ltechlin
ltechlin's Achievements
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ltechlin reacted to a post in a topic:
On call phone calls
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ltechlin reacted to a post in a topic:
On call phone calls
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How do you verify that this scale is taking temperatures accurately? Do you have to send it out annually?
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For a LISS crossmatch, we bill for the incubation of crossmatch. We also bill for the AHG charge. For a gel crossmatch, we bill the immediate spin and the AHG.
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ltechlin reacted to a post in a topic:
Emergency Cooler Protocols
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One of our trauma surgeons would like us to do what your facility is doing. The idea of the transfusionist putting the name on the transfusion tags haven't been brought up as a possibility. The surgeon wants us to head to the ER and then get some chart labels from the secretary, label the units and then bring them into the trauma room. We have resisted, there is no work space readily available and I just see it as a place for a tech to make a mistake under pressure. Interesting route your facility took. How reliable are the transfusionists/nurses with getting the patient information on the transfusion tags? Is it required that they write the patient information on the transfusion tag prior to transfusion or can they do it after? We aren't that big of a facility, but we are a level 2 trauma center and occasionally have more than one patient that requires an uncrossmatched cooler in the ER at the same time. Relying on our nurses to label the units would make me a little nervous. R1R2, some months we are at 90% unused as well. It is a bit better now that they have classified our traumas into two different groups. One group always gets a cooler, with the other it isn't automatic. They still need to call the blood bank with patient name (J. Doe) and MR# before we bring a cooler down. Yes, a lot of wasted work, but it keeps the staff in practice for the real deal.
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First a question for you, am I understanding right that you may bring a cooler down without having patient ID on each unit? Do you put patient ID on each unit down in the emergency department? Our trauma surgeons would like us to do this, but we haven't agreed. In response to your question, at our facility we are transitioning from a paper authorization form for uncrossmatched to electronic documentation. The electronic documentation for authorization is part of the uncrossmatched blood, Initial Resuscitation Cooler (2 O neg LRC / 2 AB FFP) and MTP order. We many more requests for the Initial Resuscitation Cooler than just uncrossmatched or MTP. Probably 9 times out of 10 nothing is used out of the IR cooler. Our ER also thought they didn't have to order it if it wasn't used. If we brought the cooler down, we want it ordered so we have record of the authorization. Although the doctors are suppose to put through the order, we have increased our success at having the IR Cooler put through when we got the rank and file staff involved and explained why we needed the order. They have instant access to the doctors and have helped our cause. Note, these three orders are simply for the product, they are not orders to transfuse the products. Our trauma services department is also looking for the MTP order in the hospital computer for their tracking purposes. That helped get the docs on board to get it ordered. It isn't always timely, but usually within 20 minutes of the request for the products. Same thing with the IR Cooler order, we usually see it 10-15 minutes after we get a phone call to bring the cooler down. I credit the secretaries and nurses for prompt phone calls!
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I'm answering this from home, so I don't have a copy of the form, but it basically is as follows: I _____________________ take responsibility for identifying the patient and changing the blood bank armband from ________________ to __________________. There is also a place for date and a patient sticker (name, MR # and DOB). We use this form for name changes (Doe to actual name) or if a band needs to be removed (to place an IV). Our hospital policy dictates that a John Doe isn't changed to his actual name in any computer system until he is admitted to an inpatient bed. This prevents us from dealing with a name change during a MTP in ER or OR. It was a battle that crops back up every 5 years or so, but nursing is good at following this. Policy also dictates that nursing calls us as soon as they learn the patients' true identity so that we can do a history search, but we don't have as much success with that. When we get an Armband Change Form, we update the armband (and name/DOB if needed) in our computer, on the specimen and reprint tags on any crossmatched products. If we haven't had a chance to go change the BB armband, but nursing has updated the Doe name, we hand write in the true identity name on the transfusion tag, next to the Doe. This rarely happens. Merges of MR #s for a patient (a newly issued Doe MR# with a historic true identity MR#) doesn't happen until the patient is discharged. This way we always have two identifiers, the MR# and Blood Bank armband number that is consistent.
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I saw a comment that you used HCLL. We are starting a upgrade project next week and there are some changes I would like to make. How do you document patient history check when receiving a new sample or order? Is there a way you can do it in the patient module? Or do you have it as another test bar? We are still using paper and I'm so ready to be done with that. Any other advice you have would be appreciated. This is my first blood bank supervisor job and I'm eight months in!
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Sorry Elizabeth, I don't sign on to pathlabtalk as often as I should and just saw your message.
