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 Pre-course
assessment of the participants
Status report
on quality in BTS
Mechanics of
training
Summary of
subjects covered
 First week
Second week
Third week
Evaluation by
the facilitators
Valedictory
session
Pre-course assessment
of the participants
A questionnaire with 45 multiple-choice questions
was used to assess the pre-course knowledge of the participants. Twenty-three
of the questions related to pure quality issues and the remaining pertained
to quality as applied to BTS. Participants were given 30 minutes to provide
answers to these questions. An analysis of the result showed that one-third questions
were answered correctly by three participants; 18 participants provided right
answers to two-third of questions and only one participant yielded more than
two-third correct answers. 
Status report on quality in BTS
The participants were given a questionnaire to
assess the status of quality in their respective centres. A wide variation in
quality was seen. Many centres reported some form of quality control within
the laboratories but few had a fully or even partially implemented formal
quality system that covered all major aspects of a BTS.
Mechanics of Training
The main aim of the training course was to provide
the participants with the tools of quality management and demonstrate how to
use them in BTS. The training was largely in the format of short
presentations followed by group activities and extensive interaction with the
participants to reinforce the teaching aims and learning objectives. The
group activities involved carrying out an assigned task in groups and then
reporting back for discussion with all the participants and facilitators.
Some activities involved the whole class using scenarios and role plays (see
Annex 2). The participants visited the Jakarta Blood Centre, Jakarta,
to see the quality management system in operation in BTS. Handouts of all the
presentations were provided to the trainees as part of their work book.
Summary of Subjects Covered
First week
The participants briefly presented their
expectations from the course which included improvement in their skills to
institute quality systems in their respective BTS to generate quality
products and results. They also opined that after being trained in this
workshop they will be able to impart training to their colleagues and other
personnel in BTS in their respective centres. The participants also believed
that after three weeks’ training they will be in a better position to
advocate the need for quality in BTS, handle organizational constraints and
optimally utilize the resources that are made available to them.
The major objective of the activities in the first
week was to provide the basics of quality and create firm foundations for
implementing quality systems following the ISO model. The terminology used
internationally in quality was extensively discussed. Other important topics
that were covered included: quality systems; quality policy; a quality
officer's job description; documentation, with emphasis on standard operating
procedures (SOPs); organizational structure; and process flow charts and
validation. All activities and examples used were based on everyday
activities or objects but, where appropriate, examples pertaining to the
blood transfusion service were used.
Second week
Participants were introduced to the concepts of good
manufacturing practice (GMP) and started to apply the quality principles
learnt in week one to blood transfusion activities. Job descriptions and
delegation as specifically applied to a blood transfusion service were emphasised. Flow charts and SOPs were applied to selected
BTS activities. Monitoring and evaluation activities in the form of error
reporting, corrective and preventive action and quality audits were
introduced. Validation of processes and equipment was also covered. The role
and value of training in the quality system were highlighted. Procurement,
maintenance and calibration of equipment; monitoring of assay performance and
the documentation of testing and processing were also discussed in detail.
The costing of activities in a BTS was discussed using the WHO Module
(Costing blood transfusion services WHO/BLS/98.8) as the basis. The week also
concentrated on quality aspects of blood donors, including donor education,
motivation, recruitment and retention. Donor selection, screening and
handling of donated blood and donor records were discussed. Safety in BTS, including environmental factors were
discussed.
Third week
The week concentrated on applying quality to the
main BTS activities. All aspects of the testing for transfusion transmissible
infections (TTIs) were covered, including quality
elements in laboratories and selection of test kits. An introduction to the
concepts of external quality assessment schemes (EQAS) was given. Applying
quality concepts to immuno-haematology and
component preparation, documentation of activities, process flow and related
critical points, and monitoring and evaluation in the immuno-haematology
laboratory were discussed. The clinical interface learning included a general
presentation and work on the role of the BTS in the clinical use of blood.
Participants also began a draft plan for implementing quality into their own
particular BTS which was finalized in consultation with the facilitators.
Advice was given with a template on generating a plan of action. Where quality
systems already existed, some problems were encountered on exactly what the
participants should plan for but the participants were advised to concentrate
on critical areas of their immediate concern and to ensure that they
communicated with the appropriate management personnel to ensure that a
collaborative effort was put into the proposed plan.
Post-course Assessment of the Participants
A comprehensive evaluation of the training course
was completed on the last day. The pre-course questionnaire was used for
post-course assessment as well. Eleven participants provided correct answers
to more than two-third of the questions and remaining gave right answers to
more than 50% of questions. These results revealed a significant improvement
in the knowledge of the participants because of the training.
Evaluation of course by the Facilitators
The facilitators also reviewed the course. They
expressed their satisfaction with the duration of the course, curriculum, quality of the teaching material provided by WHO and the
response and involvement of participants in various activities undertaken
during the workshop. However, some additional information was provided by
most of the facilitators to fill in the gaps. They also volunteered their
technical services for assisting in the implementation of QMP
Valedictory Session
The valedictory session was chaired by Dr Sudarshan Kumari, Regional
Adviser for Blood safety and Clinical Technology wherein participants
expressed their gratitude to WHO and the Indonesian Red Cross for arranging
this training course. They appreciated the QMP initiative of WHO and enumerated the benefits that had accrued to them
by attending this workshop. Dr Kumari requested
them to commit themselves, and their respective organizations, to the cause
of quality in BTS to ensure safety, adequacy and quality of blood and blood
products. She also assured them of all possible technical support from WHO in achieving their goals. Dr Kumari
briefed the participants about the methodical way in which they can commence
implementation of quality system in their BTS and contact the Regional
Quality Centre ( National Blood Centre, Thai Red
Cross Society, Bangkok) through their national coordinator for any technical
support and to overcome the problemes encountered
by them in initiation or implmenetation of quality
system in their centres.
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