Training activity information
Details
Perform, interpret and report serological crossmatching and electronic issue
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
- Serological crossmatch requirements
- Requirements and procedures for electronic issue
- BSH guidelines and laboratory protocols
- Immediate spin crossmatch and IAT crossmatch
- Crossmatch testing and reporting algorithms
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, interpreting, and reporting crossmatching and electronic issue.
- Consider how the learning outcomes apply, specifically learning outcomes which relate to selecting techniques, identifying algorithms, practicing according to guidelines/procedures, performing acceptance testing, and identifying transfusion requirements/management plans.
- What specific steps define accurate performance of serological crossmatch (if applicable), correct verification for electronic issue, interpretation of compatibility results, and appropriate reporting?
- What are the criteria for a compatible crossmatch? When is electronic issue permissible, and what are its safety checks?
- Discuss with your training officer to understand the preferred method of compatibility testing (serological vs. electronic) based on patient history and the specific steps required for each.
What is your prior experience of this activity?
- Think about what you already know about the purpose of crossmatching and electronic issue in ensuring compatibility. What do you know about the principles of the crossmatch test itself?
- Consider possible challenges you might face e.g., incompatible serological crossmatch, system errors in electronic issue, urgent requests requiring immediate issue. And think about how you might handle these.
- Recognise the scope of your own practice for this activity. When would you need to seek advice regarding an incompatible crossmatch or issues with the electronic issue system?
- Acknowledge how you feel about performing the final compatibility check before blood is issued, recognising the responsibility for preventing transfusion reactions.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in performing and interpreting compatibility tests and using the laboratory’s electronic issue system safely and effectively.
- Identify specific insights you hope to gain into the layer of safety provided by crossmatching and electronic issue and the potential pitfalls.
What additional considerations do you need to make?
- Have you consulted any actions identified from previous experiences with antibody identification or sample checking that are relevant to the compatibility process?
- Identify important information you need to consider before embarking on the activity, such as the patient’s current antibody status, previous transfusion history, urgency of the request, and the laboratory’s specific SOPs for crossmatching and electronic issue.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing compatibility testing?
- Are you encountering situations such as:
- A serological crossmatch resulting in incompatibility for a patient whose antibody screen was negative, requiring immediate troubleshooting
- System errors or failures occurring during the electronic issue verification process
- An urgent request overriding the standard compatibility testing timeline
How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your crossmatching technique or electronic verification steps in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately troubleshooting the cause of an incompatible serological crossmatch e.g., clerical check, re-testing
- Verifying all required electronic issue parameters despite time pressure or system issues
- Seeking expert assistance regarding an incompatible result or a system failure during compatibility testing
- How are you feeling in that moment? For instance, are you finding it difficult to adhere to strict verification procedures due to system errors? Is it affecting your confidence in releasing compatible blood?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully confirming compatibility, or needing support because the system error requires specialist intervention?
- What are you learning as a result of the unexpected development? For example, are you gaining critical insight into the layer of safety provided by crossmatching and electronic issue or the specific protocols required to establish compatibility?
On action
What happened?
- Begin by summarising the process of performing serological crossmatching and/or electronic issue. What were the key steps you followed for the technique used? What were the results?
- Consider specific crossmatches that were challenging, such as incompatible crossmatches or samples requiring complex pre-treatment. How did you feel interpreting unexpected or incompatible results?
- Include any ‘reflect-in-action’ moments during the crossmatch or issue process where an unexpected reaction or system issue prompted you to stop and reassess.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the principles and performance of serological crossmatching and the criteria for electronic issue. What strengths did you demonstrate, such as skills in performing techniques and ensuring compatibility? Were there knowledge gaps regarding specific technical aspects, limitations of methods, or criteria for electronic issue?
- Compare this experience against previous experiences. Has your ability to perform and interpret crossmatches improved?
- Identify any challenges you faced e.g., incompatible crossmatch investigation, system issues with electronic issue and how you handled them.
- Did you need to seek advice or clarification on interpreting a crossmatch result or troubleshooting a system problem?
- Did you ensure you were working within your scope of practice when deeming blood compatible and issuing it?
- Acknowledge any changes in your own feelings now you are looking back on the experience regarding your confidence in performing crossmatches and electronic issue.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take, such as specific aspects of crossmatching e.g., different techniques, interpreting complex reactions or electronic issue you need to study further. Do you need to review SOPs or case studies of incompatible crossmatches?
- How will your approach to performing and interpreting crossmatches change based on this experience
- Do you need more practice in performing the serological crossmatch technique or in using the electronic issue system effectively?
Beyond action
Have you revisited the experiences?
- Looking back at your past experiences performing, interpreting, and reporting serological crossmatching and electronic issue, have you reviewed your previous reflections?
- What specific areas did you focus on for improvement e.g., technical aspects of serological crossmatch, verifying parameters for electronic issue, troubleshooting incompatible crossmatches?
- Have you actively worked on these skills, and are you now more proficient in ensuring compatibility and accuracy in component release?
- Have you engaged in professional storytelling or shared interesting or challenging cases involving crossmatching or electronic issue discrepancies with colleagues or discussed procedures with senior staff?
- Did these interactions broaden your understanding of potential pitfalls, verification steps, or how to manage incompatible crossmatches?
How have these experiences impacted upon current practice?
- How does the cumulative learning from performing crossmatching and electronic issue, combined with your ongoing reflection, support your preparation for assessments such as a DOPS performing EI or crossmatch with selection of appropriate blood for crossmatch?
- How has your ability to perform and interpret crossmatching and electronic issue developed over time?
- Are you more confident in performing the tests correctly, interpreting results, and ensuring all criteria for electronic issue are met?
- How clearly can you now identify when a crossmatch is incompatible, an electronic issue is blocked unexpectedly, or other issues arise that require investigation or are outside your current expertise, ensuring you work within your scope?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Select suitable and valid techniques for transfusion pre-compatibility testing. |
| # 2 |
Outcome
Identify sequential testing algorithms appropriate to the samples under investigation for pre-compatibility testing. |
| # 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. |
| # 9 |
Outcome
Identify transfusion requirements and create management plans for patients following completion of all pre-compatibility investigations. |