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 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, while 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 only 42% of
the trainees could give more than 50% correct answers to all the questions.
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 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 ChittagongMedicalCollege, Chittagong, to see the quality management
system in operation in BTS. They prepared an audit report and presented the
same on the last day. Handouts of all the presentations were provided to the
trainees as part of their workbook.
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
would be able to impart training to their colleagues and other personnel in
BTS in their respective countries. The participants also believed that after
three weeks’ training, they would be in a better position to advocate the
need for quality in BTS, handle organizational constraints and optimally utilize
the resources 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
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
emphasized. 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 as well as safety in BTS, including
environmental factors were discussed.
Third week
The week concentrated on applying quality to the main
BTS activities. All aspects of 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 immunohaematology and component
preparation, documentation of activities, process flow and related critical
points, and monitoring and evaluation in the immunohaematology
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 on generating a plan of action with a template. Where quality
systems already existed, some problems were encountered on exactly what the
participants should plan for, but they 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 results revealed significant improvement in the
knowledge of the participants. The pre-course questionnaire was used for
post-course assessment as well. The number of participants who answered more
than 50% questions correctly increased to 93% from 42% as was observed in precourse-assessment.
Valedictory Session
The valedictory session was chaired by Dr Pimol Chiewsilp wherein
participants expressed their gratitude to WHO and the Government of
Bangladesh for arranging the training course. They appreciated the QMP
initiative of WHO and enumerated the benefits that
had accrued to them by attending this training course. Dr Pimol
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.
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