Cord Blood Registry & Banking Your Child's Cord Blood #CordBlood411

I participated in a campaign on behalf of Dad Central Consulting for the Cord Blood Registry. I received promotional item to thank me for my participation.

CBR - Cord Blood Registry

For expectant parents, click cordbankingbasics.com to visit the Cord Blood Registry.  Until February 24th, 2014 receive a $200 discount on New Born Umbilical Cord Blood Banking Services by completing an information request from CBR.  This discount has been extended until March 24th, 2014.

As a Clinical Laboratory Scientist I have seen trends in Medical Science come and go.  As with any industry there are advances in technology, methodologies, and most importantly a drive to overcome obstacles and bring innovative safe solutions concerning medical issues to mainstream health care.

What is Cord Blood Banking?

New treatment therapies are always in the making from the Clinical Trials Industry in which I have vast working experience.  Science and Technology go hand in hand with Research and Development to bring treatment alternatives to medical issues great and small like cancer, diabetes, hearing loss, psoriasis, brain injury, autism, and multitudes of other human disease states.  Cord Blood and its use in the treatment of various diseases is a current dynamic hot trend in the medical community that will not go away.  Many highly respected physicians as well as Clinical Research Scientists across the globe all agree that the use of Stem Cells derived from Cord Blood is the resource that will develop future disease therapies.  Therapies that are in early development now such as hearing loss and autism as well as others not even dreamed of will depend upon the basic unit of human life that is the Stem Cell.  Some will even go on record to say that the future eradication of all disease states in human biology will depend chiefly on the use of Stem Cells.

Stem Cell is a pluri-potential biological Unit of Life.  It is a very special type of living cell that inhabits our bodies from birth and is used in maintaining our bodies by replenishing needed types of cellular tissue.  Stem Cells are a sort of "cell blank" often referred to as a precursor cell.  Stem Cells can be changed as needed into various different types of cells in our bodies which then can be used by our bodies to make repair after injury, replenish necessary cellular tissue, and help our bodies to fight disease.  Stem Cells although present in each of us are relatively few in number compared to our circulating pool of blood cells and bone marrow stores.  Stem Cells can be measured numerically by Laboratory Methods such as cell harvest/Cell Sorting and enumeration employing Flow Cytometry techniques.  Although Stem Cells can be identified in blood or bone marrow samples, harvesting from theses two sources is difficult and costly.  This is where the technology of Cord Blood Stem Cell Banking holds promise for the present and future of disease eradication in the human race.  Currently, Cord Blood Stem Cells are used to treat 80 diseases and over 30,000 Stem Cell Transplants have been performed worldwide.

Cord Blood Banking - The Industry

Cord Blood Banking is an industry all to its own in the medical Sciences which is in full development.  As the storage of Cord Blood Stem Cells is established right now it will continue to flourish in years to come.  Storage facilities may become numerous across the globe in the near future. Stem Cell Banking is primarily a private commercial endeavor by companies with three main driving philosophies.

• Advance human disease treatment strategies 
• Manufacture organ tissue for transplant purposes
• Financial - this is a developing industry with great promise in entrepreneurship for those who have the research training and abilities to successfully provide a necessary service to parents, consumers, and the medical research community.  That is a huge statement concerning money.

Strict Regulation of this flourishing industry will be developed to safeguard the storage, use, and future use of Stem Cells.  This is such an important milestone in the treatment of human disease that current Congressional regulation [HR 3673 - Family Cord Blood Banking Act] is in process to allow for individuals wishing to store their newborn children' Cord Blood be able to pay for such services with pre-tax earned dollars via HSA, HRA, and FSA accounts.  This important regulation has been brought to Congress by two representatives; Aaron Schock (R-IL) and Ron Kind (D-WI) with the intention that consumers should be able take advantage of Cord Blood Banking Services and pay for these services as qualified medical expenses.  If HR 3673 becomes law, it would help families financially and really swing their decision allowing for more new parents to take advantage of Cord Blood Banking. CBR is one of two Cord Blood Banking entities that have collaborated to fully endorse HR 3673 and praise the sponsoring Congressman.

 In my opinion, this is the hot bed of Scientific Research where by Stem Cells will provide the medium for which Human Genome Mapping will be employed to manipulate those stored Stem Cells into cellular components discreetly targeting disease states providing for the cure of cancers, tissue regeneration, organ transplant, and even organ manufacturing in-vitro for transplant purposes. The storage of Umbilical Cord Blood is the ultimate gift anyone could ever buy for their new born children.  The stored Cord Blood can potentially be used in the future to treat developed disease states from childhood into adulthood. 

CBR - Cord Blood Registry is one of several commercial entities offering Cord Blood Banking Services and is recognized as a global leader in Cord Blood Banking industry.  Employing the talents of many medical and research professionals along with cutting edge state of the art facilities, CBR is able to provide consumers with safe and practical means to store Umbilical Cord Blood for their children.  CBR is currently storing over 500,000 Cord Blood Units and Cord Tissue samples.  Such cord blood is available from the umbilical cord which is often discarded after the birth of children.  CBR is at the forefront of this emerging technological service which is now becoming mainstream and available to all expecting parents.  To learn more about CBR the corporation, the facility, and their endeavors to become the safest most reliable repository for cord blood click CBR.

So basically, why should parents be concerned with Cord Blood Storage?  It is believed by many in the medical community that Stem Cells hold the future promise of treatment therapies for the future.  We as a human society are afflicted with disease states that have no current treatment possibilities or these diseases are marginally managed by current therapy strategies.  Being able to store Umbilical Cord Blood for our newly arriving children gives children a viable resource for future medical treatments to be developed in the event a child develops or is born with serious medical conditions, disease, or issues.

As a new dad, my main concerns before the birth of my children were "are they healthy?"
Advancement of my own and my wife' career was of concern to both of us to be able to provide for the growth and development of our children.  Back in the mid 1980's, during the birth of my children Stem Cell or Cord Blood Banking was not developed yet.  The long term storage of blood products such as plasma and cryo-precipitate (Cryo)  was mainstream and available at my local hospitals.  In my employment as a Clinical Laboratory Scientist working in a hospital blood bank, I routinely issued units of frozen plasma and Cryo to patients needing transfusion of these products.  However, long term storage of whole blood for transfusion was not possible then either.  Whole blood products have a refrigeration shelf life of about 40 days.  The process of storing whole blood for a patients future use was extremely expensive and not practical back then.  If Cord Blood Storage was available I would certainly have taken advantage of this service to insure that any developed health conditions in the future would have a viable fighting chance for treatment with my own children.

Why Parents Should Consider Cord Blood Banking?

Becoming a parent is a stressful time.  We all wish for healthy children for ourselves, family, and acquaintances.  But with new life beginning there is much uncertainty.  The health of a child developing into an adult and beyond without medical catastrophe is our greatest fear as a parent.  My 1st child was ill for her first two years after she was born.  Fortunately, her symptoms went away as she grew older and developed.  In my own experience, observing my child with a medical issue and sitting helplessly unable to cure or even treat the child back to health was the ultimate greatest fear of mine.   Banking Cord Blood for new born children is the ultimate protection.  Cord Blood is a resource that can be tapped by future medical advances to medically treat our most precious resources, our children.

Which Cord Blood Bank Facility is Right for Your Family?

Evaluating a Cord Blood Storage facility for the storage of your child's Cord Blood is as important as deciding to partake in this service to begin with.  Factors such as stability, security, infrastructure, location, professional expertise are all factors you should learn about any facility before choosing a service to Bank Cord Blood.  Here are some important factors you should review in this important decision making process and how to get that information.  Not one factor is more important than another but collectively all factors reviewed together will give you the information you need to select a service.

