message and contact the Security Officer at PathGroup, Inc immediately at 615-562-9255. Thank you ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Re: Basis for Quality Work in a Histotech
Yes! I hate working in those shame and blame cultures, as does probably everyone! Joelle Weaver MAOM, HTL (ASCP) QIHC From: sharon.gen...@saskatoonhealthregion.ca To: histonet@lists.utsouthwestern.edu Date: Mon, 17 Dec 2012 12:55:41 + Subject: [Histonet] Re: Basis for Quality Work in a Histotech My first recommendation would be to look at your process is there any way that you can error proof them? Make it more difficult to make the errors.When a lot of errors are occuring sometimes it is often due to how we do the job and not who does it. Sharon Genest Anatomic Pathology Process Improvement Saskatoon Health Region 306-655-8242 sharon.gen...@saskatoonhealthregion.ca his e-mail message may contain confidential and/or privileged information. It is intended only for the addressee. Any unauthorized disclosure is strictly prohibited. If you are not a named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e-mail from your system. E-mail transmissions cannot be guaranteed to be secure or error free as information could be intercepted, corrupted, destroyed, arrive late or incomplete, or contain viruses. The sender therefore does not accept any liability for errors or omissions in the contents of this message or any damages that arise as a result of e-mail transmissions. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Maximum bone sample size for methyl methacrylate embedding
Orla, Based upon my personal and professional experience, the sample size of undecalcified bone which can be properly processed into methyl methacrylate for sectioning and staining for Goldner's trichrome is completely dependent upon your microtomy capabilities. For example, if you only have access to a motorized rotary microtome, you are limited to a specimen size that will generally fit onto a 25mm x 75mm microscope slide. In reality, you are looking at a specimen that will be sectioned thin @ approximately 4-6 microns and have a polymerized resin block size no greater than 15mm in width and 20-25mm in cutting length. This means that your specimen needs to fit within these dimensions and at least leave 0.5 - 1.0mm in plastic surrounding the tissue. Again, this is if you are limited by having only a motorized rotary microtome like a Leica RM2255 or RM2265. If you have something like an EXAKT cutting and grinding system for use with cutting thick sections of metallic medical device implants and then polishing sections down to 25-35 microns, you will likely use plastic slides that have a size limitation of 50mm x 100mm. This then means that your resin block will need to be contained within these dimensions of the slide, but without worry to a 0.5mm - 1.0mm plastic resin layer surrounding the tissue because you are cutting thick and grinding/polishing down to a desired final thickness. On the other hand, if you have access to a motorized sledge microtome like a Rechert-Jung Polycut S, E or a Leica SM 2500 for cutting thin 4-6 micron sections, you are only limited by the size of glass microscope slide you can purchase and of course the cutting width of the knife which is 200mm. However, most of my routine work with this piece of equipment is with a resin block limitation of 70mm x 90mm. Please keep in mind that what I am trying to say here is that you are mostly limited by the sectioning capabilities of the equipment that you have access to for microtomy. However, I will caution you that there is also a limitation in size based upon the mastery of the acrylic resin polymerization process. As you go up in size, you increase the difficulty in the ability to manage and control the exothermic polymerization of the specimen and block. Processing and polymerization of larger specimens is absolutely something that can be accomplished without issue, but only by experience that is learned over time through repetition and patience or by training from another that has mastered the technique, something that I have done for others in the past. I hope you understand that working with MMA is not simply something where one can provide you with a protocol and then you can easily expect the same results from one person to another. While I use the same general acrylic resin protocol for every type of bone, I frequently have to adjust the processing and infiltration times to compensate for the size and density of the specimen. I also have to then change how I manage or control the exothermic reaction. This is done by controlling the rate of polymerization, proportionally to the size of the tissue and specimen block, using temperature controls like adjusting room temperature, using a water bath, etc. Now to answer your question, the size you have defined as 2 cm x 1 cm is completely adequate and fairly routine to accomplish. If you message me back privately, I will provide you with a protocol to try. Additionally, if you are doing this for the first time and would like some initial help just to get you past this project until you can practice on your own, I can also offer my services to complete this project for you on contract. Of course, as I stated earlier, I can also train you on how to accomplish this technique as it is also something that I have done in the past for several labs both domestic and internationally. Best Regards, Jack Jack L RatliffRatliff Histology Consultants, LLC317-281-1975 Date: Thu, 13 Dec 2012 17:44:04 + From: o.m.gallag...@sheffield.ac.uk To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Maximum bone sample size for methyl methacrylate embedding Dear Histonetters, Would anyone advise on the maximum size sample of undecalcified bone which could be properly processed into methyl methacrylate for sectioning and staining for Goldner's trichrome? Would anyone have a protocol for processing large bone samples (possibly 2 x1cm) into MMA as most of the protocols I've seen are based on Bordier trephine 5mm iliac crest biopsies. Thank you, Orla -- ** Ms. Orla Gallagher Bone Analysis Laboratory Mellanby Centre for Bone Research D Floor Medical School University of Sheffield Beech Hill Road Sheffield S10 2RX Website: http://mellanbycentre.dept.shef.ac.uk Tel: 00353114-2713337 (office) 00353114-2713174 (lab) E-Mail:o.m.gallag...@sheffield.ac.uk *STOP*: Do
