Mustafa HÜZ, Kutsal YÖRÜKOĞLU, Nusret AKPOLAT

PATOLOJİ LABORATUVARINDA MAKROSKOPİ TEKNİKERİNİN ROLÜ

Giriş-Amaç: Makroskopi ünitesinin planı, güvenlik kuralları, fiziki koşulları ve görev yapan sağlık personelinin yetki ve sorumluluk alanları hakkında farklı anlayış ve yaklaşımlar mevcuttur. Entelektüel birikime sahip olan Patoloji laboratuvar yönetimi ve ekosistemi, çoğu zaman öznel sayılabilecek bu yaklaşımlar üzerinden yöntem geliştirmeye çalıştığı görülmektedir. Çalışmanın amacı makroskopi ünitesi faaliyetini farklı boyutlarıyla ele alarak, hasta merkezlilik ve verimlilik ölçeklerinde bir çerçeve oluşturmak, kılavuzlara ve bu alanda az sayılabilecek literatüre katkı sağlamaktır. Gereç-Yöntem: Çalışmanın hareket noktası “Makroskopi ünitesinde çalışan patoloji uzmanı dışındaki sağlık personelinin görev ve sorumluluk alanı ne olmalıdır?” ve “Makroskopi ünitesinin planlama ve yönetiminde rolü nedir?” soruları oldu. Sorulara, ülkemiz ve yabancı sağlık kuruluşlarının dokümanları, yönetmelik, standart belgeleri, akreditasyon kriterleri ve sınırlı sayıdaki literatür taranarak cevap arandı. Yazılı kaynaklara saha gözlemleri de eklenerek bulanan cevaplar üç boyutta sistematik bir yaklaşımla ele alındı. Sonuç: Patoloji uzmanı dışındaki sağlık personelinin makroskopi ünitesinde görev ve sorumluluk alanlarının üç boyutu olduğu değerlendirildi. Bunlar; makroskopi odasının yönetim boyutuna katkısı, hasta güvenliği (numune güvenliği) boyutuna katkısı, makroskopik inceleme ve örnekleme süreci boyutunda verdiği katkı olarak değerlendirildi. İlk iki boyutta iyileştirmeler ve standardizasyon belli bir düzeye ulaşmış olsa da özellikle üçüncü boyutta henüz literatür, doküman ve uygulamada bir standardın, ortak yaklaşım olmadığı söylenebilir. Bu bağlamda etkin, verimli ve hasta odaklı bir ünite için makalede ileri sürülen argümanların tartışılmasını, süreçlerin standardizasyonuna ve dokümante edilmesine katkı vermesini umuyoruz.

Anahtar Kelimeler:

Makroskopi odası, Makroskopi teknikeri, Makroskopi eğitimi, Makroskopi odası yönetimi, Patolog asistanı

The Role Of The Gross Technician İn The Pathology Laboratory

Aims: It can be seen that there are different approaches and understandings about the plan of the macroscopy unit, safety rules, physical conditions, and the authority and responsibility areas of the health personnel. It drew our attention that the method was tried to be determined through these approaches, which can be considered subjective in the pathology ecosystem. Method: The starting point of the study was the following questions: “What should be the duties and responsibilities of the health personnel other than the pathology specialist working in the macroscopy unit? What is its role in the planning and management of the macroscopy unit? These questions were answered by scanning the documents of our country and foreign health institutions, documents containing regulations and standards, accreditation criteria and a limited number of literature. Written sources and field observations were compiled and their answers were handled with a systematic approach in three dimensions. Conclusion: It was evaluated that there are three dimensions of the duties and responsibilities of the health personnel other than the pathology specialist in the macroscopy unit. These; It was evaluated that it contributed to the management of the macroscopic room, patient safety (sample safety) contribution dimension, and contribution to the macroscopic examination and sampling process. Although improvements and standardization have reached a certain level in the first two dimensions, it can be said that there is not yet a common approach in the literature, documents and practice, especially in the third dimension. In this context, we hope that the arguments put forward in the article for an effective, efficient and patient-oriented unit will be discussed and contribute to the standardization and documentation of the processes.