• Facility - Where is the facility located geographically.  A facility located in a flood plain, near rivers, earthquake zones, vulnerability to tornado and or hurricane damage would not be a good choice.
• Security - Is the facility protected enough against fire and other destruction, power-outages, burglary, and theft.
• Stability - Financial security of an organization is important to the future functioning of such businesses.  Has financial growth been healthy in the service considered?  Is there turn over in the management team?
• Infrastructure - Is the facility well run?  What type of people are employed at the facility, their training, credentials, and licensing for these employees?  Are the facilities clean-state of the art design and what you would expect of an organization storing your child's living tissue for decades to come.  Are there continuous improvement programs ongoing within the organization?  What certifications does the organization hold?  What certifications are available in the industry and does the organization hold them all?

How does one research all this information to make an informed selection of a Cord Blood Banking facility?

• Call the facility directly and ask the questions above.  Take notes during your phone call.
• Check out any social media resources on the Internet put out by the facility such as Facebook, Pinterest, Twitter, You tube, etc.
• Go to the facilities website and look for corporate info, media releases, management biography's, and business modelling information and pictures.  A picture can speak many words.  Are the facilities posted pictures close cropped showing detail but not much substance or are there wide sweeping pictures and videos showing a real glimpse of the facility and work environment within.  Check out the Careers page to see what positions are offered and the required credentials for applying for such positions at that facility.  Pay particular attention to what positions require only a high school diploma and how high they go up into the ranks of employees.  I would think that a college degree in biology or some other relevant science would be the minimum requirement of any employee whose task it is to handle or process your child's cord blood.
• Check regulatory resources such as AABB, FDA, and CLIA for information on Cord Blood Banking and the industry.
• Google - Google the facility name of  your choice with directed searches for complaints, violations, and accolades within the Cord Blood Banking industry.
• Request information from many facilities including the one(s) recommended by your Obstetrician. Evaluate the information carefully, Formulate questions and request clarification from the facility.  How quickly do they respond?  Is the respondent info what you asked for?  If via phone, did you get answers efficiently or was your call bounced around before getting appropriate answers.  Ask for a tour of the facility and go tour the facility. Even if you cannot make the trip to a distant facility, try to visit one that is closest to you.  This will give you valuable first hand knowledge about how these facilities operate and what to expect in a facility such as security, infrastructure, and stability.

Make an informed choice for this most important gift you can provide for your children.  Their life may depend on the choices you make now before they are born.  Talk to your pediatrician and obstetrician about your choice to bank or not bank stem cells.  If you do choose to bank make sure your doctor has the ability to collect the Umbilical Cord and be able to send the tissue to the Cord Blood Bank of your choosing.

Connect with CBR via Facebook, @cordblood, YouTube, Pinterest
Scott R. Mayorga A.A.S, BS MT(ASCP)H CLS

Atlanta Shuts down with 3 Inches Snow - What a municipality Should Do Next Storm

Winter Storm Leon Causes Quite  a mess for Atlanta - January 28, 2014
by Scott R. Mayorga

Leon rolled into town on Tuesday January 28, 2014 approximately 12 Noon; Atlanta and the surrounding counties where caught off guard, ill prepared, and rather mis-informed for the snow event.  What Happened?  In a nut shell; thousands of motorists including school children on school buses were snagged in a web of confusion, hysteria, and anarchy for almost two days unable to travel on thousands of miles of roads while emergency vehicles were unable to get to those in critical situations.  Declaration of State of Emergency, activation of prevention measures, storm preparations were all too little and much too late.  Roadways clogged with traffic unable to move on pure ice paved roadways paralyzed the entire region.  There is plenty of blame post this weather event being thrown around and all of it is sticking rightly so to Atlanta and Georgia State Officials.  Winter Storm Leon was a conundrum of confusion exacerbated by lack of leadership, perpetuated by lack of control.

I will refrain from directly blaming anyone - that is counter productive.  I will lay out what I would do in the position of running "Storm Central" for the City of Atlanta and the north Georgia Region.
The Atlanta area receives significant snow accumulation every 2-4 years.  Significant is a relative term of measurement reflecting how bad the City was crippled.  On Jan. 28, 2014 with 3 inches of snow the entire Atlanta urban/suburban region was brought to its knees.  Three inches of snow in Buffalo NY would not be significant at all.  The North Georgia region might be able to muster up a hundred or so pieces of heavy equipment to fight the accumulations.  The City of New York probably has thousands of plows, sand spreaders, and emergency vehicles of some sort.  The City of NY bolts plows onto the front of garbage trucks and plows all day and all night.  In Atlanta, it is not feasible to acquire and maintain hundreds if not thousands of pieces of equipment just for a snow event every two to four years.  That being said, what is a major metro area to do to keep citizens safe.  I would think if you asked most people if they would rather have safety or anarchy- they will pick safety.  Here are my guidelines for those in the position of either acting and leading and also for those who sleep and go out to lunch doing nothing but delegating to others neither willing to do anything or are too inept to accomplish what needs to be done.  Might I digress...


Clearly and concisely asses the weather predictions. Make personal observations and decide on a plan of action at least 24 hours in advance.  The only thing that the weather man can be counted on is an accurate time of arrival of an event.  Whether 1 inch, 2 inch, or 6 inches of snow is predicted;  in the words of our fearless ex-Secretary of State Hillary "What difference Does It Make?"  Decide early what is the plan of action, get folks on the phone, mobilize what can be done well in advance.

Watch our Children. What is most important in our lives? Children right.  So for a significant event or an event that has potential to bring danger close the schools.  This was a tough storm.  The weather modeling computers had conflicts predicting this event even 5 hours before snow started falling.  Obviously, the computer models were ineffective.  Stick you head out the window.  Sniff the air.   Before a snow fall the air is thick, its cold, you can just feel it is going to snow like heck.  Look at the Radar maps.  If you say to yourself "Oh My God It's Coming Right For Us" then close the schools.

Declaration  of State of Emergency is important in many ways.  "Procedures may already be in place" but the declaration makes people take notice.  How many Atlanta workers were told to go home after the roadways were already jammed up at 12:45 PM?  A declaration early on even if premature would have given workers a heads up early and been given the chance to get rolling before icy conditions.  The declaration was not made until 3 PM or so which was some three hours after all the major arteries were dangerously clogged with vehicles that could not move.

Control flow of traffic - Trucks large and small were a major contributing factor to the mess that became of Leon.  Decades ago, I-285 "The Perimeter" was built so that trucks and other vehicles that had no business inside the perimeter could avoid the downtown areas by detouring onto the perimeter.  In a State of Emergency, I would have positioned GA State Patrol (GSP) on the roads to make sure all trucks either turn away from the city or detour onto the perimeter.  Any trucks that go inside the perimeter would be subject to stiff fine of $10,000 USD.  I know the GA States DOT Commissioner would cringe at that idea but that is how you control the situation.  Below is a map of the Atlanta major arteries.  The stars are where GSP would stage and direct trucks onto the perimeter.  Any trucks ignoring directions of troopers and the hundreds of overhead electronic interactive signage would be rounded up in the City and vehicles would be impounded.  Sounds harsh?  Too bad.  It is a State of Emergency.  It Doesn't mean go sell Girl Scout cookies in front of Walmart!

Map by Scott R Mayorga

Most importantly, open up HOT lanes and HOV lanes of traffic. Why restrict travel lanes during a State of Emergency.  That is just moronic.  Get the vehicles off the road as efficiently as possible, Period.

Mobilize the GSP and salt spreaders before the precipitation starts.  If a salt truck rolls by your brand new car and sprays your quarter panel with rock salt - Oh Well.  Get out of the way.  If that happens you are probably not paying attention, talking on the phone, or almost asleep at the wheel.  During the Leon event way into evening hours cars were paralyzed unable to move.  Opposite lanes-predominantly northbound were mostly devoid of vehicles.  GSP could set up those lanes of highways to allow vehicles to travel north in the empty southbound lanes.  Possibly, under escort of National Guard even?  What about that National Guard.  What are they good at? There expertise is moving people and equipment rapidly and efficiently.  How about some porta-toilets?  Hey what a great idea.  Mobilize the National Guard with porta-potties onto the roads in the event that things go bad.  There are plenty of privately owned salt/sand spreader trucks that could be mobilized by the city as a one day contract. I would use them.  A big problem was that salting was not done before the snow fell.  After accumulations snarled traffic to a stand-still the decision to mobilize salt spreaders was too late.  Is this not obvious? 

