bevydawn

We have a relatively new open heart program at the facility that I work so we havent yet gotten this down to a fine art. But I can say that they dont require us to have platelets on hand unless there is something that makes the dr think it will be necessary such as Plavix being administered. We have several surgeries that go really well and use no platelets and then we may have one go bad. So for the next few cases they will over order and we lose a bunch and then they calm down and quit ordering them. One weekend in December we lost 6! Of course we have a newly opened Cancer Center so we can use some that the open hearts dont use on our oncology patients and as the cancer center gets more patients that will probably be even more true. But all together I would estimate our wastage at around 40%.

We don't keep a computer problem log; if we have problems with our computer system, we just refer it to our LIS people who either resolve the issue, educate us on our mistakes, or contact Cerner to get the problem resolved.

The facility that I work at switched to Cerner Millennium from Classic last April (2004). When they did the switch over, they took any patient history from 01-01-90 on and put it in Millenium, which here includes aborh. I agree with the comment that dispense is harder, although I dont know that I would say harder but it doesnt seem to flow as nicely, a little more time consuming. I too would rather memorize acronyms rather than using the mouse constantly, but there are a lot of little shortcuts you can learn to minimize use of the mouse which helps out a lot! The icons dont bother me too much, I have all mine large (you can choose large or small icons) just to minimize my clicking on the wrong thing because the little ones are definitely little. Plus you can arrange them to your personal desire, everyones is what suits that particular person. And as far as them crowding the screen, thats not really an issue for me because every icon you click on opens up a new window. The one thing I really like in BB is you can do multiple different things at once. All you have to do is open up different folders within the same window and click between the different folders so you can be doing a type on a couple people, a screen on a couple more, and a crossmatch, a cord blood, and confirm typing all on the same screen, just different folders. One bad thing about BB...its really easy to get results hung up or units "locked", especially when you're first learning and then you have to waste time forcing results out or unlocking units. And of course there's always my extending preadmit specimen expirations issue that I am having right now, but hopefully I figure that out in the near future. I hope I havent confused anyone too much, I just think there are good and bad points as which is probably true with any system.

Well I have discussed this at great length with our LIS specialist who does all the blood banking/computer things. She says the problem is that anything the computer recognizes as a crossmatch or screen it will give the same expiration date, that there is no way to differentiate between a preadmit and a typical inpatient type and cross. She says that even if we build a different test code for a preadmit type and screen or type and cross that the computer will automatically give it the general 3 day expiration, or if we were to extend the expiration it would extend ALL specimens expiration. Surely there has to be a more simple way around this out there somewhere...?!?!?

Currently at the facility that I work, we use the general rule of all specimens are only good for 3 days. I would like to extend preadmit specimens to 14 days given the patient signs the statement of no transfusions, no pregnancies. My problem is with our computer system. We use Cerner Millenium and when we have tried doing this in the training environment, the only way we can get it to work is to over-ride again and again which I think could be confusing to some people. Does anyone else using Cerner have any ideas about how to make this process flow a little better?

We do not currently screen units for C or E when a patient has anti-D. Giving Rh negative units should decrease your odds of getting a C or E positive unit and we just take our chances of the patient developing the C or E. And that has only happened very few times over the past several years. So obviously we do not screen units for patients that have a passively acquired anti-D. All we do for them is an AHG crossmatch until the anti-D is no longer present.

I mean if the forward and reverse type do not match. I get phone calls all hours of the day from techs having trouble with types and we have a technical manual right beside our procedure manual. However, if its not in our SOP's they wont do it without consulting me first. That is why I would like to have some kind of something in our SOPs to give them some guidance.

I was reviewing and updating our policy and procedure manual and noticed there is nothing in there to guide techs in the event of an ABO discrepancy. Does anyone else have a policy and/or procedure for techs to refer to for this and is it more informative or procedural??

Our L&D collects our cord bloods in EDTA and we've never heard any complaints.

I would like to get some feedback as to what kind of workup other facilities require when a transfusion reaction is suspected. Currently we do a full workup on all possible reactions but I would like to go to doing only the clerical check and pre- and post-DATs unless something in those shows a reason to do the full workup. Can anyone tell me what procedures and guidelines you follow??

How does not testing OB patients for weak D affect how and when fetalscreens are done and the results? We routinely test all our OBs and cord bloods for weak D and the only reason we are still doing them on OBs is because the higher-ups feel that it would cause too many problems with the Fetal Screen.

I agree with everything everyone said about my previous question about unit DATs, but here's my problem...the old BB supervisor (who still works here) says that it is required because in the product insert of antigens tested by an indirect method it states that they can not be accurately tested on blood with a positive DAT. Because I am the new guy here, I have to prove that my argument holds merit and that we are wasting our time, that just because that is stated doesnt mean it is a requirement. Any suggestions or words of wisdom?!?

I just took over as Blood Bank Supervisor in a small hospital where they have the "if its not broke, dont fix it" mentality. However, I would like to make some changes. One thing I would really like to change is unit DATs. They require them on all donor units that are to have an indirect antigen test performed because it may cause a false positive. I have worked at several other facilities and have never had to do this anywhere but here. Can I get some input about whether this is done at other facilities? I cant find any literature about this in any books, except of course, in our SOPs! Thanks for any help!!