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When we come up against a warm autoantibody, we will run a saline panel (in addition to enzyme and PEG/LISS) and if the warm autoantibody isn't reactive in saline, we recommend using saline technique for crossmatches. If there is reactivity in the saline panel, we'll do an adsorption, auto or allo depending on transfusion status, to identify any underlying alloantibodies. If we find none, we communicate that back to the submitting lab. We don't provide guidance to crossmatch with adsorbed serum/plasma as that can give the clinician a false sense of security that the crossmatch is compatible; it won't be because of the warm autoantibody.

I agree, however, it opens the door to hospitals considering nurses as satisfactory substitutes for laboratory professionals. It's hard in some markets to hire a MT/MLS/CLS; I'm thinking rural communities in particular. I don't think any manager with laboratory experience would hire a nurse to perform lab work unless they were forced to by administration or desperation. On the flip side, if nurses are considered qualified to manage laboratories, who's to say they wouldn't consider a nurse for employment. Today's my Friday doom and gloom attitude. I have a bad feeling I'm going to wake up pissed for 3.9 more years.

Our previous computer system allowed us to put in the antigen typing QC when testing patients and donor units. It was horribly cumbersome. Our rule here is that we only do QC on antisera once in a 24 hour period, starting at midnight. We could never tell if QC had been done by an earlier shift on a particular antisera so we would do it again. My boss finally relented and went back to paper forms due to cost savings and we also saved tech time and frustration by using a paper form. Are you using a shared excel sheet that all techs use to enter QC? If I was inspecting, I would want to know how you could protect the info already entered, e.g. could someone change the entered information whether intentionally or by accident. In order for things to be added daily, you would need to prove that previously entered info is secure. If it is not secure, how would you know if something was changed on a excel sheet? Could you see a print out of the changes and who made them? I have had files disappear. Yes, our stuff is backed up but you have to tell the IT people when you thought it was deleted so they can look thru the dumped files of the whole system. I have lost files myself by moving them accidently to another file. I freaked out for a period of time. How would you document review within 30 days? You would need to add your electronic signature and date and it couldn't be changed or altered. If there is something wonderful out there, I am interested. Otherwise I will stick with the old fashioned paper forms. They don't take up much room in a file and I don't have to worry about them disappearing into nothing. I think I'll let the next supervisor do something wonderful when I'm gone. There are just too many questions surrounding electronic QC. (I sound like an old fuddy duddy. LOL)

I've had inspectors (usually older ones) that are still not trusting of computers. Which I find very hard to believe in this day and age but...there are certain things I still print and keep just for them. I have fought citations and won, but sometimes you just want them to look at the stuff and keep moving. Much less drama.

The update from ASCP reads: ASCP DISAGREES WITH CMS NURSING POLICY The Centers for Medicare and Medicaid Services formally responded on March 13 to a letter from ASCP, the ASCP Board of Certification (BOC), and the American Society for Clinical Laboratory Science (ASCLS). CMS was responding to a letter, detailed in last month’s ePolicy. ASCP, BOC and ASCLS wrote CMS, urging the Agency to respond in writing that the biological sciences do NOT include nursing. Unfortunately, CMS still is holding fast to its April 1, 2016 announcement that a bachelor’s degree in nursing is equivalent to a degree in biological sciences. Per CLIA, this means that an individual with a bachelor’s degree in nursing can perform high complexity testing and that they do not need to satisfy any clinical training requirement before doing so. It also means that an individual with a nursing degree can qualify to direct a moderate complexity lab or serve as the supervisor of a high complexity laboratory. ASCP disagrees with CMS’ position that a rule is necessary to change the Agency’s policy. ASCP is concerned that a rule change could take years to accomplish and that to protect patient health urgent and timely action is needed to fix this policy. Note that it reiterates the idea from CMS that a B.S. in Nursing is equivalent to a B..S. in biological sciences. In the US, however, I am not sure you will find many institutions that employ Medical Lab Scientists that are not also board certified to work in a clinical lab. I do not see many nurses passing a board exam. So I do not think because CMS decides (arbitrarily, in my opinion) that a B.S. is a B.S. is a B.S., this will result (for now anyway) in a influx of unqualified nurses working in the lab.. And yes, I agree that with the present administration, there is, indeed, a lot of B.S. being generated here. Scott

If doing a test won't change how you will manage the patient, then I think it is seldom worth doing. Besides, it will make your computer unhappy and you know how difficult they can be when they are unhappy.

I would thoroughly agree with exlimey, including his citation of Scott's point - DON'T DO IT!

If there were only a few bacteria or yeast in there I am pretty sure that they would flourish in a 37 C environment. If I was a red cell I would npt want to be mixed with that! Scott

Most typically Screening Cells will be treated. If that screen is negative, then no further action is required (except perhaps antigen-typing the patient). If the DTT-treated screen is positive, it may be necessary to DTT-treat a reagent red cell panel (or selected cells).