And now the big one - Weather Services and the fickle weatherman.  Stop relying on the computer models.  Get away from the screen and stick your head out the window.  Predict as you were trained to do.  Tuesday morning, the radio forecast for the weather that day was obviously turmoiled with confusion, uncertainty, and capped off with a fickle statement of "Stay Tuned for updated information".  Well that was just 3 hours before the snow started falling.  I saw the radar maps the night before and knew there was going to be some precipitation.  When I went outside that morning I could feel that "It's Going to Snow Feeling" in the air.  It is the weather.  Predictions are just that - Ones opinion about what the weather is going to bring.  Tuesday morning the term "Dusting" was used more than once in the weather reports at 8 AM EST.  That obviously told most people the event was not serious.  On top of School buses running children to school, and the lack of leadership and guidance from elected officials, a total lackadaisical state of wait and see prevailed.  Well wait and see went well beyond the first flakes and even further past jammed up roads.  How about some reminders reported with the weather report?  Reminders? What a novel idea!
If you must travel in the face of danger:

• Pack extra clothing
• Pack some food and water
• Pack your medication
• Pack a blanket
• Make sure you have a cell phone charger and money in your wallet
• How about some salt, kitty litter, or sand
• A small shovel? Maybe.
• A weapon of self protection - most definitely

Think before you embark.

The tragedy of the whole event that has become Winter Storm Leon was that people trapped on roadways in vehicles engines running until fuel tanks were empty had no food, no water, no medication, and no bathrooms.  Worse yet were the school children trapped inside school buses for 10-14 hours.  The children stuck at schools sleeping in the gym had fun.  I know my kids had plenty of sleep overs.  Thank goodness the teachers were able to handle the situation.  There were no tragedies at the schools so I can only imagine the kids and the teachers made the best of it and raided the cafeteria for snacks and drinks.  Probably the only leadership exhibited during the Storm and aftermath was by the teachers who cared for and supervised the children at the schools - Bravo!

Folks, have some common sense.  My work colleagues and family members all have stories about the storm and the mayhem that ensued.  Teleworkers had the best of the day or two.  Working from home was the best idea.  Then there were the workers who left too late in the afternoon.  Drivers stuck in the snarl for 8-10-16 hours.  A ride home from work only 10 miles distance took some half a day to complete.  Some never made it home that evening.  Some were stuck without necessary medication.

Inadequate warning, poor leadership, slow action, and complete lack of crucial action all came together to make Winter Storm Leon a catastrophe that will be remembered for decades to come.  Atlanta has become a the butt of numerous jokes not because of three inches of snow - because poor leadership made a situation so much worse than it had to be.  Lack of action allowed the severity of the impacts to elevate drastically to dangerous levels putting countless lives in jeopardy.

Next time we can do better.  If the city needs help next time the prediction is "Just a Dusting" just call me.

Scott R. Mayorga  A.A.S., BS MT(ASCP)H CLS
hematech@yahoo.com
labhematech@gmail.com
@hematech

Santa's Reindeers Really Do Fly?

As far back as I can remember, I sat in the lap of Santa Claus December after December as a child and had my picture taken with the Jolly St. Nick.  I remember vividly visiting Santa at A&S Department Store within a magical display of Christmas Trees, Decorations, and a big beautiful throne of which Santa sat. 

Me with Santa

That was a special time each year.  Of course December 25th has greater meaning than that of the all giving Santa, in fact December 25th is the Birth date of Jesus.  Jesus was conceived on March 25th and was deceased on that same day. Prophets were conceived and died the same day of the year.  Nine months from March 25th is December 25th; when Mary gave birth to the miracle of Jesus. Don't let the Ney-Sayers try to con you otherwise into thinking Christmas is a Pagan Holiday.  That is hog-wash.  Pagan beliefs were just that, beliefs conceived some hundreds of years after the death of Jesus-period.  Might I digress...

This past weekend my Grandson visited Santa, sat on Santa' lap, and asked for a "Yellow Remote Control Cool Car".  It was magical.  It was sweet.  This was one of the best looking Santa's by far.  Grandson was feeling really special.  He believed.  He smiled at the big guy in the Red Suit.  Close by, in a fenced in pen, Santa's reindeer were on display.  These were stocky little animals, big antlers, fur on their legs, gentle, and really cool looking.  But, as folklore has it - Santa's Reindeer fly.  They really fly!  How else would Santa get around the world delivering goodies and packages to all good girls and boys on Christmas Eve?  Why of course with a sleigh pulled by his reindeer!  But can reindeer really fly?  Come-on?  Four legged terrestrial animals, with stocky bodies, hoofed feet, furry legs, and big noses.  Hardly what I would call aerodynamically conducive to cutting through the cold night air in the upper atmosphere.  So how do reindeer fly?  I will attempt to scientifically explain how reindeer fly while pulling a sleigh weighing hundreds if not thousands of pounds up into the sky at great speed.

Reindeer are terrestrial animals (mammals) that are equipped for thriving in very cold environments.  They are mild tempered gentle animals with anatomy similar to a cow with multiple stomachs, large teeth for chewing grass, and no tail.  No Tail?  If a reindeer can fly would one think a tail was necessary for flight like a rudder on an airplane?  Not so - not necessary for reindeer.  Reindeer have large antlers on their heads.  Special antlers that have multiple purposes.  With those antlers reindeer can monitor temperature, atmospheric pressure, wind speed, and direction.  All the measurements necessary for flight of a large airliner in the sky.  Reindeer also have large eyes and excellent vision.  As the story goes the lead reindeer on Santa's sleigh is named Rudolph and has a red nose that glows.  However, with magical antlers and large eyes reindeer have no trouble seeing and navigating through weather good or bad, rain or snow, wind or sleet. Rudolph's red nose is just an anomaly of reindeer anatomy whereby extra blood pools in his nose and glows in the bright light of the winter moon.  When eight or so reindeer are tethered together their collective strength is more than enough to pull Santa, the sleigh, toys and goodies, into the air up up and away into the night sky.

It is like magic.  Reindeer really do fly.  Just ask any child.  With a kick of their hoofs, a twinkle in Santa's eye, navigational antlers and flight is just moments away.  Magical spirit in the mind of all God's children is the catalyst and all that is needed for reindeer and sleigh to leave the ground up up and away.

Reindeer are special animals with or without folklore and stories.  It is no wonder Santa  has a flock of them to guide his sleigh.

Merry Christmas Everyone
Happy Hanukkah
Joyous Kwanzaa
Best Wishes and may your holiday be safe, warm, and healthy.
Have a good one Santa!

To see Santa's Reindeer and learn about these fascinating animals click here>>>reindeercam

Scott R. Mayorga  A.A.S., BS MT(ASCP)H

Biometric Scanning On Your i-Phone But Not at Your Local Hospital

So - you got a nice new i-Phone 5 equipped with that neat biometric scanner!  You can scan your finger tips, your nose, your toes, even your nipple will work to identify you to your new cell phone.  That is really cool.  You can even have your i-Phone open up to your spouse or significant other by scanning their appendages too.  Isn't it great how science betters our lives?

Why don't hospitals employ this now commonly available method for human identification in Emergency rooms and admitting offices?  I sure don't know why?  With the risks of health care fraud so great in today's dangerous world why would a hospital not employ this method to identify visiting patients? Let's explore the science of biometric scanning, how it works, and why this technology should be mainstream but is not.

