A note to my colleagues
As you all know we just returned from a trip to Brea, CA, where we trained at the Beckman Coulter Training Center. First and foremost we would like to thank each of you whose schedules were adjusted to accommodate our trip. The class was titled DxC600i Intermediate Operations Training and was chiefly centered on our learning a more advanced level of operations and maintenance for the DxC integrated system. We write this letter in hopes of elucidating what we did on this excursion and ensuring to each of you that we are now resources that you can use. There is much more information than can fit into a single compact letter so, in advance, we must apologize for the length of this message; just know that there is much more that was not included.
Many thought this class was going to be an advanced maintenance or service class, we were wrong. Though we did spend the majority of our time and energy on troubleshooting, we were also introduced to the ability to set up new tests on the system (i.e. hCG5 taking the place of TBhCG), setting up and changing the parameters of certain tests (normal and critical ranges), and learning some of the theory behind specific Access and DxC testing and maintenance. This letter is devoted to the troubleshooting as it was the primary focus of the trip and of the questions we’ve already received, and let’s face it, the other stuff isn’t nearly as exciting nor as common.
This training was not a specific training on a certain number of maintenance/service functions, rather, it was a training session to teach us how to think about troubleshooting in a systematic way. Harry Whatley, our coach for the week, was the best mentor. He disliked the terms trainer and instructor because he wanted to be on the sidelines helping us to learn where to look for a solution not just rote learning specific maintenance tasks. The coach isn’t on the field telling the quarterback where to throw the ball, he’s on the sideline advising the quarterback what to look for and what to expect.
“When in trouble, or in doubt,
run in circles, scream and shout.”
Thinking systematically about troubleshooting really helps to zero in on the problem, and it isn’t a process that only works in the lab. Harry gave us some steps that we, in turn, pass on to you. These steps seem basic and we all do them in our head already but giving them a name and fleshing them out certainly helps you keep a clear head while facing the unknown whether it be the instrument or your car. The steps below are much like the acronym we all already know; Stop, Think, Act, Review.
The Flow of Troubleshooting
- WHAT’S WRONG (Stop)
- QC/Calibration out? Strange results? Bizarre sounds? Smoke? Fire?
- Are there messages on the system? Are there error codes on the results?
- Error message will usually take you to a specific entry in the IFU and provide a solution (press the blue question mark by the event id!)
- HOW BAD IS IT (Think)
- Assess the severity, Do we stop running patients to work on the problem or can it wait while we focus on patient care?
- Is it everything run on the system or just one sample? Is it all your QC or just one? Is it every level of calibrator or just one?
- Was it a Range problem, a Span problem, or a Back-to-Back problem?
- WHAT JUST HAPPENED (Think2)
- Not asking about the problem, asking about a change in the environment around the instrument
- New employee? New reagent pack/lot? New QC lot? Maintenance procedure completed recently? Power outage? Temp/Humidity fluctuation?
- USE RESOURCES (Think3)
- Find out if this problem has happened before and how it was fixed. Ask co-workers, check logs, check the IFU (Instructions for Use) to see if a solution is proposed.
- Ask someone who knows nothing about the system, a fresh perspective may be useful in finding a solution.
- Call service (be ready for the call! have the codes or numbers ready and available before you call)
- MAKE A PLAN (Act)
- Rule out what isn’t the problem. Think about what is unique to the problem and common to something that did work.
- Use the scientific method. Change one variable at a time to discover the culprit.
- Three things are required for a result – Sample, Reagent, Instrument
- Begin with sample (QC and calibrator are considered sample, it is the cheapest and easiest to begin with), then go to reagent, then to instrument
- EVALUATE THE PLAN (Review)
- Was it successful? Yay! Make note for future instances.
- Was it unsuccessful? Oh No, devise a new plan and change a different variable.
Beyond the systematic approach to troubleshooting, drafted above, the concept of common versus unique really seems to be the best way to examine a problem. Below are three scenarios that will, hopefully, explain the idea clearly.
- If you have CK-MB and Trop QC results in which level 1 is ok but level 3 is all out, what’s common? Reagent, Instrument. What’s unique? level 3 sample! Likely a bubble or wrong level poured.
- If you have a Na calibration pass but the CO2 calibration fails, what’s common? The instrument, the calibrator (sample). What’s unique? CO2 reagents. In this scenario we would begin with checking the CO2 reagents.
- If you have Multi-Qual QC levels 1 and 3 running but the lytes and glucose fail on both levels and everything else is fine, what’s common? sample, instrument (is it really? MC vs. CC) Instrument is unique! likely an MC error.
Apart from the instrumentation, we were engrossed in learning about Dr. Arnold Beckman and how he grew the company from such lowly beginnings to being a world leader in innovation and instrumentation. He was born in the year 1900, developed a small invention known as the pH meter, made a better and easier to use spectrophotometer, encountered famous names in history like Linus Pauling, William Shockley, and the Coulter brothers, and then lived until the age of 104! Our coach, Harry, recounted a story of meeting Dr. Beckman at his birthday party at the Brea Training Center in the year 2000; he was still sharp as a tack and witty at the age of 100. If you have some free time read this guy’s wikipedia.
Sadly he has passed away but he left us with a nugget of advice that we would each do well to follow. We close this letter with his seven rules in the hopes that we can internalize them which may, just may, make our lab that much better and the future brighter. Remember, we understand that our going on this trip constitutes our being a resource at your disposal when attending to the DxC600i systems.
Dr. Beckman’s Seven Rules for Success:
1. Maintain absolute integrity at all times.
2. Always do your best; Never do anything half-heartedly.
(Either get into it, or get out of it)
3. Never do anything to harm others.
4. Never do anything for which you’ll be ashamed later.
(This is an important one!)
5. Always strive for excellence – there’s no substitute for it.
6. Practice moderation in all things – including moderation.
(There’s nothing wrong with a little excess once in a while)
7.Don’t take yourself too seriously.