title: Development and operation of a quality assurance system for deviations from standard operating procedures in a clinical cell therapy laboratory.
abstract: BACKGROUND
  Errors and accidents, or deviations from standard operating procedures, other policy, or regulations must be documented and reviewed, with corrective actions taken to assure quality performance in a cellular therapy laboratory. Though expectations and guidance for deviation management exist, a description of the framework for the development of such a program is lacking in the literature. Here we describe our deviation management program, which uses a Microsoft Access database and Microsoft Excel to analyze deviations and notable events, facilitating quality assurance (QA) functions and ongoing process improvement.
  
  
  METHODS
  Data is stored in a Microsoft Access database with an assignment to one of six deviation type categories. Deviation events are evaluated for potential impact on patient and product, and impact scores for each are determined using a 0- 4 grading scale. An immediate investigation occurs, and corrective actions are taken to prevent future similar events from taking place. Additionally, deviation data is collectively analyzed on a quarterly basis using Microsoft Excel, to identify recurring events or developing trends.
  
  
  RESULTS
  Between January 1, 2001 and December 31, 2001 over 2500 products were processed at our laboratory. During this time period, 335 deviations and notable events occurred, affecting 385 products and/or patients. Deviations within the 'technical error' category were most common (37%). Thirteen percent of deviations had a patient and/or a product impact score > or = 2, a score indicating, at a minimum, potentially affected patient outcome or moderate effect upon product quality.
  
  
  CONCLUSIONS
  Real-time analysis and quarterly review of deviations using our deviation management program allows for identification and correction of deviations. Monitoring of deviation trends allows for process improvement and overall successful functioning of the QA program in the cell therapy laboratory. Our deviation management program could serve as a model for other laboratories in need of such a program.
authors.affiliation: Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine University of Minnesota Medical School, Minneapolis, MN 55455, USA.
authors.forename: D
authors.initials: D
authors.lastname: McKenna
authors.forename: D
authors.initials: D
authors.lastname: Kadidlo
authors.forename: D
authors.initials: D
authors.lastname: Sumstad
authors.forename: J
authors.initials: J
authors.lastname: McCullough
mesh_terms: D064987:Cell- and Tissue-Based Therapy / Q000592:standards*; D002624:Chemistry, Clinical / Q000592:standards; D002984:Clinical Laboratory Information Systems / Q000295:instrumentation; D019411:Clinical Laboratory Techniques / Q000592:standards*; D003199:Computer Systems; D001330:Electronic Data Processing / Q000379:methods; D006801:Humans; D007753:Laboratories / Q000592:standards; D017056:Medical Laboratory Personnel / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D011786:Quality Control; D012984:Software; D013597:Systems Analysis; D017749:Total Quality Management / Q000379:methods