My first exposure to biometric scanning was at the GA DDS - Dept.of Driver Services office when I applied for a drivers license in GA.  My finger was scanned at the office then I was issued my drivers license.  My next encounter with a biometric scanner was with my wife' Leslie of  Leslielovesveggies new i-Phone 5.  Now it is all the rage on that new Apple device.  No more remembering a pass code to open your phone.  Just swipe your finger, her finger, or my finger!  But, biometric scanning is not new.  The use of biometric scanning has been employed to identify humans and our pets for many years although identifying pets requires a chip implanted under the skin.  That is a big no-no for civilized humans.  However, humans have excellent physical traits that are perfect for biometric scanning such as finger print, vein recognition, eye recognition, palm scanning, on and on.  You name a part and it can identify quickly and noninvasively.  Biometric scanners for the finger or palm read the patterns in the skin and/or veins then archive the image in a database tied to your identity.  This method of identification is used all over the globe to open doors for employees, open safes for the rich, identify the sick at the hospital and the not so nice folks at the jail.

There is one country across the globe that uses biometric scanning practices to identify its population; India.  As of 2013 nearly 600 million people in that huge country have been identified in the largest database of its kind.  Countries such as Australia, Brazil, and Germany all use biometric scanning to identify its population to some degree.  So what is biometric scanning for the identification purpose?  It is the use of a scanning device capable of capturing distinctive attributes or traits selectively identifying a human being, storing those captured attributes in a database, with capability of matching scanned attributes to match identities.  Biometric scanning can use finger print, palm print, vein recognition, facial recognition, or iris scan.  The first time identity is established with biometric scanning methods is called "enrollment".  Identity is confirmed thereafter with verification which matches a scan against database knowledge to confirm identity.  Simple right?  Well not exactly.  Finger prints wear out, iris characteristics change, faces change and that can produce false reads or naive reads. With the development of more sophisticated multi modal systems false read rates can be eliminated.

So why if this technology is widely available, easy to use, and is non-invasive do so many health care facilities not use biometric scanning to identify patients?  Health care can be administered safely and accurately if we properly identified patients?  EHR or Electronic Health Record is so important to keep accurate but is so easy to become compromised, stolen, or abused.  Your EHR is worth hundreds of thousands dollars to the criminal element. Defrauding a hospital Emergency Room is not hard.  Hijacking your medical record and financial health information is not that much more difficult.  The only way to stop medical fraud is by positively identifying the patient.  So here is an example.  You have health insurance but your brother does not and he needs some acute treatment, maybe some stitches for a laceration or he needs antibiotics for a festering skin lesion right?  So he goes to the hospital that you have gone before recently.  He walks in with no ID but says he is Mr. SO&So Smith.  He arms his memory with his brothers SS# and some other background info such as his employment, address, telephone number.  Bingo! He looks like his brother, almost the same age, ba-da-bing he now is the brother.  Wam-Bam out the door discharged with treatment covered by his brothers insurance or worse Medicaid/Medicare. Don't think it happens?  I have a bridge at the western tip of Long Island for sale.  It is a steal at One Million Dollars - yeah that's the ticket....

Anyway, that is just one way how hospitals, doctors offices, clinics, and pharmacies are defrauded by health record hijacking and identity abuse.  The only way to stop it is by positively identifying the patient.  Estimates are as high as 28$ million per hour for health care fraud and abuse in the United States.  The FBI is in charge of investigating Health Care Fraud and has tips on prevention .  Their investigations in 2010 totaled up to $80 billion dollars in health care fraud.  The FBI has a long mugshot list [Mug Shots]of individuals wanted for Conspiracy to Commit Health Care Fraud.  With government health care spending poised to balloon into $Trillions per year the criminal element is just salivating at the chance to hijack your health record and set up criminal operations like none seen before.

Here is an example of how you can be a victim of Medical Identity Error resulting in financial harm. Suppose you are sick and go to the hospital for treatment.  You have been there before and you trust the care you will get.  The patient registration person gathers your identification and then finds you in the hospital database.  Your name is Jim or Jane Smith.  You know how many J. Smiths are in any given hospital database?  Well, your visit at the ER is matched up to J Smith alright, except he is James Smith, who is HIV +  and owes the hospital thousands of dollars in bad debt and unpaid bills.  Bingo, you now own James Smith' medical bills and a disease that is mandated to be reported.

Up till now I have just been talking about the financial risks associated with health care fraud deliberately perpetrated by criminals for financial gain or by error.  What about the "Medical Errors" that occur across this country on a daily basis?  Errors you say?  There are errors in health care?  Why yes. According to the American Association For Justice preventable deaths from medical errors average 98,000 deaths per year.  An error starting with patient identification can be deadly!
 Here is another example; Suppose your wife is ill and you take her to the ER.  She has been there before, they have a record of her because she is diabetic, and also highly allergic to certain preparations of insulin. The staff identify her and but register her under a medical record one number off of her true medical record number because of a data entry typo error on the keyboard.  In the ER she gets real bad and goes into Diabetic coma.  The doctor gives insulin but now your wife goes into anaphylactic shock because it is the wrong insulin. A few short minutes go by and your wife is in ICU, nearly dead, clinging onto life.  Hours go by and you think she is ok for the night so you go home for some rest.  Your awakened by hospital staff in the early hours to come to the hospital without any further explanation...

These are just a  few scenarios that could happen because of patient mis-identification.  Hospitals have a process whereby duplicate medical records are reconciled into one.  Sometimes when you visit a hospital ER the computer system is down for some reason so all patients are registered on paper record which is then entered into the computer database systems later.  You will be given a temporary medical record number until your visit can be reconciled to you historical records. This is called "MRN Merging". Not so bad if you truly do have a duplicate EHR and the two are merged together.  But what if the merge is incorrect?  Catastrophic consequences can be produced in some cases.  Your blood type can be changed, you can suddenly acquire a disease you never had before, or you can unexpectedly own debt that is not yours or your insurance company' responsibility.

So why do health care facilities not want to positively identify their patients?  There are less than 300 hospital facilities in the United States that employ biometric scanning to correctly identify their patients?  They may have the most expensive and sophisticated equipment on hand but will ask you who you are to identify yourself.  If you have picture ID use it but some people show up at the ER without ID.  The reasons why health care facilities do not use biometric scanning are:

• $$$Expense - Biometric scanning Systems and the database management tools used to identify patients and relate this data to EHR is expensive.  Probably the most common reason this technology has not been adopted to main-stream health care practices.

• Abuse of such databases has great financial enticement - the sale of such biometric identification data is a lucrative proposition for those who will have access.  However, the penalties for sharing PHI - Protected Health Information are steep and can include jail time for those found guilty of Health Care Fraud Conspiracy.

• Civil Rights activists and privacy proponents hate anything that positively identify the population and store such identification in databases.

Well then, it is a two way street.  Maintain privacy but then risk acquiring the medical record of someone else.  Raise the level of health care safety at the expense of losing anonymity?

I would much rather be positively identified when it comes to serious medical treatment like surgery, pharmaceuticals, or transfusions than be mis-identified or have my medical record abused for financial gain by someone else.

What can you do to protect yourself..

1. When you visit your doctor or most importantly a hospital make note of your MRN.  Next time you go back compare that number to any new registrations or visits to make sure the registration process identifies you properly.
2. Carefully monitor EOB- Explanation of Benefits that you receive in the mail.  Report any inconsistencies to the hospital , insurance company, medicare (CMS), or your doctor.
3. Carefully monitor your bank statements and credit card statements for any suspicious  or unknown healthcare charges and take action immediately if anything suspicious shows on a statement.
4. Never give any personal information about yourself over the phone.  A "scammer" might get a hold of your name and phone number to call you asking about your last visit to a health care facility as a Customer Service Survey.  Hoping to gain additional information; you may be asked for this information directly on the call or purposely asked to verify incorrect info so that you can "Correct the Records".
5. If you have a choice of hospitals to go to and one uses biometric scanning and one does not, go to the one with biometric scanning.  Tell the staff you came because they can positively identify you.
6. Call your local hospital and request they start using biometric scanning for identification and that would make you more confident making a visit.

Good luck my friends.  Its a dangerous Health Care World out there.

