Carrie Easley

And we do aliquots in syringes and bags.  We also reconstitute whole blood to a specified crit.

We are a pediatric hospital with about 330 beds.  That does not include the bascinets.  We have a very active Heme/Onc program, as well as CV and neonatology, and Level 1 trauma service.  Those are the services that use the most blood.  
We do stem cell, heart, liver, and kidney transplants.

Thanks, Brenda!  I feel the same way.  No matter how good a procedure, you have to understand the process enough to open it.

How do we survive without a BBIS? Well, it takes a boatload of paperwork and even more time to deal with the paperwork. We've never had a BBIS, so we don't truly know what we're missing (though I have a vivid imagination, did work with a BBIS validation years ago, and I am soooo looking forward to getting SafeTrace Tx up and going - I have been the squeaky wheel for years pushing for a system and they finally said YES  ).
We've given as many as a thousand units of red cells a year with paper records, though we are currently down to 700ish with patient blood management taking effect. I track products with an Access data base and we had a DOS data base before that . We use report forms built into our LIS - the LIS we are using now and what we were previously using. These are strictly reports, nothing more. All other documentation of testing, etc. is on paper. Prior to that (and not so many years ago) we typed our reports on a typewriter - I kid you not! Our entries in the LIS are made manually from drop down boxes, a minimal number of free text boxes and using barcode scanners for DINs and product codes. We have rules in the LIS to remind staff about required testing. All entries are verified by a second tech and are further reviewed at a later point by myself or a designee. Old school, but it works. The pertinent information passes from our LIS to EPIC, so BPAM works. I wish we were going to use the SafeTrace blood admin module, but that decision was made for us.
I stress to every nurse that I talk with about patient ID that the information that BPAM is checking is a manual entry, so is not a guarantee of anything. If something doesn't look right, they are instructed to stop instantly and contact us. The 2 person bedside check of armband and unit tag/bag information that we were doing prior to BPAM is still critical. And our medical director and I meet every new nursing hire for a pep talk in Blood Bank about patient ID, transfusion safety and MTP/emergency release.
We pass Joint Commission, CLIA and CAP inspections w/o issue and transfuse our patients safely because I am a well known, absolute DRAGON about following procedures and doing things right! (Did I mention that I can't wait to get SafeTrace up and running ??? )

Folks, please read this carefully, I suggest he is saying it is acceptable to call him Malcolm, as compared to Mr. Needs - hence informal.  He did not suggest he would find it acceptable to refer to him as a tosser, wanker, or some other (really cool sounding British) pejorative. 
I need to move to England, if only for a short time.  American English is so boring.

You are by no means alone John, but (I THINK) most of these acronyms are to do with Information Technology (IT) than actual blood confusion!

Wow, out of the business for a couple of years and I don't have a clue what most of the acronyms in this thread mean!!   

Worse than last year when I posted. Pretty dismal outlook in NY State.

It's been years since I took my SBB exam but......
Read AABB Technical Manual cover to cover
Read AABB Standards cover to cover - twice
Make sure you can do the math: RhoGAM dose calculation, FFP and Cryo dose calculation, etc etc - anything you come across in the Tech Manual that includes calculations, make sure you can do them.
Be very familiar with donor standards.
ABO discrepancies
Antibody ID - what is clinically significant, what is not and you may have a question or two or three asking you to ID an antibody from a workup they provide for you.
Maternal/Neonate - which antibodies can cause HDNF, exchange transfusion (unit selection, testing, etc), RhoGAM
Coag - coag cascade and treatment with FFP, Cryo, Factors
Modern Blood Banking and Transfusion Practices - Denise Harmening --- this is an excellent book, I would recommend reading it cover to cover as well.
Good Luck!
 
 
 

I too am the only dedicated Blood Banker .  I have found it more and more challenging as staff is quickly retiring and being replaced with young grad generalists.  I try to reinforce the theory behind all of the blood bank tests in order for them to grasp the whole picture for trouble shooting those patient's that are the exceptions to the rules but there is only so much new grads can absorb during training.  They are learning our processes, a new computer system, and often have not been in Blood Bank for over a year and that was only for a rotation during school.    It takes years to become a seasoned tech. Between training new techs, 6 month competencies, annual competencies, meeting changing standards, and dealing with shortages I find it a little overwhelming. Unfortunately I believe this is the new Norm and agree we are in a staffing crisis which needs addressed now.

I'm the only dedicated blood banker at my facility. All our new hires are generalists, almost all of them are fresh grads or have minimal blood bank experience at much smaller facilities. They all have to be competent for antibody ID and corresponding antigen negative crossmatches, emergency release, mass transfusion, neonate transfusion, basic troubleshooting for the instrument, etc. My training period for staff is far longer than anywhere else in our lab and my competency assessments are a very lengthy ordeal to ensure that all staff members are performing at an acceptable level. I spend a lot of time reinforcing the concept of 'patient safety comes first'. I send out a lot of informational emails to reinforce policy and procedure. I work one-on-one with staff members if they have questions or problems. Automation and blood bank information systems help when you are dealing with non-dedicated staff to standardize and lock down your processes.  You've got to have excellent SOPs that have exhaustive detail. Hiring smart, motivated people helps. I make myself available, even when I'm on vacation.
BUT... doing all of that is just making it work with what you've got. It expects a great deal from your generalists. It doesn't solve the problem. It's an enormous problem and it's not going to get better unless something changes. Training programs are closing every year. The average age of blood bankers is increasing. Our profession is invisible to the world at large. Smart people can get better paying (and maybe less stressful) jobs in other areas of healthcare and other occupations. Administrations everywhere are expending a lot of energy and financial resources to attract and retain nursing staff. Do that do that for lab staff at your facility? Sigh!