[Histonet] Stark Law
Is anyone familiar with the Stark Law or can recommend a good resource? The lab is located in California. Thanks, Jennifer ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] Basis for Quality Work in a Histotech
You're right Tim. I don't know how much time I have saved by listening to my inner voice and doublechecking things when the case number and name on a recut/stain request. One of our docs is famous for putting down wrong case #'s. Even when everything looks OK, sometimes the docs accidentally mark the wrong stain as our sheet is in a grid and they are mentally in the wrong column. I even get suspicious if they order an unusual stain that is sitting right next to a more routine on the list. I call it my Histo sense :) 5 minutes of double-checking is much more efficient than having to recut and restain again. Claire From: histonet-boun...@lists.utsouthwestern.edu [histonet-boun...@lists.utsouthwestern.edu] on behalf of Morken, Timothy [timothy.mor...@ucsfmedctr.org] Sent: Monday, December 17, 2012 11:52 AM To: Lynette Pavelich; Sheila Haas; histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] Basis for Quality Work in a Histotech Here is our slide labeling procedure. It is simple, but we insist it be followed. This will be modified once barcoding is instituted to use scanning ID of slides vs block. We also instituted block ID beads at the embedding center. That has helped tremendously to identify people that may need embedding retraining. One other thing I should mention. People in the lab should be told to trust their inner voice. We had several labeling errors that on investigation were suspected or ignored by a tech in the chain or events. In one case the sectioning tech pulled the wrong block from the file, labeled the slides with that block number and sent it to the IHC group. An IHC tech took the slide and noticed the number was wrong but ASSUMED the sectioning tech had made an error, so corrected the number to match the request on her log. The mistake was only caught by the pathologist who noticed the IHC slide did not match the HE slide from the proper block. I tell my techs: Trust your instincts. If something seems wrong - for whatever reason - STOP!!! Investigate the issue. You will save time, effort, and maybe lives. I also tell my techs not no pathologist will remember how fast you were, just how many mistakes you made. Tim Morken +++ Slide Labeling Procedure at the Microtome Slide labeling at the cutting station is the most important part of the process used to identify slides. A mistake at this point will cause a mix-up in slides or cases and could lead to improper diagnosis and treatment for patients. Because this is such an important step the following procedure must be followed exactly. Deviation may cause mislabeling. Deviation from the procedure may be cause for reprimand and termination. Important points: 1. Label slides for one block at a time. 2. Do not pre-label slides before cutting sections from a block, or for any other blocks. 3. Work with one block at a time as much as possible. If the block must be re-soaked before completing the slide count then the block must be isolated from the other blocks to prevent a mix-up. 4. The stainer tech will compare stained slides to the blocks to ensure they are correct. Sectioning Procedure 1) Pick up the next page of the processing log and the blocks that are on that page. 2) Verify that the blocks picked up are on the processing log. a. Put the blocks in order according to the processing log. b. Put a check mark “” next to the block line on the log to indicate the block is present in the group. c. Note any problems with the blocks 1. Put an “X” mark next to any problem blocks and note the problem. a. Add-ons b. Missing c. Reprocessing needed d. Re-embedding and reason e. other 3) Face-trim the blocks and put them on ice (if necessary) in order as shown on the processing log. 4) Pick up the first block on the log. a. Do not pre-label slides for this or any other block 5) Place the block in the microtome and cut sections according to a. requests on the processing log and established sectioning requirements b. “Tissue Sectioning Standards” of the Sectioning section of the Histology Laboratory manual 6) Pick up the proper number of sections on the appropriate slides. 7) Label the slides a. Write the Accession number and Part letter/number of the block on the microtome. b. Label slides with your initials (legibly) c. Label initial slide in the group with the cassette color and page number (this slide is first in the rack and faces forward for the Stainer person to see) d. NOTE: If the block must be re-soaked to complete the slide count, then isolate the block on the ice tray by putting it at the back of the tray facing backwards. This will indicate that some slides have been cut previously. 8) Place the slides for HE in the HE staining rack a. Write the color
Mondays fun fact RE: [Histonet] Maximum bone sample size for methyl methacrylate embedding