Scott R. Mayorga A.A.S., BS MT(ASCP)H CLS

For more information on health care fraud  and biometric scanning click the links below.
NHCAA

Two College Kids Messing Around in a Morgue - Ruh Roh!

As young adults you, me, we all did dumb stuff from time to time...
 

Like the time a friend and I went down steep-steep Cotton Tail Road on our skateboards with no helmets or safety gear and crashed hard resulting in many inches of road rash and near concussions.  My head bleeding, my forearms looking like chop-meat, I then proceeded to drive us both home stopping at a convenience store for a soda.  The store owner nearly called the police on us.  Ah - those were the days.

You would think that working in a clinical laboratory, safety is a main concern and for the most part that is true.  But, when the manager tells two young lab assistants to dump some old chemicals down the sink, well mayhem can and will ensue.   This is the tale of what happens when critical thinking skills are not applied to a situation and great danger can overcome the festivities.

The word "old" is just a useless adjective when attached to the word "chemicals".  Chemicals in pure form should always be handled with a clear head and proper protective equipment.  Old chemicals can diminish in reactivity but still remain quite concentrated and active enough to cause bodily harm, damage, and other dangerous risks.

And so the story begins with a request from the lab manager of his young minions; "Take these boxes of old chemicals and dump them down the morgue sink - But be careful.  See photo below taken by Photographer Brandon Merkel of the laboratory morgue some 20+ years later.  We were working part time in a mental health facility laboratory with over 100 years of history.  Some of the chemicals were real old. But, you see we were educated, college trained, young, and rather invincible in our own minds.  So this was going to be an easy work day Right?

Photograph by Brandon Merkel

Well nothing was farther from reality.  I agreed to take the first few hours and my cohort would take over after I left for the day.  I proceeded to sort jars of chemicals by my own self starting relevance by recognition.  If I recognized the name of the chemical I opened the jar and poured it into the drain followed by copious amounts of water.  For the most part I was OK.  I had gloves, lab coat, and goggles covering my eyes.  Luckily, I was only working a 4 hour shift.  One chemical at a time followed by water, I was having good luck.  I was careful not to mix the chemicals together in the drain.  On and on it went.  No incident and no drama for me. Then it was time to leave for the day to attend my evening college classes.  My cohort took over.  He thought he was invincible too.  Unfortunately, he was not.  Critical thinking was not present in his work.  Instead of dumping - rinsing - waiting - repeat; his work flow was more streamlined.  He Opened several jars randomly grabbed out of the box, poured into the sink, after a scary amount of chemical was present water was added to rinse down the drain.  Well, under such a routine it was only a matter of time before disaster was at hand.  Several chemicals mixed together producing a cloud of dangerous noxious vapors which overcame my cohorts senses and eventually his faculties.  When he fell to the floor luckily he knocked down a box of chemicals and made enough of a ruckus that other laboratory staff heard and came to investigate what happened.  They pulled my cohort to outside air, opened doors and windows to release a eye tearing, breath stealing vapor cloud from the morgue.  My poor cohort almost bought it in the most ironic of places - right next to the morgue table.  What a disaster.  My cohort was alright though a temporary leave of absence was in order for the poor kid.  He was lucky that day.  So what have we learned?  Chemicals are dangerous.  Mishandling them is deadly.

As laboratorians working with various chemicals on a daily basis we are trained how to properly handle chemicals, how to mix them, and how to dispose of them whether in pure or aged state or post use.  This is all very good to know. But what about at home? Should we be concerned about household chemicals present in our living spaces?  The answer is an emphatic YES.

Here is a brief list of do's and don'ts for chemicals around the house.

Keep chemicals in original containers.
Date opened chemicals so you can keep track of their age, use, and reactivity.
Do not mix chemicals together.
Follow "How To Use" instructions directly on the label without deviation.
Discard empty containers.  Do not use empties for storing or preparing other chemicals.
Acquire MSDS forms for the cleaning chemicals you have in your home from the manufacturer; for example SC Johnson. 
If you purchase concentrated cleaners and mix with water also purchase generic non-labeled application containers or sprayer bottles for such use.  Mark the container with exactly what is contained and at what concentration.  Date the container with the date of preparation.  In the event of an accident with the chemicals, a spill, or splash in the eyes it is important to know what exactly the chemical compound is.
In the event that a child has exposure to the chemicals, it is critical to know and be able to calmly tell
poison control what chemical and at what concentration the exposure happened with.

Don't;
Mix different chemicals together - Cleaning a toilet bowl then spraying the seat with a chlorine based cleaner can result in deadly vapor production.  In the enclosed confines of a small bathroom you could wind up on the floor in trouble.  Some chemical compounds are heavy and thus hover the floor so your head on the floor is a bad place to be!
Don't;
Use old containers for preparing new cleaning solutions.  They are not properly labeled and the initial mix  of solutions may not work as expected or may be dangerous to handle.  An exposure at some later time may lead to erroneous information given to poison control in an emergency resulting in further harm or death to the affected individual.

Never: Mix chlorine based chemicals with ammonia based cleaners.  This is a recipe for quick
illness and death.
Never: Mix drain cleaners with anything other than water.  Use rubber gloves when handling drain cleaners, oven cleaners, or anything labeled as "Caustic".

The most dangerous chemical compounds you can purchase without special permits is by far caustic drain cleaners and concrete scrubbers (Acids). Absolutely, Do Not mix these together and it is against the law to use these products in a way deviated from intended use as per the product labels.

Don't be stupid my friends - use your critical thinking skills.  Chemistry is wonderful when used properly.
Please click through links below to important information concerning the safe handling of chemicals in the home...

OSHA.gov
American Assoc of Poison Control Centers
National Capitol Poison Center
US Chem Safety Board
Guide to Chemical Hazards

Brandon Merkel is a photographer on Long Island NY.  Permission was granted by Mr. Merkel to use the morgue picture above.  The picture was taken some 20+ years after this story took place in
Sept. 1981.  The morgue autopsy table is shown slightly out of original position and plumbing fixtures are missing in the photograph.  The 16 square doors oriented floor to ceiling are the morgue refrigerator.  I observed an autopsy in this morgue room.  This room was located in Building 23, Pilgrim Psychiatric Center, Brentwood, NY.  The predominance of the ground floor was clinical laboratory which I worked as lab assistant for 6 months until Jan. 1982. There are multiple pictures to be found on the internet taken in this morgue but show the condition of the refrigerator in various stages of disarray and destruction.

Scott R. Mayorga A.A.S., BS MT(ASCP)H CLS

Excuse me - How cold is the Dry Ice in that Cooler?

 Dry ice maintains a temperature of -80ºC which makes it a perfect shipping medium for blood products, frozen foods, and other temperature labile items

If you are a manager, supervisor, head, chief or otherwise known as leader in your organization you know full well being placed in the "Hot-Seat" becomes a comfortable position par for the course that comes with said titles.  Eventually, being looked upon as the leader can have its trying moments.  I have explained in previous posts about representation of a laboratory facility in an inspection or audit role.  In a less stressful situation such as interaction amongst staff of your own facility things can still get dicey.  Decorum, tact, and Witt will always prevail in every situation or interaction.  As the leader you are relied upon to give sound judgement, smart opinion, astute evaluation, and complete answers to questions.  As the leader, sometimes it is hard not to get "Fed-Up" with ridiculous questions or challenges that sometimes challenge not only reasoning skills but also patience.  Working in a large facility with hundreds to thousands of fellow staff members it is only a matter of time before one of those staff members really tries your patience.  Here is one such observation that although I gave a good observation and astute answer to a ridiculous question I ran the risk of running myself under hot water.  Every situation is different.  Whenever patient care is involved you always have to give 100% attention and serious response.  When the same issue is bantered about over and over again sometimes it is best to stop the BS and say it straight - Straight Talk From The Hematech.