Keywords:

Gross Room, Gross technician, Grossing tecnician training, Macroscopic room management, Pathologist assistant,

PDF

___

1. Sağlık Hizmetleri Genel Müdürlüğü Sağlıkta Kalite, Akreditasyon ve Çalışan Hakları Dairesi Başkanlığı, (2020), SKS Hastane (Sürüm 6.1), Alıntı (07/02/2022) https://shgmkalitedb.saglik.gov.tr/Eklenti/41258/0/skshastane-seti-s-61--09082021pdf.pdf.
2. TC. Sağlık Bakanlığı, (2013), Tıbbi Laboratuvarlar Yönetmeliği, Resmi Gazate, Alıntı (07/01/2022), https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=18933&MevzuatTur=7&MevzuatTertip=5.
3. Tıbbi Atıkların Kontrolü Yönetmeliği, (2017), Resmi Gazete Sayı: 29959, Alıntı (07/02/2022), https://www.resmigazete.gov.tr/eskiler/2017/01/20170125-2.htm.
4. Patoloji Dernekleri Federasyonu, Patoloji Laboratuar Teknikleri Kurs Videoları, Alıntı (07/02/2022), http://www.turkpath.org.tr/index.php.
5. Graban, M., & Toussaint, J. (2018). Lean hospitals: improving quality, patient safety, and employee engagement. Productivity Press.
6. Zarbo R. J. (2012). Creating and sustaining a Lean culture of continuous process improvement. American journal of clinical pathology, 138(3), 321–326.
7. Smith, M. L., Wilkerson, T., Grzybicki, D. M., & Raab, S. S. (2012). The effect of a Lean quality improvement implementation program on surgical pathology specimen accessioning and gross preparation error frequency. American journal of clinical pathology, 138(3), 367–373.
8. Imblum, B., Stern, E., & Fortuna, D. (2021). The Gross-to-Scope Program for Gross Room Personnel: An Innovative Initiative for Providing Case Follow-Up and Education to "Close the Pathology Loop". Academic pathology, 8, 2374289521990781.
9. Yörükoğlu, K., Özer, E., Alptekin, B., & Öcal, C. (2017). Improving Histopathology Laboratory Productivity: Process Consultancy and A3 Problem Solving. Turk patoloji dergisi, 33(1), 47–57.
10. Crowson, A. N., Harvey, M., & Stout, S. (2019). Data warehouse strategies and the modern anatomic pathology laboratory: Quality management, patient safety, and pathology productivity issues and opportunities. Seminars in diagnostic pathology, 36(5), 294–302.
11. Bahensky, J. A., Roe, J., & Bolton, R. (2005). Lean sigma—will it work for healthcare. Journal of Healthcare Information Management, 19(1), 39-44.
12. Grimm, E. E., & Schmidt, R. A. (2009). Reengineered workflow in the anatomic pathology laboratory: costs and benefits. Archives of pathology & laboratory medicine, 133(4), 601–604.
13. Mullay, S., Newell, T.R., Prichard,J., Eastman, S. (2017) Evolving Anatomic Workflow Drives Pathology Design. MedicalLab Management, Cilt 6, 8-10.
14. Karen K. Mortland, Anne C. Belanger, Rodney S. Markin, Patrick J. Maul, Jonathan Y. Richmond, Anne C. Belanger. (2007). Laboratory Design; Approved Guideline-Second Edition. Pennsylvania: Clinical and Laboratory Standards Institute. CLSI document GP18-A2 (ISBN 1-56238-631-X).
15. World Health Organization. (‎2019)‎. Guide for establishing a pathology laboratory in the context of cancer control. World Health Organization. https://apps.who.int/iris/handle/10665/330664. License: CC BY-NC-SA 3.0 IGO.
16. Sağlık Hizmetleri Genel Müdürlüğü Sağlıkta Kalite ve Akreditasyon Daire Başkanlığı, (2020) Sağlıkta Akreditasyon Standartları Laboratuvar Seti v2.1, Alıntı (11/02/2022) https://shgmkalitedb.saglik.gov.tr/Eklenti/39247/0/sas-laboratuvar-setipdf.pdf.
17. Westra, W. H., Hruban, R. H., Phelps, T. H., & Isacson, C. (2003). Surgical pathology dissection: an illustrated guide. Springer Science & Business Media. ISBN 0-387-95559-3.
