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I've been pretty much off the grid for the past month and thought I would check in. We're driving around Alaska enjoying retirement. Hope all you folks are holding down the fort. I'm sure you are doing a great job.

Sorry for the delay in replying. I am not receiving this newsletter in my email anymore for some reason. Yes we use Cerner. I don't think the baby and mom are linked. If they are, the lab can't see it on our side. We used to put the cord blood workup under the mom's number. That changed when the EMR came along to foul things up. Now the baby is ordered under their own medical record number. We have L/D wrap a mom's chart label sideways on the top of the cord blood and the baby label is placed up and down in the normal way. That way we have the mom's name and number when we are putting in the baby results. We look up the mom to make sure we have a current blood type. If current, we type the mom's type into the results. If it is not current, we get a new specimen. Blood Bank history is not always reliable. Unfortunately, the computer doesn't compare the baby type to the mom type, we have to do that. Talking about the history is not always reliable..... a patient came in to have a baby. The blood type didn't match the history. Had her collected again. It still didn't match her history. Started digging in the computer. Turns out, she had a baby 3 months earlier. (???) Called L/D to see if this was some type of weird OB case. No, it turns out the one that gave birth 3 months earlier had a Medicaid card and it worked so well when she gave birth that she loaned it to her friend. Just a little bit of fraud. Go figure. Never rely on computer history

Mabel, ours is a little different than our emergency release, in that the provider has to sign it prior to issuance of the blood. We even had to create an order in patient keeper, which is our electronic provider ordering system, in case the provider was at home and too lazy to come in and sign it... We also added the comment that the provider needed to discuss the additional risk with the patient. I've attached a copy. HIGH RISK TRANSFUSION FORM.doc

This is what I'm hearing: Now the factory is very tied up with a FDA review. Ark Bio-Medical Canada Corp. reports that they are working with the FDA to resolve this issue. I think it is mostly involved with documentation. There have been no problems related to the methodology with the hundreds of units in place.

This is included on our Emergency Release form. We have a category for testing problems. It includes unidentified antibody of unknown significance, probable cold agglutinin is present and may mask alloantibodies, a nonspecific autoantibody is present and may mask alloantibodies, the crossmatches are incompatible. Finally there is the "other" with an explanation. The physician signs the the statement "I understand the risk involved, but in my opinion, an emergency exists that requires the transfusion of potentially unsafe blood. I release the facility from any and all liabilities attendant to the administration of this blood. The medical director is consulted prior to release of blood in these circumstances. Hope this helps.

I have an incompatible form. It states the nature of the incompatibility and documents the incompatibility and also that the Medical Director or designee has discussed the case with the attending. It is based on my uncrossmatched form's format. Don't have access to it right here and now but should be easy to make one up. Run it by your risk management folks after your Medical Director approves.

If I'd remembered which one, I would have posted it.

My opinion: Why are we recording vital signs? The person recording them has to be able to interpret them in regards to the transfusion taking place. They must be trained to recognize changes that are indicative of a reaction regardless if they are an RN or not.

I agree MaryPDX, but, unless the Reference Laboratory is made aware that the patient has been on Dara, time and reagents can be wasted by trying to sort out the problem by more "traditional" means.