Dry ice is nothing more than solidified carbon dioxide with some impurities mixed in.  As such, this substance is very efficient at keeping materials in close proximity in a frozen state.  Dry ice maintains a constant temperature of -80ºC which is very, very cold.  Laboratorians know that in order to keep blood specimens stable for long periods of time -80ºC is the temp required inside a frost-less freezer or dedicated laboratory grade freezer.  If specimens are going to be shipped across the state, overnight, or across the globe the only way to do that is with a well insulated cooler box full of dry ice to keep the specimens in a frozen stable state.  Well everything works great when there is enough dry ice packed in the box, the box is sealed properly, and the shipping is prompt and on time.  A small cooler box with 1-2 lbs of dry ice sealed appropriately will keep contents frozen for up to 5 days.  Add more dry ice such as 2+ lbs and you can insure stability of contained specimens for up to 7 days.  

This is the story of a physician office that would just not follow directions for shipping frozen specimens.  If you put a couple of pebbles of dry ice in a box you can't expect to have stability for very long.  That will not last more than an hour or two.  Well, delivery after delivery, specimens from this one physician office arrived devoid of dry ice and warm as the ambient temperature.  After several failed attempts to ship specimens to the core lab something was just plain wrong and the responsible people for packing and shipping were failing in their duties.  Project management type staff members are responsible for well managing the project and the customer.  I had had it by now.  After many emails back and forth, phone calls, disputed state of arriving cooler boxes it was time to educate the project manager.  One such day, a cooler box was expected from said physician office with supposed frozen specimens.  I notified the project manager to come to the lab to visually inspect the cooler box as it was opened.  The project manager ran right over.  As several of us, me the lab manager, several technical staff members, the project manager who was in a new position, and an assistant we all observed the opening of the box.  What would we find?  A box full of dry ice and specimens or another failed attempt at shipping specimens.  Well, after anticipation of the physician staff finally getting it right - No, just a box of warm specimens and no sign of dry ice.  What could possibly be wrong?  Why is this happening?  "Something is terribly wrong" said the project manager.  I said, "yes something is wrong - if they placed the required amount of dry ice in the box we would have frozen specimens today?"  Some banter went back and forth with the project manager; yes they were putting in dry ice, yes it was the right amount, then the ridiculous started.  Assertions flew about the cooler box and how faulty it was.  That was hog wash; it is a styrofoam box used for hundreds of shipments each day to that facility.  Then the "Piece de resistance" came out of the mouth of the intrepid project manager.  She asked, "So- how cold is the dry ice is those boxes over there?"  I replied, "they are full of dry ice and dry ice is -80ºC."  Then she asked, "Well how do you know that dry ice is cold?"  I looked at her dumb founded.  Devoid of an astute smart complete response I said the following; "Well,... stick your hand in a box of dry ice for 30 minutes, take your hand out, then smash your hand on that table over there."  "If your had shatters into a million pieces you know that dry ice is cold."  Of course that elicited a dumb chuckle from the assistant and some smiles from my staff in attendance. Blank stare from the project manager was followed by more dumb inquisitive banter.  Now the morale of the story is I might have felt better after I said what I said and it really needed to be said at that point in the situation - but that banter would come back to bite the lab.  As it turns out that project manager started dating the medical director of the laboratory.  Over head pages from the project manager emanating from the sound system through out the facility complex were heard beckoning the medical director by his pet name which we all promptly heard for the first time and only time.  I guess she got the smack-down because she never over-head paged the man again.  Anyway, might I digress?  She suggested to the medical director probably over sultry pillow talk that the cooler boxes used for transporting frozen specimens were faulty.  It could not be the staff of the physician office not placing enough dry ice in the boxes; No it had to be the cooler boxes.  Well that prompted a very scientific, thorough, and painstaking review of so said boxes.  The result of that validation found that not only were the boxes doing their job the specimens were perfectly safe for a very long travel.  

Here is the validation overview:
A handful of specimens were packed in a standard styrofoam cooler box ( approx 8" x 8" by 12") with 2.2 lbs of dry ice. In with the specimens was a very expensive temperature recording device that was capable of recording the environment temperature for over a weeks time.  The box was packed and shipped exactly as instructions were given to all physician offices shipping samples to the core lab.  The package was shipped over 1200 miles to an office then without opening the box it was return shipped back to the lab.  Well, low and behold, the temperature inside the box never wavered, dry ice was still in the box upon its return to the core lab, and specimens maintained frozen state the whole way.

Yes, dry ice is cold, very cold.  It makes for an efficient medium to pack and keep frozen all sorts of items such as foods, chemicals, and blood.  The validation was a success.  Eventually, the physician office caught on and thawed specimens were seen no more.  Good for patient care - good for my sanity.

So, think about that wise crack before you let it fly.  You never know if the receiving person is going to sleep with your boss and cause you grief.

Take care my laboratory friends.  Be careful what you overhead page.  
Another tip! Be careful of the email you send.  How embarrassing it is to be in a room observing a presentation from a managers laptop, projected on the wall for all to see.  Then in the lower right hand corner MS-Outlook flashes the subject line of an incoming email and the senders name.  Whoops, there flies another pet name!  From another Medical Director to the underling.  How true, how sad, how true.

Scott R. Mayorga A.A.S., BS MT(ASCP)H CLS

How to Pass the NGSP A1c Proficiency Testing Survey Like a Pro

 Proficiency Testing (PT) of clinical laboratories is an important part of Laboratory Quality Assurance

All clinical laboratories participate in subscription type PT such as (CAP) or CDC Lipid Survey in addition to State Sponsored PT programs such as N.Y. State DOH or PA DOH, etc.  One of the toughest most difficult PT surveys to pass in my opinion is either the CDC Lipid Survey or the
NGSP - National Glycohemoglobin Standardization Program.
HBA1c is a component of Hemoglobin that is glycated (Hemoglobin + Glucose) at normal levels in patients with normal sugar metabolism.  Individuals with diabetes do not metabolize sugars normally and therefore glucose levels in the blood are erratic leading to all sorts of ancillary disease states of the kidneys and circulatory system as well as negatively affecting ones vision and propensity to develop infections.  Good glucose control is the key to surviving with diabetes for an extended lifetime.  Those with poor control of glucose suffer many different ways on a daily basis and do not live a long life time.  As a clinical laboratory it is for the good of all people to be able to produce the most accurate reproducible data possible day after day, patient after patient, normal and abnormal.  Passing a HBA1c CAP survey is good but passing NGSP is better.  Then there are some patients that have a Hemoglobin make up that interferes with all HBA1c testing methods. For more info on that click here;Testing interference with HBA1c

NGSP is a subscription PT testing program that challenges all aspects of a laboratories glycohemoglobin testing including the testing platform, reagents, calibrators, user technique, and ancillary equipment.  NGSP is the ultimate PT QA program for ensuring quality in testing and reproducible results in HBA1c testing.  Click here for more info about obtaining certification. The data analysis of the NGSP PT results are so exact and statistically critical; passing this survey a difficult endeavor to undertake.  I know, I have managed a laboratory that successfully passed the NGSP for 5 years straight while employed at that lab.  Possibly not as excruciating to pass as the CDC Lipid Survey which I also participated in and actually visited the laboratory at the CDC in Atlanta that prepares the specimens for the CDC Lipid Survey.  I sat down to talk with the director in charge of administering the CDC Lipid Survey program; that was really neat.  The next CDC Lipid PT I had overseen passed as well.  Although, continued success with the CDC Lipid PT is almost impossible under the scrutiny of any manager.