I have to admit that we may get dinged by an inspector one day on documenting patient history check. Until 2 years ago, we used a "patient card" to document reactions and then entered everything into HCLL when all of our testing was done. This card had a spot to either put an X or the year we last did testing on the patient. This was our documentation of history check. The card was a crutch and staff was reluctant to give it up. Two years ago we went semi-paperless and only used the cards for complex patients... anyone with an antibody, discrepancy, antibody crossmatch, DAT, antigen typings, etc. A few months back, we dropped using the cards for everyone except the most complex patients, DATs and antigen typings. We don't document patient history check in HCLL, but it is written in policy that it is done. We train that the first time a tech holds a particular patient's tube in their hand that they must search for history. We also have that as a bullet point of something we watch for when doing our direct observation competency annually.
All that being said, we have been through two Joint Commission and one FDA inspection since we stopped documenting history search on every patient and haven't had it mentioned... yet. I have considered having the techs add a comment when they check in the specimen, but you know they won't put it on every time and I hate policing something that is often going to be forgotten.
Myself, I am blood bank coordinator. There is a lab manager that oversees blood bank as well as chem and histo. We have a good working relationship and she pretty much will go with whatever I and our two unofficial lead techs advise. I was a supervisor over our chemistry department back in the day, but got out when I was tired of the HR end of things as well as the hospital politics. I am much happier having a hand in the department at the coordinator level without the other luggage that comes along with being a manager. Good luck with your supervisor position!
Do you use electronic crossmatch on HCLL? We were going through the validation process, but our tech that does the validating wasn't happy with an item and we have tabled it for now. Mediware tells her they are aware of the problem but there is no fix at this time. Makes me sad.
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ltechlin reacted to a post in a topic:
O neg with Ant-c?
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What do you do with thawed FFP (right out of the water bath) and platelets?
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O neg with Ant-c?
ltechlin replied to Barb Thompson's topic in Immunohematology Reference Laboratories
Does your report give a transfusion recommendation? -
We have used Rhophylac for years as well. We don't have an OB department, so it is only being used in the emergency room. Even with this low usage, I only have had one phone call where the nurse was having trouble with figuring out how to use the device. By the time I walked down to the ER, she had it figured out.
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How are name changes handled in your facility? Handled by registration and lab is notified via computer system. Does your policy indicate that the compatibility label always match the identifiers on your specimen? Specimen, patient armbands (hospital and blood bank) and Transfusion Record Form attached to blood product must match Does a name change always require a redraw? No, we allow an Armband Change Form to be completed by the person changing the blood bank armband. From this we update the specimen and Transfusion Record Form on the unit. Of course, we are checking the information sent from the registration department's computer system to ensure that the information is correct. Does your system process name changes automatically? Not in the blood bank. General Lab, yes, it is automatic. If you use an additional Blood Bank band, do you require a redraw so the Blood Bank band identifiers match the patient identification band after the name change? No, we use the Armband Change Form to maintain an audit trail. We only redraw the patient if the Blood Bank armband has been removed without utilizing the Armband Change Form. Is your policy the same with Trauma? Yes, with the exception that hospital policy states that name changes are not done until the patient is admitted to a floor, discharged or transferred to another facility. This way we shouldn't be having to deal with a name change until after the patient is stable and the urgent need for blood has passed.
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Soft vs Mediware HCLL
ltechlin replied to B Postive's topic in Computer Systems / Software / ISBT128
We have used HCLL for about 10 years. Prior to that we had Mediware's Hemocare product, so I can't compare it to another vendor's product. As with all computer systems, there are always a few things you'd like to see changed, but overall we really like HCLL. It does a good job for us! We didn't have the time or manpower to interface results from HCLL to our hospital computer system 10 years ago, but will be doing that later this year. We also do not have their stem cell software. If you have some specific questions, feel free to ask. -
Changing FFP (with 24hr exp) to thawed FFP with 5 day exp
ltechlin replied to aj2018's topic in Transfusion Services
We label using a digitrax printer as well. Love it! We have consulted with iccbba.org for help in choosing the correct thawed code when we have had a question. If you don't find the answer to a specific question, the people at ICCBBA will help you out over the telephone or email. -
Typenex Barcode Plus Condendsed Armband
ltechlin replied to ltechlin's topic in Transfusion Services
Thanks cthherbal! -
Typenex Barcode Plus Condendsed Armband
ltechlin replied to ltechlin's topic in Transfusion Services
I'd be interested in exactly what product this is! Do you have an item # or name of the product? -
Typenex Barcode Plus Condendsed Armband
ltechlin replied to ltechlin's topic in Transfusion Services
The locks look pretty slick! Great that your facilities will purchase them. Thanks for the information. Our nurses can currently scan medications at the bedside before they administer them, we'd like to get there with blood products as well.
