bevydawn

Obviously I understand the idea behind using the corresponding antisera to do the QC, but should I purchase high-priced, rarely used antisera just to prove a patient doesn't have that antibody? The reason we discontinued carrying many of these reagents is because of the insanely high cost of them and the rarity with which they were used. Am I going to have to choose between sending easy specimens to a reference lab to finish the workup just because we don't carry that particular antisera or buying the antisera? Seems like a lose-lose situation.

We have been following the old generalization that blood should be returned within 30 minutes in order for it to not be discarded but I am working to change that. I am debating between the Safe-t-Vue and the Hemotemp II to monitor the temperature of returned blood. Can anyone give me their opinions of either product? I am assuming since we do not send blood out in coolers that we would need to use the Safe-T-Vue 6 also, correct? We also have a smaller sister hospital that we supply blood to and so I would assume when sending them products we would use the 1-10 rule and would then need the Safe-T-Vue 10? Currently we just pack blood in our blood supplier's boxes and follow their packaging recommendations. Thanks for any input!

I have seen on other threads where people are performing weak D testing using IgG gel cards. Being a huge fan of gel I was wondering if someone could give me more information on how you do this. Is it as simple as it sounds? Another concern I have is how could I possibly vaildate this? Although we do many weak D tests on cord bloods and prenatals, we rarely ever see a positive result. It would take us forever to get 20! Any suggestions?

So I want to make sure that I am on the same page here as everyone else. Is everyone saying QC on in-dated panels is, or is not required? And as for using anti-sera as positive control, what if you do not have the anti-sera to the antibody you are trying to rule out? We only keep anti-sera to our most common antibodies. For everything else, we just order antigen typed units from our blood supplier. Could the QC reagents we use for our daily QC (positive screen) be used?

Is anyone doing method comparions twice a year as this CAP questions states is necessary? If so, how many patients do you do each time?

How do different facilities display the new expiration of plasma after it has been thawed? Do you put a sticker with the new expiration somewhere on the bag, just on the transfusion tag,...? Any input is greatly appreciated!

Can anyone tell me how your facility handles when a patient has a suspected transfusion reaction to platelets? What all is included as part of the reaction workup? Thanks!

Does anyone record the lot # of blood bank saline that is in their wash bottles on the actual wash bottle anywhere? There has been some debate at my facility as to whether or not this needed to be done. Thanks.

Can someone tell me how long a vial of Rhogam can be out of Blood Bank on the floor before it is considered expired? We have always treated it the same as our products and given it the 30 minute out rule, but one of my techs decided to read up and check to see where this came from and was unable to find any set amount of time in the package insert. Is 30 minutes the standard?

I had an issue at my facility recently with a tech trying to pull the "I don't know how to, it's been too long" pertaining to performing an elution, so she choose not to do it and to send it to a reference lab (it was an off-shift when I was not there). I came in the next day, completed the workup and called the reference lab to cancel what she had sent. Elutions are something that we do and is included as part of our training for new employees. Because we offer it, obviously we also do the CAP survey. My question is, can anyone offer suggestions for making a competency for all of my techs to do to keep them up on how to do an elution? I rotate my surveys but have around 20 techs that work in blood bank at least a couple of shifts a month and only 4 survery samples a year. Many of them are "lucky" and may not have a patient with a positive DAT that requires an elution for quite sometime so they get out of the groove. I usually use my old surveys for students and new employees. Can anyone tell me how to make a sample for an elution that will work? I will greatly appreciate it (though my techs may not!).

Below is the form letter we always use. Then I attach a copy of our Transfusion Review Criteria and the patient's chart. It's worked for us for years. I think it is worded nicely to keep the doctors from getting all defensive. June 16, 2008 Dear Dr. _______, M.D.: In keeping with JCAHO requirements, the Transfusion Committee regularly reviews blood component transfusions using guidelines and criteria approved by the medical staff. Transfusions that are not within the guidelines are reviewed by the Transfusion Committee. Such transfusions are not necessarily problematic; frequently clinical issues surface at the time of the Transfusion Committee review that indicate the transfusion was entirely appropriate. If there is any question as to the transfusion not meeting guidelines, the transfusing physician is asked to submit a response to justify transfusion. This is the case for ______________(patient), MR #01234567, admit date 06/16/08. Please review and respond as soon as possible so the Transfusion Committee may note adequate justification for transfusion. A copy of the transfusion review criteria and patient chart are enclosed. Sincerely yours, (medical director)

We have two separate anti-D's in our LIS. One is just a regular anti-D for those that have a true antibody and then we have "anti-D with Rhogam" which the doctors can translate to the patient has an anti-D but they have also received Rhogam. This way we are not calling it a true anti-D nor are we saying definitively that it is due to the Rhogam. We then require a footnote to be added documenting when the last vial of rhogam was administered. Once the anti-D is no longer demonstrating, the "anti-D with Rhogam" will allow us to treat this patient as a negative history and allow electronic crossmatch. The plain old response of anti-D will not allow that for those which are true antibodies.

My laboratory Director is wanting me to cut way back on the anti-sera I keep on hand to antigen type. It just isn't cost effective for us to keep $1000 reagent on hand that we may only use one time, if at all before it expires. In the past, whenever we received an antigen-negative unit from our reference lab, we have always confirmed the unit is in fact antigen-negative upon receiving it. Generally we never ordered antigen negative units unless we were unable to find one in our inventory or it was someone with a combination that was going to make it extremely hard to find compatible units. Does other facilities confirm the antigen-negative units when they receive them? If so, how do you get around it when you no longer have the anti-sera?