Let me tell you about my experience with the NGSP PT Survey and offer some helpful hints to any laboratory wishing to endeavor down the path of NGSP Certification.  NGSP is a certification process whereby a laboratory, instrument vendor, or other entity is awarded certification for one year.  Renewal of the certification occurs on an annual basis on the certified labs anniversary.  There are 4 testing events throughout the year including the certification or re-certification process and 3 quarterly testing events.  Each testing event consists of small samples shipped from NGSP HQ on dry ice to the subscribing laboratory.  Each testing event must be completed within stipulated time period with results emailed, shipped, or otherwise electronically returned to the NGSP program for analysis.
NGSP will statistically analyze submitted laboratories data and compare against other certified laboratories.  The comparison performed may be against same method or different methodology.  It really doesn't matter who is used as comparison.  NGSP is the standard by which all instruments, methods, and laboratories are compared to.  Your lab either compares or does not.  If your lab compares well enough on the certification PT process Level II certification can be obtained.  If your lab performs really well, Level I Certification is obtained.  Currently for 2013, there are 138 laboratories worldwide that are certified with 100 certified as Level I labs.  There is a reason why some lab can only achieve Level II certification - The process is arduous, difficult, stressful, and fraught with possible minute unknown errors in testing that can skew results tenths of a percentage which can make any lab a Level II lab.  It is rather stressful simply because the annual expense  is $5000 USD for a Level I lab and once you achieve Level I and the status the certification brings to a lab it is terrible to lose that status.  NGSP and the directorship of that program are globally recognized as experts in HBA1c metabolism, testing, testing methods, and testing procedures not to mention a fine PT program with astute statistical data analysis.  If your lab is contemplating NGSP Certification then buckle up ~ you are in for a rough ride.  Put up your money and get prepared to take a beating.

Ok lets get started - What do you need to know?
1st - NGSP is not your run of the mill CAP survey.  There are more samples to test than CAP and lets face it passing a CAP survey for HBA1c is like driving a car through the Lincoln Tunnel.
 CAP HBA1c 2013 Summary  The data analysis applied to the NGSP  survey program is exacting and tight.  There is no room for error and minute changes in instrument function form day to day will bring you down to Level II fast.
2nd - Do your homework.  Go to NGSP on the World Wide Web and look around.  See who is listed as Level I and Level II.  Make sure you take note of the manufacturers and what they routinely pass as either Level I or Level II.  If a particular instrument can't routinely make Level I what makes you think you can do better with the same instrument on your lab bench with your scientists? If you don't have a Gold Standard method think about getting a Gold Standard method Such as Tosoh or Bio-Rad before going down this lonely country road to NGSP Certification.
3rd - Make sure you have well trained scientists who can tell the instrument is not running right on a minutes notice and can rectify issues expertly.  Also, make sure your maintenance program is fastidious and complete without lapse.  Make sure your chemistry is spot on.  Everything about your instrument has to be perfect or even Level II will be out of your grasp.
4th- If you currently have QC ranges that you can drive a city bus through (> 0.3% HBA1c on any given level of Quality Control) and use every tenth of that range on a monthly basis you are going to fail miserably.  Don't even think about NGSP if you can't handle an sd of 0.1 across your whole testing linearity.  Your lab will fail miserably otherwise.
5th - Once Level I Certification is obtained a Level II testing event will place your lab on "Probation".  Passing the next quarterly event with Level I is a necessity otherwise your Lab will be officially graded as Level II for your poor Level II two testing event performance.  

So- you have the nerve to force your scientists to a 0.1 sd under much grumbling from them and you are confident for several months like that.  Go ahead - go for it.  Just know that one little slip of the wrist during pipetting, diluting off by tenths of a %, and any maintenance lapses will cause unknown suffrage and possible failure.  Even Level I labs suffer an inconsistent Level II testing event now and then; in five years of straight NGSP testing I had two Level II events; that was 90% Level I for 5 years.  If you consistently use the same instrument, the same scientist, the same pipettes, chances are your consistency will prevail a strong Level I performance time after time.  But, that is not reality.  If you have the stomach like I do you will monitor everything like a crazy nut ensuring that no matter what instrument, what scientist, what pipette, what Lot number of reagent, and what calibrators are used, and dam those torpedo's. I passed year after year after year.  Yeah - that's how you do it.  I had 6 instruments and 7 scientists and rotated amongst them all with expert success.  Am I bragging - You Bet! "Don't try this at home folks I am a professional".

 Alright you take the plunge - You purchase your certification kit and wait for it to arrive.  Now what?
Make sure you have staff on hand that can competently receive and store the testing kit once it arrives at your facility.  You must keep the kit frozen at -80ºC at all times until ready to test.  -20ºC is going to ruin the samples.  If the kit gets lost in your facility and the samples thaw uncontrollably you are going to have to beg NGSP for another kit.  Do it a second time and you may not get a replacement kit.  If the kit gets lost along the way you must let NGSP know immediately after the expected receive date.  That is not the labs fault.  But, once the package is signed for it is yours.

Make sure everyone involved in the testing is trained well, knows what they are doing, can handle the 0.1 sd QC no problem, and did I say they must know what they are doing???  I am not kidding.  There is no room for minute error in the NGSP statistical analysis.

Make sure your instrument maintenance is up to date or complete it before the testing event starts.  Be careful though.  You must also ensure mechanical performance will continue for the testing event.  The last thing you need is for mechanical failure in auto dilution area of the instrument day 3 or 4 into the testing event.  If this is your Certification Process - you better pray nothing happens during the 20 days of testing!  You bet. That is what I said.  Certification is 20 straight days of testing HELL!  If anything breaks down during that time, you better fix it and fix it so the instrument performs just the same as before it broke.  Hence you will fail miserably.

A word about calibration.  Most HBA1c instruments produce a calibration from two analyzed samples in the calibration kit and that kit is compatible with certain or single lots of reagent.  Make sure you are following instrument manufacturer guidelines for use of calibrators exactly as specified.  No cutting corners, no deviations, no mistakes or you will fail NGSP miserably.
You must make sure everything about the testing instrument is perfect, producing the same result on the same sample day after day after day.  NGSP is not only testing for accuracy but just as importantly reproducibility.  Don't kid yourself and don't be a fool. Preparation is the key.  Human error is the enemy, instrument mal-function on a sporadic basis is the unknown.  You will know something bad happened that you were not aware of when you get your results back from NGSP and you missed Level I by 0.03 or something minute like that or worse yet don't even make Level II performance.

Ok, so I think I have successfully scared anyone unknowing of the the NGSP process.  Can it really be that bad?  Yes it can.  Can Level I labs fail now and then? Yes.  Will they ever figure out what happened? Possibly not.  Will they pass next event with Level I performance?  probably yes.  But just remember, out of 139 certified labs only 100 attained Level I Certification.  39 labs were unable to attain Level I performance for two straight testing events!  Here is what you really need to know to successfully pass this arduous PT program.  

• Xanax will be your friend.
• Treat your NGSP testing kit samples like gold.  Refreeze them immediately after done testing the samples for the day.  Don't waste them.  Don't wait hours to refreeze either.  Unstable NGSP samples are a terrible thing to use.  Make sure they are clearly identified for future use.  NGSP knows labs save the samples for future reference and they send only about 0.5 mL of sample in each tiny vial. Re-test old NGSP samples before the testing event starts.  This will insure exact analysis is coming from your instrument.  If you have more than one instrument then test against both or two or three of your available instruments.  Pick the best performing instrument.
• Once you establish that your instrument is analyzing exactly as needed Do Not Make Any Changes that will affect performance.  Get your maintenance procedures done an any instrument that may be used for NGSP, preliminary test with old NGSP samples and calibrators as unknowns, then promptly start NGSP if you are satisfied.  The more time that elapses after you "prelim" the instrument and NGSP testing starts the more unknown can happen.
• If your staff is not comfortable using such small quantity of PT sample in a small tiny vial then have them practice with such small vials before the testing event begins.
• Save calibrators that were used during very successful NGSP testing events.  Test these calibrators as unknowns in the same manner as true NGSP samples will be tested in your lab.  Make sure you are recovering exactly the data you expect with the saved calibrators.  This can be used as a reference mark to make sure analytically your instrument is performing optimally before the NGSP testing event commences. 
• Make sure any pipettors used are in good mechanical order and are calibrated as exact.  This is going to be the most common issue that will bring you down to Level II or fail you miserably.  I cannot stress this enough.
•  Make sure you have enough reagent on-board to complete the testing event.  If you run out of reagent mid way and change even a buffer solution, you run the risk of failure.
• Make sure your scientist is a pipetting expert.  Pipette by the book.  There is no room for slouching here.  Practice can be obtained via a laboratory scale.  The testing scientist must be able to pipette minute sample amounts with the same accuracy time after time.  Practice until perfect.  Did I already say that pipetting errors will bring you down?  Take heed.  Make sure the technique is spot on perfect.
• Make sure you know what type of freezer is used to store the NGSP test kit.  If you store in a frost less freezer you will ruin the samples.  It is a done deal.  Get yourself a good lab grade freezer that will not cycle off and on furiously to avoid frosting.  Yes they are expensive and frost will build up inside like a glacier but that is the only way to successfully store the kit and any samples you save from the kit post test event for future reference.