18. T.C. Sağlık Bakanlığı, Halk Sağlığı, (2019), Laboratuvar Güvenliği El Kitabı, Alıntı (14/01/2022), https://sbu.saglik.gov.tr/Ekutuphane/kitaplar/Labaratuvar_Guvenigi_El_Kitabi.pdf.
19. NHS Estates, (2005), HBN 15-Facilities for pathology services, Department of Health and Social Care, Alıntı (10/01/2022), https://www.england.nhs.uk/wp-content/uploads/2021/05/HBN_15.pdf.
20. International Health Facility Guidelines, (2017), Part B – Health Facility Briefing & Design 145 Laboratory Unit, Alıntı (10/04/2020), http://healthfacilityguidelines.com/ViewPDF/ViewIndexPDF/iHFG_part_b_laboratory_unit.
21. Cree, I. A., Deans, Z., Ligtenberg, M. J., Normanno, N., Edsjö, A., Rouleau, E., Solé, F., Thunnissen, E., Timens, W., Schuuring, E., Dequeker, E., Murray, S., Dietel, M., Groenen, P., Van Krieken, J. H.,. European Society of Pathology Task Force on Quality Assurance in Molecular Pathology, & Royal College of Pathologists (2014). Guidance for laboratories performing molecular pathology for cancer patients. Journal of clinical pathology, 67(11), 923–931.
22. Bauer, D. R., Otter, M., & Chafin, D. R. (2018). A New Paradigm for Tissue Diagnostics: Tools and Techniques to Standardize Tissue Collection, Transport, and Fixation. Current pathobiology reports, 6(2), 135–143.
23. Wolff, A. C., Hammond, M. E. H., Schwartz, J. N., Hagerty, K. L., Allred, D. C., Cote, R. J., ... & Hayes, D. F. (2007). American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. cancer [published correction appears in J Clin Oncol. 2010 Jul 20;28(21):3543]. J Clin Oncol. 2010;28(16):2784-2795.
24. Carr RA, Sanders DS, Stores OP, et al. The Warwick system of prospective workload allocation in cellular pathology--an aid to subspecialisation: a comparison with the Royal College of Pathologists' system. J Clin Pathol. 2006 ve doi:10.1136/jcp., 59(8):835-839.
25. Carr, R. A., Sanders, D. S., Stores, O. P., Smew, F. A., Parkes, M. E., Ross-Gilbertson, V., Chachlani, N., & Simon, J. (2006). The Warwick system of prospective workload allocation in cellular pathology--an aid to subspecialisation: a comparison with the Royal College of Pathologists' system. Journal of clinical pathology, 59(8), 835–839.
26. Meijer, G. A., Oudejans, J. J., Koevoets, J. J., & Meijer, C. J. (2009). Activity-based differentiation of pathologists' workload in surgical pathology. Virchows Archiv : an international journal of pathology, 454(6), 623–628.
27. Bell, W. C., Young, E. S., Billings, P. E., & Grizzle, W. E. (2008). The efficient operation of the surgical pathology gross room. Biotechnic & histochemistry : official publication of the Biological Stain Commission, 83(2), 71–82.
28. Lott, R., Tunnicliffe, J., Sheppard, E., Santiago, J., Hladik, C., Nasim, M., ... & Movahedi-Lankarani, S. (2015). Practical guide to specimen handling in surgical pathology. College of American Pathologists, 1-52.
29. Young, F. Y. (2014). The use of 5S in healthcare services: a literature review. International Journal of Business and Social Science, 5(10).
30. Kanamori, S., Shibanuma, A., & Jimba, M. (2016). Applicability of the 5S management method for quality improvement in health-care facilities: a review. Tropical medicine and health, 44, 21.
31. Griffiths, M., & Gillibrand, R. (2017). Use of key performance indicators in histological dissection. Journal of clinical pathology, 70(12), 1019–1023.
32. Reilly, T. L., & Wright, J. R., Jr (2020). A History of the American Association of Pathologists' Assistants: Creating an Organization, Winning Hearts and Minds, and Building an Invaluable Profession. Academic pathology, 7, 2374289520975158.
