Transfusion - Pre-compatibility Testing —
Training activity: 1

Details

Perform sample identification and acceptance according to current guidelines and laboratory policies

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Sample and patient identifiers and pre-transfusion sample acceptance
• Quality assurance procedures and their application including concessionary testing
• Audit trail from vein-vein including use of laboratory information management systems (LIMS)
• Appropriate testing streams dependent on clinical details of patient

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to performing sample identification and acceptance.
• Consider how the learning outcomes apply, specifically those which relate to identifying algorithms, describing limitations, practicing according to guidelines/procedures, and performing acceptance testing.
• What specific steps or criteria define successful sample identification and acceptance according to guidelines and policies?
• What constitutes an unacceptable sample based on laboratory policy and current guidelines?
• Discuss with your training officer to understand their specific expectations regarding the thoroughness and speed of sample checks.

What is your prior experience of this activity?

• Think about what you already know about the critical importance of correct sample identification for transfusion safety.
• What are the common reasons for sample rejection?
• Consider possible challenges you might face e.g., illegible labels, missing information, difficult venous access leading to suboptimal samples. And think about how you might handle these.
• Recognise the scope of your own practice for this activity, meaning know when you might need to seek advice from senior staff regarding complex sample issues or exceptions to policy.
• Acknowledge how you feel about undertaking this activity, especially if it involves confronting ward staff about sample issues.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to meticulous checking and applying policies consistently.
• Identify specific insights you hope to gain into the impact of pre-analytical errors on patient safety and laboratory workflow.

What additional considerations do you need to make?

• Consult actions identified following previous experience with sample handling or rejections that could inform your approach.
• Identify important information you need to consider before embarking on the activity, such as the current version of the laboratory’s sample acceptance policy, specific requirements for transfusion samples, or the clinical urgency of the request.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing sample identification and acceptance?
• Are you encountering situations such as:
  • Mislabelled, haemolysed, or insufficient samples requiring immediate scrutiny regarding whether to accept the sample
  • An unclear request form or a discrepancy in clinical information that complicates the identification process
  • A busy environment leading to potential errors, requiring extra focus to maintain strict adherence to guidelines

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to sample checks in the moment?
• Consider the steps you are taking in the moment, such as:
  • Immediately deciding on whether to accept or reject a non-conforming sample, weighing the safety implications against clinical urgency
  • Seeking immediate support or clarification from a senior colleague if you are unsure about the correct policy or criteria for a problematic sample
  • Documenting your decision and any necessary mitigation steps correctly in real-time
• How are you feeling in that moment? For instance, are you finding it difficult to maintain strict adherence to policy in a busy environment? Is it affecting your confidence in justifying the sample handling decision?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully troubleshooting the acceptance issue, or needing support because the policy deviation is complex or requires senior authorisation?
• What are you learning as a result of the unexpected development? For example, are you learning about the critical importance of accurate sample identification or gaining insight into exceptions to policy?

On action

What happened?

• Begin by summarising the key points of the experience, detailing the steps you took to identify and accept samples for pre-transfusion testing. How did you apply current guidelines and laboratory policies?
• Consider specific samples that were challenging or unexpected, such as incorrect labelling, insufficient volume, or haemolysed samples. How did you feel dealing with these critical issues?
• Include any ‘reflect-in-action’ moments where you had to pause and check the guidelines or policy during the process. What prompted this immediate check?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the critical importance of correct sample identification and acceptance criteria. What strengths did you demonstrate, such as skills in applying policies or recognising unacceptable samples?
• What skills and/or knowledge gaps were evident e.g., unfamiliarity with specific sample requirements or rejection criteria?
• Compare this experience against previous experiences. Was your ability to work in accordance with guidelines and procedures improved?
• Identify any challenges you experienced e.g., pressure to accept a suboptimal sample or ambiguity in guidelines and how you reacted to these. Were you able to overcome the challenges?
• Identify anything significant about the activity, such as needing to seek advice or clarification regarding a complex sample issue. Did you ensure you were working within your scope of practice when making decisions about sample acceptance?
• Acknowledge any changes in your own feelings now you are looking back on the experience regarding your confidence in performing sample identification and acceptance.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, such as specific steps to improve your understanding or application of sample acceptance policies. Do you need to review relevant guidelines or attend training?
• What will you do differently next time you encounter a challenging sample?
• Do you need further practice in applying specific guidelines or managing interactions about sample issues?

Beyond action

Have you revisited the experiences?

• Looking back at your different experiences performing sample identification and acceptance, have you reviewed your past reflections?
• What specific steps for improvement did you previously identify regarding adherence to guidelines, recognising unsuitable samples, or documentation?
• Have you actively worked on these areas, and are you now able to demonstrate improved proficiency in this critical initial step of the transfusion testing process?
• Have you engaged in professional storytelling or discussed challenging scenarios involving sample identification or acceptance criteria with peers or senior colleagues?
• Has hearing their perspectives on interpreting guidelines or handling complex samples changed your own approach to sample acceptance?

How have these experiences impacted upon current practice?

• How does the cumulative learning from these experiences and your reflections help you ensure accuracy and compliance in sample handling, potentially supporting any DOPS or OCE where correct sample management is implicit?
• How has your ability to perform sample identification and acceptance robustly evolved over time?
• Have you become more adept at quickly identifying potential issues or discrepancies? How confident are you now in knowing when a sample requires further clarification or should be rejected because it is beyond the acceptable criteria, indicating you are working within your scope?

Relevant learning outcomes

#	Outcome
# 2	Outcome Identify sequential testing algorithms appropriate to the samples under investigation for pre-compatibility testing.
# 3	Outcome Describe the limitations of methods used in pre-compatibility testing including sources of error and sample issues.
# 4	Outcome Practice in accordance with guidelines and procedures relevant to pre-transfusion testing.
# 5	Outcome Perform acceptance testing of samples requiring pre-transfusion testing and ensure samples follow appropriate testing streams relating to clinical condition.