Overall you must be confident in your technology, your technique, and your abilities.  If you have all three you will pass.  If you falter, well you know the end result.  Level II or worse and ultimate humiliation of not passing a PT you paid good hard earned money for the nerve to take a numb skull crack at it try.  

If NGSP is for you - know well what you are getting into.  Only a short list of labs can pass this strict PT program. Will you be one of them?  Do you have the nerves of steal?  Do you have the knowledge and experience with your testing method to realize what is good and what is bad data and how to fix that mess?  If so, see you in the winners circle! http://www.ngsp.org/docs/labs.pdf

 Take care my brave friends - Test with confidence and see you in the NGSP winners circle.

Scott R. Mayorga A.A.S., BS MT(ASCP)H CLS




   

She's wearing a see through blouse - Are you kidding me?

Playing the role of a manager in any industry requires quick reflexes, change on the fly decision making, and having "wherewithall" to quickly assess a situation and intervene appropriately.  Reacting to a bad situation unprofessionally can set up a bad series of events leading to staff disciplinary action, your own disciplinary action, or decreased morale amongst general staff members.  Being able to assess quickly and react soundly is a chief attribute of a good manager.  Dealing with sensitive water cooler topics such as sexuality can be hazardous in the workplace.  Reacting poorly to such occurrences can land a manager into hot water fast.

One such issue came about which I will describe below and what is the proper way to handle such a situation.  Managing a huge staff of professionals is a daunting task.  Most of the time my major issues involved scientific questions and situations that effected the scientific work going on in a clinical laboratory.  When situations involve extreme emotion, despair, or horrific distress of an employee care must be taken to handle the employee with dignity, care, and respect.  Sometimes just sending an employee home is not appropriate.  In extreme situations of stress or distress it is wise to send an employee home with someone of the same sex to make sure the staff member is ok and makes it home safely.  Then there is verification from the accompanying employee that safety is insured.  That last thing you want as a manger is to send someone home only to make it half way  and die in a traffic accident or kill someone else in a horrific auto accident.  So be it, some situations are not as serious but still must be handled with dignity and smarts.  I give you the story of the "Lady with the see through blouse".

On a busy weekday in the ole lab, the hustle and bustle of specimen receipt and accessioning, all staff were on deck wearing gloves, lab coat, and face shields.  That PPE was hiding one little aspect of one particular employees appearance that day.  After, the specimen receipt process was over, staff routinely took breaks for the morning.  Well that is when the raucous started.  I was sitting in my office reviewing documentation, answering emails, and what ever, when a female staff member came startling in and said; "You have to do something about "Hortense -I'll call her".  I asked what was wrong?  The staff member blurted "she is wearing a see through nude blouse with a see through bra - Nothing is hidden"....  "Everyone is gawking at her".  I just said, "You have to be kidding me? Hortense"? The reporting staff member walked away satisfied she had done what she thought needed to be done.  And she did.  What's a manager to do?...Now I could have confronted the staff member out in the lab and assessed the blouse myself in front of other staff members.  That would not be good.  That could turn out to be very embarrassing for me and the employee if it really was an issue of virtual nudity.   I could request the employee to come to my office but that would also be risky if there really was virtual nudity and the employee intended to walk around in a provoking manner.  That one on one situation could quickly escalate to a sexual harassment claim.  Don't want to go there either!  What is the proper way to handle it?
Gather up another management level same sex (as the troubled employee) co-worker and carefully interview the staff member.  This would also be valid for addressing a complaint of workplace vulgar language complaints, inappropriate website surfing, etc.  The key is you don't want to address an issue such as this alone and certainly not two same sex managers interviewing an opposite sex offender if you can avoid it.  Well with that startling claim of virtual nudity, I indeed gathered up another female manager to assess the employee. Right!
Upon, requesting "Hortense" to come to my office I did not immediately notice "anything" with a half opened lab coat she was wearing.  However, when she arrived at my office without the lab coat that was a different view.  If anything can be said about the outcome of this issue it is that the employee apologized and fixed the problem immediately.  Weeks later she was able to again say she was sorry and laughed about how she did not realize what she looked like.  With the 2nd female manager in my office with the employee I was able to safely assess the situation, point out to the staff member that the clothing of the day was inappropriate, and that some options were available to remedy the situation.  First, Hortense was displaying virtual nudity.  Graphic display of chest anatomy is an understatement of the actual situation.  A sheer nude colored blouse with a sheer nude colored bra is not proper attire for any workplace.  Hortense was somewhat surprised about that when I told her that her appearance was inappropriate with see through clothing.  As she looked down at herself, her face turned white as a ghost, she looked at the female manager who then affirmed that "Yes honey - Your clothing is see through leaving nothing to the imagination".  With that; profuse apology followed from the employee.  The discussion about what needs to be done followed.  Options included going home on vacation time; going home-coming back appropriately dressed on vacation time; and lastly - put on a sweater or a change of clothing and don't take it off the rest of the workday!  Hortense picked wore a sweater all day buttoned up to her chin.  That was the best option under the best conditions.  No need to get HR involved.  No lost time for productivity.  We were all adults and that was an adult fix for the situation.  Incident over with minimal stress on the employee, I won points for handling the situation adeptly, and no one got hurt.  Yes- there were some rumblings around the workplace during the day followed by chuckles but that was to be expected.  "Nudal frontity" unintended in the workplace is funny and as in this case was innocently perpetrated.  However, what if "Hortense" had a fight with husband that morning at the house.  Wore barley nothing to work to make him mad and intended on poking someones eye out with genitalia? What would you do to address that situation?  Luckily this was an innocent mishap with an employee that was extremely embarrassed and willing to cooperate fully.
Workplace behavior is extremely important to productivity, morale, and emotional stability of individuals on the workforce who can easily succumb to workplace stresses.  Letting bad behavior go in one instance can perpetuate more bad behavior and easily become a mitigating issue for a trouble causing employee when approached with disciplinary action.  Unfair treatment to one is showing favoritism to another.  Ignoring bad behavior from one staff member unfairly affects the rest of the staff who do their job, cause no problems, and work productively.  Real serious issues can escalate from favoritism and there is nothing more destructive and pervasive to workplace cohesiveness than illicit sexual behavior and or sexual affairs between employees in the workplace.  I have seen this happen from the top down from management.  When top leaders are engaging openly in this behavior the resulting degrade in morale is so pervasive that many staff members think they can get away with anything.  When this happens, the workplace is totally out of control, rules are not followed, and staff start leaving in rapid succession leaving behind sour exit interviews.  Not good.  Yours Truly.

So I have a saying, a Mayorgism if you will...
The talent that is mistreated and forced out will haunt the establishment for years to come; treat staff fairly, keep the loyal~Scott Mayorga

With that I say Good day to you - be smart - assess the situation - may you always make the right choice of action.

Scott R. Mayorga A.A.S. BS MT(ASCP)H CLS

The talent that is mistreated and forced out will haunt the establishment for years to come; treat staff fairly, keep the loyal~Scott Mayorga - See more at: http://hematechstraighttalk.blogspot.com/2013_07_01_archive.html#sthash.2UkfyVg0.dpuf