Off topic but interesting anyway concerning acrylics. Just a fun fact since we use these chemicals Jack says below: I will caution you that there is also a limitation in size based upon the mastery of the acrylic resin polymerization process. As you go up in size, you increase the difficulty in the ability to manage and control the exothermic polymerization of the specimen and block. That is a huge problem in acrylics and while large acrylic structures are made now, they were mostly failures before an ARTIST (ie, a non-chemist) got involved in acrylic sculptures. I read an article years ago about an artist who figured out how to make massive acrylic sculptures. Chemists at Dupont thought it was impossible to do. The artist figured it out. He said one day it was like everything simply came together in his mind and the chemical process was evident. He went on to make acrylic bathyspheres for the Navy and Oil industry and undersea researchers - still the only person to have figured how to do it. BTW, he uses an autoclave to do the curing. A HUGE autoclave. Link below, click on Apolymon and Bathysphere http://www.brucebeasley.com/home.htm From Wikipedia. In 1968, Bruce Beasley began investigating the use of transparency as a sculptural medium. He was successful in creating small transparent sculptures in cast acrylic but experts at Dupont and Rohm Hass were convinced that it was impossible to do castings as large as Beasley envisioned. That year, the State of California invited Beasley to participate in a competition for a monumental sculpture for the state. At first, the jury was unaware that Beasley was experimenting with transparency as a sculptural medium and invited him based on his work in cast metal. Beasley was determined to pursue transparency and proposed a monumental cast acrylic sculpture. Upon seeing Beasley's proposal, they questioned the sculptor about its viability. He convinced them that creating what he envisioned was no problem but privately knew that he would have to invent a new process, which he did.[4] His proposal for Apolymon, a transparent sculpture in cast acrylic won and he installed the piece in Sacramento in 1970. 1970s Fascinated by the esthetics of transparency, Beasley worked in cast acrylic for the next ten years. In 1974, members of the undersea research community approached Beasley to see if he could adapt his technique to cast transparent bathyspheres for undersea exploration. He succeeded in creating the bathyspheres for Johnson Sea Link submersibles for Harbor Branch Oceanographic Institute. It was these submersibles that were deployed to locate the crew compartment on the bottom of the ocean after the Space Shuttle Challenger disintegrated upon liftoff in 1986. Tim Morken -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Jack Ratliff Sent: Monday, December 17, 2012 11:46 AM To: Orla Gallagher; Histonet Cc: ratliffhistol...@me.com; Jack Ratliff Subject: RE: [Histonet] Maximum bone sample size for methyl methacrylate embedding Orla, Based upon my personal and professional experience, the sample size of undecalcified bone which can be properly processed into methyl methacrylate for sectioning and staining for Goldner's trichrome is completely dependent upon your microtomy capabilities. For example, if you only have access to a motorized rotary microtome, you are limited to a specimen size that will generally fit onto a 25mm x 75mm microscope slide. In reality, you are looking at a specimen that will be sectioned thin @ approximately 4-6 microns and have a polymerized resin block size no greater than 15mm in width and 20-25mm in cutting length. This means that your specimen needs to fit within these dimensions and at least leave 0.5 - 1.0mm in plastic surrounding the tissue. Again, this is if you are limited by having only a motorized rotary microtome like a Leica RM2255 or RM2265. If you have something like an EXAKT cutting and grinding system for use with cutting thick sections of metallic medical device implants and then polishing sections down to 25-35 microns, you will likely use plastic slides that have a size limitation of 50mm x 100mm. This then means that your resin block will need to be contained within these dimensions of the slide, but without worry to a 0.5mm - 1.0mm plastic resin layer surrounding the tissue because you are cutting thick and grinding/polishing down to a desired final thickness. On the other hand, if you have access to a motorized sledge microtome like a Rechert-Jung Polycut S, E or a Leica SM 2500 for cutting thin 4-6 micron sections, you are only limited by the size of glass microscope slide you can purchase and of course the cutting width of the knife which is 200mm. However, most of my routine work with this piece of equipment is with a resin block limitation of 70mm x 90mm.
RE: [Histonet] Stark Law
http://starklaw.org/ The Stark law keeps physicians from referring work to themselves - the very simple version.. See the web site for details.. Joyce Weems Pathology Manager 678-843-7376 Phone 678-843-7831 Fax joyce.we...@emoryhealthcare.org www.saintjosephsatlanta.org 5665 Peachtree Dunwoody Road Atlanta, GA 30342 This e-mail, including any attachments is the property of Saint Joseph's Hospital and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email. -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Jennifer MacDonald Sent: Monday, December 17, 2012 2:37 PM To: histonet@lists.utsouthwestern.edu Subject: [Histonet] Stark Law Is anyone familiar with the Stark Law or can recommend a good resource? The lab is located in California. Thanks, Jennifer ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet This e-mail message (including any attachments) is for the sole use of the intended recipient(s) and may contain confidential and privileged information. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this message (including any attachments) is strictly prohibited. If you have received this message in error, please contact the sender by reply e-mail message and destroy all copies of the original message (including attachments). ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] Stark Law
Google Jane Pine Wood - best Stark law attorney in the US. Sent from my iPhone On Dec 17, 2012, at 12:36 PM, Jennifer MacDonald jmacdon...@mtsac.edu wrote: Is anyone familiar with the Stark Law or can recommend a good resource? The lab is located in California. Thanks, Jennifer ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] HE with Mayers
Hi Everyone:If anyone is using Mayers Haematoxylin progressively, can you please share your HE protocol with me?Thanks:)Sheila ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Disposable Blades and Handles
Hi, Please we are looking for the type of disposable blades and handles that we can use to cut frozen sections on our TBS CRYOSTAT. Any suggestios will be highy appreciated. Thanks, Wilson ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