I'm at a 220 bed hospital, we have dedicated Transfusion Medicine technologists on all shifts. We have hired new grads, they are able to work successfully alone with proper training and the willingness to learn on their part. 

We are a very popular place to move (Central Oregon) and we are having trouble finding people to hire.  To answer the original question, we have one dedicated first shift BBer and everyone else is a generalist.  We have capped the number of people trained in BB (about 24) so that they get enough shifts in here to stay competent.  They do pretty well.  We have evening shift coordinators who are a bit more advanced and staff can always call me.

I am a generalist in a 270 bed trauma 2 hospital.  The tech shortage is bad all over.  If you are in a system that cannot find some way to attract new graduates (wages), then you are having real trouble.  We can't hire people, in spite of the fact that we have a local college CLS program nearby that puts out about 15 graduates a year.  We can' t even keep the students that have interned here!
This shortage has been developing over years.  We have been begging the administration here to wake up and do something, because its starting to get really bad. Unlike other times when we've had staffing shortages (been here for 30 years), there is no relief in sight. 
According to various articles in journals over the years, in the US we are seeing about 15000 openings a year with only about 6000 graduates.  There will have to be some drastic changes to many labs to provide appropriate patient care.  The changes have to be made NOW, they should have been done here years ago.  
Scott

Reviving a dead post....
I am growing increasingly concerned about staffing shortages in the Blood Bank.  I'm in Texas and most of our good techs are aging out of the field.  It is almost impossible to find and experienced blood bankers that are not already working full time somewhere.  Filling positions with techs that have blood bank or micro experience is HARD!  New techs are not staying in the field and lack the experience to work alone.  At 51, I am at least 10 years younger than blood bank staff on all shifts and am worried about filling those roles over the next 5-10 years.  What are your experiences?

We match Rh/K/Fya for all peds SS patients and all adult SS patients who have made at least a single RBC alloantibody.  We make every effort to send warm autos for RBC genotyping and match everything we reasonably can.  Our blood supplier maintains an online antibody registry for their customers, so it helps with continuity of care if people hospital hop (assuming all customers utilize it).

Dear God, you have my deepest sympathy. 
1.  Push the company to give details on their benchmark standards and where they come from.  Chances are, you are not in the same boat.  We had a similar problem here because our Micro and BB staffing for the weekends did not meet corporate standards (desires), but we were unable to cut staff because of the physical layout of our facility and the distance between the departments. 
2.  Your situation matches one hospital I know of, if you could contact them - University Medical Center, El Paso, TX.  The Blood Bank is in the Main hospital and the main lab is way across the parking lot.  They are a level 1 trauma center and a big surgical hospital, but the NICU is in a separate hospital next to them and did have it's own Blood Bank staff.
3.  Do you have current FTE numbers that justify your current staffing?  What is the difference in the "factors" in the staffing equations that are being used that lead to this new company coming up with their figures vs. your current FTE figures?
Good luck.  Patient safety arguments sometimes sway Administrations when nothing else will.  If you can make a case for how dangerous it is for the staff of a Trauma center to be too little, too late - maybe it could help.
 

Yes.  Our OR nurses document every four hours.  If the cooler temp reaches 6 degrees C, they call and request a new cooler with fresh blocks.  We have quite a few cases that easily exceed four hours.  We also put temp indicator stickers on each unit to make sure they weren’t left out of the cooler.  We validated at RT, Trauma Bay (warm extreme), and CV surgery suite (cold extreme).  We did those for both maximum (6 units) and minimum (1 unit).  Message me if you need more specifics!

Yes.  Our OR nurses document every four hours.  If the cooler temp reaches 6 degrees C, they call and request a new cooler with fresh blocks.  We have quite a few cases that easily exceed four hours.  We also put temp indicator stickers on each unit to make sure they weren’t left out of the cooler.  We validated at RT, Trauma Bay (warm extreme), and CV surgery suite (cold extreme).  We did those for both maximum (6 units) and minimum (1 unit).  Message me if you need more specifics!

Our fetal bleed screen kit (Immucor Rapid Screen) is only approved for postpartum testing with known infant type.  Antenatal bleeds and losses > 20 weeks require a KB in our facility.  Which screening kit do you use?

I may be wrong, but isn’t washing the reason for your 24-hour outdate.  Irradiation itself doesn’t abbreviate to 24 hours.

I may be wrong, but isn’t washing the reason for your 24-hour outdate.  Irradiation itself doesn’t abbreviate to 24 hours.

We don’t charge.

We would issue with 15 minutes left on the type and screen.  And, per the AABB's 2010 Ask the FDA and CLIA Transcript:
Question 34: The Circular of Information, for the Use of Human Blood and Blood Components, in the Instructions for Use section, item number 13 states: "Transfusion should be started before component expiration and (be) completed within 4 hours." What is the FDA's interpretation with regard to this instruction? For example, is it acceptable to start a component at 23:45 on the expiration date and allow the unit to be transfused for 4 hours (until 03:45 the next morning)?
MS. CIARALDI: Our regulations in 606.122 state that administration should start within four hours of entering the product. To us, this means that transfusion must be started within the shelf life of the unit. The length of time to hang a unit, specified in the Circular of Information, is four hours. We are aware that this may sometimes result in the transfusion ending after the unit has expired; however, we do not object to this practice.

Might be a rare IgG anti-A1 - you may not see in in the Reverse (presumably IS or buffer-only gel card), but is detected when you do anything with an antiglogulin reagent. You could try doing the Reverse by IAT. The DAT may just be a red herring, but it might represent a weird autoantibody that favors group A cells.