33. American Association of Pathologists’ Assistants. AAPA Position on Utilization of Non-Pathologist Grossing Personnel in the Anatomic Pathology Lab. [Çevrimiçi] [Alıntı Tarihi: 25 01 2022.] https://www.pathassist.org/news/558572/AAPA-Position-on-Utilization-of-Non-Pathologist-Grossing-Personnel-in-the-Anatomic-Pathology-Lab.htm.
34. Touro College of Osteopathic Medicine, Pathologists’ Assistant MS Program, Alıntı (10 02 2022), https://tourocom.touro.edu/academics/pathologists-assistant/.
35. Drexel University, College of Medicine, The Pathologists' Assistant (PathA) about the program, Alıntı (10 02 2022), https://drexel.edu/medicine/academics/graduate-school/pathologists-assistant-patha/about-the-program/.
36. Bortesi, M., Martino, V., Marchetti, M., Cavazza, A., Gardini, G., Zanetti, E., Bassi, M. C., Ghirotto, L., Costantini, M., & Piana, S. (2018). Pathologist's assistant (PathA) and his/her role in the surgical pathology department: a systematic review and a narrative synthesis. Virchows Archiv : an international journal of pathology, 472(6), 1041–1054.
37. Grzybicki, D. M., Galvis, C. O., & Raab, S. S. (1999). The usefulness of pathologists' assistants. American journal of clinical pathology, 112(5), 619–626.
38. Clinical Laboratory Improvement Advisory Committee (CLIAC), CLIA Personnel Regulatıons Workgroup Summary Report, Alıntı (15/02/2022) https://www.cdc.gov/cliac/docs/addenda/cliac0419/7a_Personnel_Workgroup_Report.pdf.
39. College of American Pathologists, (2017), Anatomic Pathology Checklist-Accreditation Programs, Alıntı (15 01 2022), https://elss.cap.org/elss/ShowProperty?nodePath=/UCMCON/Contribution%20Folders/DctmContent/education/OnlineCourseContent/2017/LAP-TLTM/checklists/cl-anp.pdf.
40. University of Wisconsin Hospital and Clinics, Alıntı (15/01/2022) https://www.uwhealth.org/files-directory/position-descriptions/laboratory/pathology.grossing.technician.510044.pdf.
41. Marmara Üniversitesi, Patoloji Laboratuvar Teknikleri, Alıntı (15/02/2022), http://ptl.shmyo.marmara.edu.tr/genel-bilgiler.
42. Dimenstein, I. B. (2015). Grossing histotechnologist training. Journal of Histotechnology, 38(2), 33-38.
43. Grealish, M., Wolff, A., Eastwood, J., Lee, D., & PA Section of the CAP-ACP Executive Committee (2017). Standardisation of practice for Canadian pathologists' assistants. Journal of clinical pathology, 70(12), 998–1000.
44. CAP Personnel Requirements by Testing Complexity, Alıntı (15/01/2022) https://documents.cap.org/documents/2016-07-18-personnel-evaluation-roster-personnel-requirements-test-complexity.pdf.
45. Vikipedi, Alıntı (15 02 2022), https://tr.wikipedia.org/wiki/G%C3%B6zetim#cite_note-1.
46. Nakhleh, R. E. (2006). What is quality in surgical pathology?. Journal of clinical pathology, 59(7), 669-672.
47. Kuijpers, C. C., van Slooten, H. J., Schreurs, W. H., Moormann, G. R., Abtahi, M. A., Slappendel, A., Cliteur, V., van Diest, P. J., & Jiwa, N. M. (2013). Better retrieval of lymph nodes in colorectal resection specimens by pathologists' assistants. Journal of clinical pathology, 66(1), 18–23.
48.Yüksek Öğretim Kurulu (2021) Yükseköğretimde Uygulamalı Eğitimler Çerçeve Yönetmeliği, Resmî Gazete, Alıntı (25/02/2022), https://www.resmigazete.gov.tr/eskiler/2021/06/20210617-2.htm.
49. TC. Sağlık Bakanlığı, (2014), Sağlık Meslek Mensupları İle Sağlık Hizmetlerinde Çalışan Diğer Meslek Mensuplarının İş Ve Görev Tanımlarına Dair Yönetmelik. Resmî Gazete, Sayısı:29007, Mevzuat Bilgi Sistemi, Alıntı (15 02 2022), https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=19696&MevzuatTur=7&MevzuatTertip=5.