Can anyone please tell me their interpretation on this question concerning a small hospital blood bank that doesn't "manufacture" any products. My medical director and I are having a slight disagreement on the interpretation. Thank you! **NEW** 10/31/2006 TRM.30950 Phase I N/A YES NO Is there a policy requiring notification of the Centers for Biologics Evaluation and Research according to U.S. federal regulations when a biological product deviation occurs? NOTE: A manufacturer is required to report to the Center for Biologics Evaluation and Research (CBER), Office of Compliance and Biologics Quality (OCBQ) as soon as possible, but not to exceed 45 calendar days from the date of discovery of information reasonably suggesting a reportable event has occurred. In accordance with 21 CFR 606.171, transfusion facilities that are not licensed or registered with FDA are required to report to FDA any deviations or unexpected events associated with manufacturing that may affect the safety, purity or potency of a distributed product. Manufacturing in a transfusion service may include compatibility testing, component preparation, labeling, storage, and distribution of units for transfusion. A BPDR is reportable to CBER if the transfusion service releases a blood product from its control and the error has the potential to effect the safety, potency or purity of the product, even if it is not administered to a patient.

I am just about finished with my CAP checklist but I am confused about this question. It wants to know if the transfusion service has a "mechanism for evaluating and selecting suppliers of critical materials". I'm not really sure how to address this as we have been using the same suppliers since long before I was here. At my last inspection the inspector put it on the recommendation sheet but did not elaborate, she merely just copied the question. I realize that as a recommendation it's not a major concern but fear this years inspector may have problems with it also. I was off on maternity leave so I did not get the oppurtunity to discuss it with her and what she felt this particular question was asking for. Can anyone tell me how they are addressing this question? Thanks for any help!

I have a couple of QC questions, one about traditional daily QC and one for those people using MTS cards to perform ABORh types. We are currently in the process of switching our primary method of performing types from the traditional tube method to the gel method. What do you use as the negative controls for the reverse type? I've never sat down and questioned why we do our current QC the way we do because it has always been the same since I have been here, but for the tube, we only run 6 tubes: A, B, D, D2 (which is with Ortho Confidence System cell 2), A reverse, and B reverse. Everything is positive except the D with confidence cell 1. Trying to incorporate gel type QC has me questioning if this is enough for our current methods(?). Our gel systems specialist sent me a copy of Ortho's QC for the gel cards and it requires group AB plasma known to lack unexpected antibodies. According to their procedure 2 cards are run, one with confidence cell 1 and the confidence antibody solution (results as AB neg) and the other with confidence cell 2 and the AB plasma (results as O pos). I'm curious if this is what other facilities do for their QC and if so, where do you get your AB plasma? (We rarely ever have AB patients!). Anyone who can offer up any words of wisdom would be greatly appreciated!!

Our hospice has just recently started inquiring about doing in-home transfusions. I know this is obviously something that is done, but have never worked somewhere where it has been practiced. Does anyone deal with this at your facility? If so, what are some considerations we need to make before deciding to do this or not to do this? Any insight would be greatly appreciated!

We have used Cerner Millennium since April 2004 and to date, I have not found a way around this. We do have blank emergency tags printed, but those would have to be filled in manually by hand and we prefer not to go this route. So, when we need to emergency release we just have to move quickly and use the time while the printer is printing to pull off our segs and anything else such as that that we need to do. It actually goes pretty quickly, but when it is an emergency it seems like it takes printers forever to print out what you need!

I am just wanting to see if any other facility keeps a log of their autologous or directed units? The facility I work at does but I am not sure if it is just extra paperwork I have that I don't need or if it is something other facilities do also. Currently, any autologous or directed unit we receive is recorded into a binder along with the sheets from our blood supplier telling us whether the patient donated or was unable to. Then, it is recorded whether that unit was discarded or transfused. I'm not sure I understand the point of it, when we should be able to look this up in our computer system, but I want to check before I toss it. Thanks!

Whenever we hire a new tech, I keep a file with all the new techs work in blood bank such as their antibody panels, computer competencies, etc. There is also a blood bank orientation form that goes into their file with the lab director. My question is, does anyone else keep a file on their new employees as I do? If so, do you keep it indefinitely? And what if an employee quits? How long should their file be kept? I have been forced to empty out old filing cabinets and I am trying to decide what is worthy of being saved and what needs tossed. Thanks!

We actually call ours FP24, simply removing the "fresh" and just making it frozen plasma. We did send out a memo to our physicians to let them know there would be a change.

We do use a bedside identification system at my facility. However, only laboratory personnel are trained to use it. Nursing draws patients with ports and our Oncology patients are almost always drawn by the nurse whether they have a port or not because our Cancer Center is an off-site facility. Therefore, our bedside identification system is not 100%. I imagine it would be hard even if nursing was trained to use it as there is frequently issues with connectivity throughout different areas of the hospital as well as other computer type problems encountered on a pretty frequent basis. There is nothing that is going to be a perfect answer to this issue for all hospitals.

Can anyone share how their facility's Transfusion Service yearly competencies are set-up? When I took over as the BB Supervisor here, there was only one competency per year and only the previous supervisor was doing the CAP surveys. I have made a schedule for the surveys so that everyone gets to participate (they are thrilled) and try to do at least one 'dry' and one 'wet' competency per year. However, I was told that I need to come up with a more extensive competency program and was just curious what kinds of things other facilities do as part of their competency checks. Thanks for any input.

Ours was during the very last month and when we went and inspected another facility, it was also within their last month. I don't know if that is how they are all falling or it just worked out that way with us. Also, I'd look more for a Tuesday, Wednesday, or Thursday...

We keep our expired panels for a couple months but they are completely seperated from my in date panels. I keep my current panels in my Reagent Refrigerator and my expired panels in our large lab walk-in refrigerator with big signs on them stating they are for student or rule-out use only. We do have a Blood Bank policy stating that this is how they are to be labeled and all that good stuff. It has satisified our inspection needs thus far.