In this case study, the transfusion service at Hospital B lacked formal, documented  training and competency assessment programs. The part-time technologist on duty had not been trained in the new inter-hospital transport procedures and had never undergone formal, documented competency assessment.

1. What changes to the training and competency assessment system at Hospital B's transfusion service would you recommend?

   • develop, maintain, and document both a training program and a formal competency assessment program for all of its staff

   • assess staff competency following training and then at regular intervals
   • implement SOPs only after staff training is complete
   • assess effectiveness of its training program at least annually

Training and competency assessment programs do not exist. As required by quality systems and government regulations,  the transfusion service must:

1. Do part-time staff need the same training as full-time staff?

   Yes. Training and competency assessment is required for all staff, regardless of whether they are fulltime, part-time, or casual.

2. Do staff have a responsibility to refuse to perform duties for which they have not been trained?

   This question is easy in theory but difficult in practice. In refusing, staff may experience workplace discipline, a deteriorating environment,  and possible loss of job. On the other hand, performing tasks for which training has not been provided creates a safety issue for patients, an ethical dilemma for healthcare staff, and possible liability concerns. For example, see this article about refusing an assignment because of qualifications:

   • Nursing responsibility and the law
   • Standards of practice for MLTs (ACMLT); An excerpt:
     • Standard 5: Ethics. The MLT practices in accordance with the ethical guidelines of the profession.
       Indicators: To apply Standard 5, each MLT:
       
       1. practices within their level of competence
       2. recognizes their knowledge or skill limitations and, when necessary, seeks the help, guidance and expertise of others
       3. reports unsafe practice or professional misconduct to the ACMLT

   Given that patient safety must be the paramount issue for healthcare professionals, staff do have a responsibility to refuse to perform duties for which they have not been trained.