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Stepwise Success

Don’t Bother the Blood Bank Tech!

Published January 4, 2013 6:11 AM by Scott Warner

We have a sign in our lab that says Do Not Talk To the Blood Bank Technologist. It reminds us all of the nature and danger of distractions in our work: beepers, timers, telephones, instrument alarms, sensor alarms, doorbells, personal issues, and (not least of all) conversations. The only distraction a blood bank tech should be concerned with is an abnormal reaction.

When I was a kid riding the bus our driver had a similar sign on his visor, right below the mirror used to eyeball us. Same idea. Distractions can be dangerous, especially in familiar tasks that can have a critical outcome if they fail. One winter morning I glanced up as our bus driver swerved around a gangly moose in our headlights. Yikes!

Back to the lab. Part of developing a professional work ethic is recognizing personal limits and tolerances for distractions. Since laboratory medicine involves juggling several to many tasks at once, the latter is a job requirement. However, everyone has different tolerances. One tech may feel comfortable answering the telephone in the middle of a crossmatch, while another may not. In my experience, tolerance is part nature, part nurture. We can learn habits to recover our place, in other words, but only to a point.

For example, in reading tube tests for macroscopic agglutination using a viewer, I have always shaken the tube, written down the reaction, and then double checked the visual evidence in my mind. Did I really see the “smoky tail” of a negative? Did that really look like a 2+ with small agglutinins and a clear background? Any interruption or uncertainty means repeating the sequence.

Any interruption in any sequence like this, from checking patient identification to aliquoting samples to reading reactions to instrument maintenance is potentially dangerous. It’s easier to focus on real time events or those that have just happened than recreating what we think is happening. All good techs develop personal habits in time that minimize disruptive effects of inevitable distractions.

Sometimes, we even talk to ourselves. I wonder if that’s Ok in blood bank.

NEXT: Bad Handwriting


A good discussion of how important it is to know my own limitations.   I take into account how many hours I've been on the bench that day (we work 10 hrs and then take call for the next 12) and communicate with the ED or floor staff that I may not be answering the phone while I am performing Blood Banking which is almost always a STAT situation.  They are usually trying to diffuse the stress they feel as the minutes pass and all they can do is WAIT.  I appreciate the suggestion that they are welcome to walk to the lab and address me directly but not to phone which requires me to stop what I am doing, get up and answer the call and then come back to what really should be an uninterrupted process.  I see from the comments that many smaller hospital labs face the same challenges.  A mistake could be so costly in both the patient's life and also the tech's that there should be support from lab directors everywhere to prevent them--as with many situations, thinking ahead and communication between staff can only improve the odds that an error never happens.

Roxie, Generalist January 18, 2013 12:32 PM

Thanks for all your comments. I like the idea of the blood bank being a "no phone" zone! The stress is very real and adds significant risk.

Blood bank tube testing has changed little over the years. It still relies on real time visual reads and short term memory for quality assurance. I wonder what the differences are in techs' abilities to see weak reactions, too, since microscopic reading has largely been replaced by agglutination viewers. If you're tired and working at night, for example, your eyes can have difficulty adjusting and focusing. Can you miss a reaction? I'll bet this happens more than we would guess. It's a difficult skill to assess.

A lab can add checks at critical steps, such as a second tech repeating an ABO and Rh if the patient has no history, but this won't help a tech working alone with an ED doc screaming for blood.

Scott Warner January 18, 2013 6:09 AM

One of the most irritating and frustrating experience I had in 30+ years of laboratory medicine was working in the blood bank on the weekend or holidays alone. A pneumatic tube system from the ED ran directly over the blood bank, and each time I would hear a tube with specimens being delivered I would cringe because of the interruption. Just performing testing in the blood bank is stressful, but any additional interruptions add even more stress. The typical reply when asking for some assistance was, "you will just have to suck it up". I love laboratory medicine but could not tolerate all the stress of working alone, and as a consequence I decided to retire. I spent the last 10 years volunteering in the hospital ED where I once worked.

William, Retired - MT (HEW) MLT (ASCP) January 17, 2013 11:39 AM
Summerville SC

I work midnight shift at very busy rural hospital.  It is our hospital policy, that we don't have phones in blood bank section.  We don't answer the phone while working in blood bank. If there an extremely urgent case that needs lab, docs or nurses have to walk down to lab talk direct to tech.

Alfonsus Nguyen January 17, 2013 10:12 AM


Great comment.

You describe a common and serious problem. If one is working alone, there are more distractions that are more urgent. I'd say from experience the same principles apply but in shorter time bursts. The chance of error is greater, it seems.

Perhaps, this is where experience and temperament make the difference. In time we all learn to respect our limits and be distrustful of our short-term memories. I'd be interested to know how work patterns in blood bank generally differ from a fully staffed day to sparsely staffed evening shift. I'll bet there is a difference!

But I'm just guessing. How do you handle it?

Scott Warner January 7, 2013 7:38 PM

I agree with your recomendation, but how do you handle this problem in a small rural hospital, when your working the night or week-end shift, & you are the only tech working. You have to cover the ER, in-house & OB areas, along with the blood bank. Not only do you do blood bank, but chemistry, hematology & urinalysis?

Glenn, Generalist - Retired, mercy January 5, 2013 10:15 AM

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About this Blog

    Scott Warner, MLT(ASCP)
    Occupation: Laboratory Manager
    Setting: Critical Access Hospital
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