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We've been working hard on training for emergency release for all nurses. Every new hire comes into the lab and gets a pep talk from me and our medical director about emergency release, mass transfusion, observing closely for transfusion reaction and patient safety/patient ID. We include emergency release and mass transfusion because these requests can come from almost anywhere before a patient is transferred to the OR or ICU. Included in the discussion is expected turn around times. We give them 5-10 minutes, depending on how many questions are asked. This is in addition to the education they get as a new hire, which includes all of those topics. Annual skills assessment for all nurses also includes these topics. It is starting to pay off. (Ironically, the department that struggles the most with this is the ED.) If we get 'excited' requests for blood 'right now' out of the blue, we also offer uncrossmatched blood and make it clear that the provider has to sign for it. If they take us up on that we know it's serious. How did we get this to happen? - occurrence reports that brought problems to the attention of nursing management and the involvement of Quality.

I have one planned for later this year. The monster would definitely be more fun than weak D.

Exlimey, Sorry to get back to you so late, but I don’t even know that you need my 2 cense now, everyone seemed to cover my thoughts already. Since (little) k is so rare it will not hurt to check for it on your patients and give (little) k negative units to the few (if any) that are negative for the antigen. We do a molecular genotype on our Darzalex patients before they receive their first treatment, so we have their K and k results in hand ready if need be.

Thanks guys, I let this thought go... we wont dont it. Instead we'll warm up a bottle for use in prewarm procedure then toss it after.

I'm afraid that I have to disagree. bbguy.org is not good - IT IS BRILLIANT!

You could enter a patient safety event. This may get someone's attention.

View Printer Configuration ZT410 - I like the "refrigerator light" in this printer! +25.0 DARKNESS 3.0 IPS PRINT SPEED +000 TEAR OFF TEAR OFF PRINT MODE GAP/NOTCH MEDIA TYPE TRANSMISSIVE SENSOR SELECT THERMAL-TRANS. PRINT METHOD 1248 PRINT WIDTH 1222 LABEL LENGTH 41001-97/1408-02598 PRINT HEAD ID 39.0IN 988MM MAXIMUM LENGTH MAINT. OFF EARLY WARNING NOT CONNECTED USB COMM. BIDIRECTIONAL PARALLEL COMM. RS232 SERIAL COMM. 9600 BAUD 8 BITS DATA BITS NONE PARITY XON/XOFF HOST HANDSHAKE NONE PROTOCOL NORMAL MODE COMMUNICATIONS <~> 7EH CONTROL PREFIX <^> 5EH FORMAT PREFIX <,> 2CH DELIMITER CHAR ZPL II ZPL MODE CALIBRATION MEDIA POWER UP CALIBRATION HEAD CLOSE DEFAULT BACKFEED +000 LABEL TOP +0000 LEFT POSITION DISABLED REPRINT MODE 050 WEB SENSOR 080 MEDIA SENSOR 052 RIBBON SENSOR 050 TAKE LABEL 027 MARK SENSOR 027 MARK MED SENSOR 002 TRANS GAIN 017 TRANS BASE 058 TRANS LED 001 RIBBON GAIN 255 MARK GAIN 043 MARK LED DPCSWFXM MODES ENABLED ........ MODES DISABLED 1248 12/MM FULL RESOLUTION 2.0 LINK-OS VERSION V75.19.7Z <- FIRMWARE 1.3 XML SCHEMA 6.5.0 0x0012.0x0047 HARDWARE ID 4096k............R: RAM 65536k...........E: ONBOARD FLASH NONE FORMAT CONVERT FW VERSION IDLE DISPLAY 05/16/17 RTC DATE 19:58 RTC TIME DISABLED ZBI 2.1 ZBI VERSION READY ZBI STATUS 3,075 LABELS NONRESET CNTR 3,075 LABELS RESET CNTR1 3,075 LABELS RESET CNTR2 16,300 IN NONRESET CNTR 16,302 IN RESET CNTR1 16,302 IN RESET CNTR2 41,407 CM NONRESET CNTR 41,407 CM RESET CNTR1 41,407 CM RESET CNTR2 EMPTY SLOT 1 EMPTY SLOT 2 0 MASS STORAGE COUNT 0 HID COUNT OFF USB HOST LOCK OUT

Most programs will not ID the antibody. They are just a tool for the blood banker to use during ID. In my experience, most blood bankers, including SBBers could not tell the difference between an anti-D+C and either an anti-C+G or anti-G, anti-hrB, rather than anti-C+e or anti-hrS, rather than anti-ce (anti-f) IMO (sad but true).

My - how things have changed since this thread started in 2011. We no longer get a paper copy of the Dr's request - they now have to do electronic orders and we built several questions in that make them enter the justification for the transfusion. We do require them to bring a photocopy of the signed page of the Transfusion Consent form every time they pick up a unit. That has lead to 100% compliance with the signed consent form being in the chart (now all scanned in electronically). Even in emergencies - they know to bring a small pickup slip with a patient demographic label on it. For our Emergency Release form - we do eventually require patient demographics so we know who the unit went to. We can release without it, but require it later. As above (from mollyredone) if the patient was on the floor - we could enter electronically for uncrossmatched units because the patient will be in the computer. We are being pushed by the hospitalist physician's to give them uncrossmatched, Emergency Release blood too - very rarely I hope. The one time they thought we weren't "fast enough", we discovered that they did not even know that a STAT Type and Crossmatch takes about an hour and that there is no way to shorten the incubation time. We had to teach them the whole uncrossmatched, emergency release procedure and the correct way to request it and that they would have to sign the Emergency Release form as the requesting physician. We will have to see how that all goes, all of my techs know to offer "uncrossmatched" now if everyone is "excited" about the "blood is taking too long!!" In the past - Emergency Release only went to ER or OR and they were familiar with the procedure - the floor RNs had never even heard of it. Might be worthwhile to find out why the "floors" suddenly need your Red tag units. May be a training issue. Good luck.

Attached is the "pick up" slip I designed for sending blood in the tube system. I stole from many sources, so I won't try to give credit here... Our process is the floor sends the pick up slip through the tube. We send the blood and the slip to them (we use the secure feature in the tube system). They sign the slip and return it to us. If we don't get the signed slip back in 10 minutes, we call to find out what happened to the blood. This is a very new process for us and we are only using it in a very low volume area right now, so I won't make any claims about its success rate. Pick up forms 090110.xls