UK TRANSFUSION LABORATORY COLLABORATIVE 2017 survey indicates that staff shortages are not being addressed Authors: Hema Mistry, Rashmi Rook and Paula HB Bolton-Maggs No Disclosures
Introduction UK transfusion laboratory collaborative (UKTLC) WHEN WHO WHAT Staffing Knowledge & Skills IT
Method Distributed to 302 laboratories to be answered on Wed 15 th March 2017 Survey consisted of 51 questions Survey Replies/Total laboratories Response (%) 2017 245/302 81.1 2015 204/327 62.4 2013 188/304 61.8 2011 162/322 50.3
STAFFING
60.0% How have the Blood Transfusion staffing levels changed since May previous year 60.8% Percentage of laboratories (%) 50.0% 40.0% 30.0% 20.0% 10.0% 51.1% 26.0% 41.2% 6.9% 9.4% 2013 2015 2017 23.4% 19.2% 18.6% 10.3% 30.2% 2.9% 0.0% Remained the same Increased Decreased No answer
What is the percentage variation in current workload compared to that in May 2013 (or previous year)? 70.0% 66.7% Percentage of laboratories (%) 60.0% 50.0% 40.0% 30.0% 20.0% 2015 2017 20.9% 49.7% 44.5% 10.0% 0.0% 9.0% 4.2% 1.1% 1.6% 2.3% Decrease in workload <50% Decrease in workload >50% No change/negligible Increase in workload <50% Increase in workload >50%
120 Reasons for leaving Key: Number of staff >5 Number of laboratories 100 80 60 40 5 4 3 2 1 20 0 Retired Early retirement Redundancy Promotion Left for a new organisation at same grade Left an NHS job for a non NHS post Left an non NHS job for an NHS post Left the profession for employment elsewhere Left substantive employment to work as agency/locum
Vacancies 120 70 The vacancies or long term absences or maternity leave in each grade and the length of time posts have been vacant 63 100 60 54 Years 80 50 47 >3 3 Number of staff 60 40 40 30 20 2 12<18 months >6<12 months < 6 months 2013 2015 2017 20 10 0 Blood transfusion 0technical lead Band 7 BMS Band 6 BMS Band 5 BMS Band 4 Trainee Band 4 Associate practitioner 2013 2015 2017 Band 3 Healthcare support worker Band 2 Healthcare support worker Yes - staff vacancies
KNOWLEDGE & SKILLS
Do you feel that a newly HCPC registered BMS has an appropriate level of education (knowledge and understanding) to work in blood transfusion? 140 Percentage of laboraotories (%) 120 100 80 60 40 20 0 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 37 20.0% 10.0% 78 0.0% The number of applicants 57 2015 2017 27.2% 52 49 28 12.9% The suitability The calibre of of the applicants Yes applicants 43 92 The number of applicants 23 118 121 72.8% 87.1% 52 The suitability The calibre of of the Noapplicants applicants 2015 2017 SATISFIED NOT SATISFIED
Which description best fits the HCPC staff member(s) working last night? (tick more than one box if required i.e. where there was more than one HCPC registered member of staff working) 60.0% 56.5% 63.5% 60.6% 50.0% Percentage of laboratories (%) 40.0% 30.0% 20.0% 16.5% 13.5% 15.3% 16.0% 2013 2015 2017 16.6% 10.0% 8.8% 10.6% 6.5% 5.9% 0.0% 2.9% 1.1% N/A Do not provide an overnight service A permanent member of A member of staff transfusion staff rotating with other sections in haematology 2.1% 2.6% A multidisciplinary member of staff A permanent night worker 1.2% 0.0% No HCPC registered staff working last night
Capacity planning Percentage of laboratories (%) 80 70 60 50 40 30 20 10 In your professional judgement does your full establishment of staff allow you to deliver all operational and regulatory activities? Yes No Unknown 0 2011 2013 2015 2017
Training & Development 80 Does your laboratory have a training and development budget? Percentage of laboratories (%) 70 60 50 40 30 20 10 Yes No 0 2013 2015 2017
Percentage of laboratories (%) Percentage of laboratories (%) 40.0% 80.0% 35.0% 70.0% 30.0% 60.0% 25.0% 50.0% 20.0% 15.0% 40.0% 10.0% 30.0% What are the main issues with having substantive staff on formal training programme 12.2% 17.4% 25.7% 28.1% 27.5% 33.7% 26.6% 7.2% 2013 2015 2017 17.3% 15.1% 14.4% 10.5% 68.2% 69.1% 18.7% 19.2% 2015 2017 68.5% 5.0% 20.0% 4.1% 2.2% 0.0% 10.0% 0.0% None No staff available to Administrative 6.1% Interferes with 5.0% Funding Time away from work train them burden routine 3.4% service undertaking Other delivery academic parts of No, remained the same Yes, has become easier course Yes, has become more difficult In your opinion has the ability to train/mentor inexperienced staff altered during the last 2 years?
Human Factors n=83/96 The BMS was sick and should not have been at work, but there was no one else available to cover the night shift so they came in. Staffing levels are critically low and there is no give in the system to allow for sickness. All band 6 staff are locums, because the pay is better
Wrong component transfused where there were five opportunities for detection A unit of red cells was commenced in error instead of the prescribed STAFFING plasma The laboratory prepared the wrong component type following a telephone request - insufficient staffing and excessive workload Two registered nurses checked the red cells but did not refer to the prescription so ISSUES failed to notice it was the wrong component type Verbal evidence from the ward manager confirms all patient details were checked correctly but the prescription form was not checked
Incorrect blood component transfused n=170 KNOWLEDGE AND SKILLS
UKTLC 2017 Reduction in funding for training & development Increasing workload Loss of body of knowledge as experienced staff leave Laboratory Errors Vacant posts unfilled for long periods Poor quality of applicants Educational events not well attended further loss of knowledge No staff available for training and keeping competencies up to date Increase use of unqualified, multidisciplinary & locum staff
General comments Quality of service is suffering due to increased numbers of very inexperienced staff and the inability to recruit anyone with BT experience. As the technical transfusion lead I struggle to keep up with workload within my core 37.5 hours, and regularly work additional hours. Lack of resource and support leads me to feel stressed and under considerable pressure regularly, and the only aspect that keeps me in this profession is my personal interest in the subject Rotation of staff due to shift systems means less continuity.
Key SHOT Messages 2016 Laboratories should always have adequate staffing at the appropriate grade to support those that require training Gap analysis should be performed against national transfusion guidelines and SOPs amended to correct deficiencies and to identify any necessary alterations to laboratory procedures Appropriate use and management of LIMS are essential for patient safety
Conclusion The standard of transfusion knowledge and education within laboratories is becoming a prevalent source of error Anecdotal evidence that there is a national shortage of qualified BMS staff applying for vacant positions and vacancies being filled with less qualified staff It is everyone's responsibility to ensure they complete their part of the process fully with care