RKB1988

We have used DI water in ours for years at the other location and at my previous employer and nothing has ever happened that is corrosive. Our tap water is far from acceptable to use so we steer clear of that. We have the manual and did see that statement. 
I only ask this because the supervisor before me attempted to do a study and cultured the water for a month and nothing ever grew, but since the research was not done correctly, it could not be used to extend the cleaning time. 
 
Thanks for the advice!  

Hi John,
We bill them for the products.  If the RBCs are retuned, there is 0 charge.  No charge for any service or processing on our end.
As I mentioned, we bill for all liquid plasma as it's not a product we transfuse in the hospital, and we don't want it returned to reduce the chance we use it in error.
They bill for the transfusion.
BMF is an unusual setup, they are a consortium funded nonprofit.  We're one of the hospitals that funds them.
Thanks

Cliff, my 1st thought was to ask, who handles the financial aspects of your process?  In other words who charges who for what concerning any blood transfused by the helicopter crew?  What made me think of this was when you mentioned that BMF sold the plasma to a fractionator instead of returning it.

We were the first to provide helicopter blood in MA.  It was a long process, but we've simplified it as much as possible.
Our primary supplier in MA is ARC.  They would not perform the ABO / Rh retype for Boston MedFlight (BMF).  The products come to us.  We went with O Pos RBCs.  We have our own donor center but are not licensed, so chose to get them irradiated from ARC as they will travel outside of the state.  That was OK for a couple of years, then we started adding bases and liquid plasma.  We contacted FDA and learned we were allowed to irradiate the plasma, so they now have that too.
We worked very closely with BMF in setting up their program, they were the greatest bunch of people to work with.  They have a blood bank fridge and freezer at each base and are using Credo coolers.  We worked with them to perform validations on the products stored on the ground and air ambulances.  All coolers maintain temp far past 12 hours.  They swap out the coolers every 12 hours.  We were concerned this might be considered storage more than transport, so they now monitor all coolers 24/7.  They have Wi-Fi on the helicopters.  They return the RBCs if they get too close to their outdate.  The plasma we do not want back as we do not use this product in our hospital.  They sell it to a fractionator.
We've been inspected by TJC since we've gone live, and the survey went fine.  We had a virtual inspection with FDA in July, no comment as of yet.  AABB chose not to go out to any of the bases.
They have transfused a lot of products making this a very successful program.

I can describe how it works for our healthcare system and PM a copy of our policy.  The pre-hospital transfusions on the helicopter pre-dated me at this facility but I have expanded to ambulance pre-hospital transfusions on 3 ambulances with begging to increase to 4 ASAP.
We maintain sets of 2 O NEG RBC and 2 low-titer liquid Group A plasmas for 1 helicopter and 2 ambulances that work out of the level 1 trauma center. We set up a dummy patient for each vehicle and units are pre-labeled for that dummy patient, segments are retained at the Blood Bank, each unit wears a Saf-T-Vue10 indicator and a triplicate Emergency Release form with unit numbers documented on the form with one copy of the form retained in the Blood Bank to keep track.  Each vehicle uses the Pelican Biothermal Credo and changes out each blood product set once every 24 hours.  The crew at the vehicle base is responsible for exchanging the cold panels for the credo.  Each credo carries a datalogger and the datalogger report is downloaded and emailed to the Blood Bank at least weekly for review.  Each credo is validated to maintain temperatures for up to 3 days prior to being released for active use.  When a patient is transfused, the flight/medic crew is responsible for returning one of the copies of the emergency release form signed by the crew's MD to the originating Blood Bank and one copy goes on the patient's chart. Units are released from the dummy patient, crossmatched (if we get a sample), and transfused in the LIS to the actual patient.  The crew returns to their base to replenish the units that were transfused.
If the patient is transferred to a hospital that isn't part of our healthcare system, we still have a copy of the form returned to us and the crew will tell us where the patient was transported to and we "transfuse" the dummy patient with unit comments in the LIS with whatever information we received from the crew .
 

O.R. has forever been, and forever will be the weakest link in transfusion services. As was previously stated, there are a lot of moving parts and many of those vital parts have no computer access since they are contracted workers. For instance, the perfusionists and anesthesiologist have no computer access since they are only here for the case. All orders are verbal orders. They are the ones starting and ending the transfusions. There is no computer in the suite, everything is done at the desk by the circulating nurse. We have fought for decades to change that process but have had no success. Everything is manual in O.R.

This is interesting.  We had the Emergency release order placed/signed by the physician in Epic.  FDA inspected sited that the physician signing and order wasn't enough because we had to also include the clinical reason the blood was requested and the AABB statement.  I added order questions in epic with answers like "acute blood loss" but in the end we opted to just keep the paper form to avoid any more scrutiny from FDA.

We require the RNs (or another aide) to bring a small pickup slip with the patient admission label on it.  This label includes the pt's full name, MR# and Acct# (financial #) and the BB ID band number when they are picking up RBCs.  We do not require a BB ID band # for plasma transfusions.  They also must bring a copy of the current "consent to transfuse" form - filled out correctly.  
Outpatient RNs bring a copy of the transfusion order and the consent form - with the Pt's BB ID band # if picking up RBCs.
O.R. is required to bring one of the small pickup slips with the Admissions label and and the BB ID band # if requesting RBCs.  They are not required to bring a copy of the consent form.
E.R  - in an emergency situation, uses an Emergency Release form (handwritten by us) based on information in the computer or that the E.R. fills in.  They do not have to bring a consent form until everything is caught up and the TS is completed and the pt is off Emergency Release protocols.
Because we still use and require a unique BB ID wristband for blood (RBC) transfusion - both the floors and the O.R. have to prove we are all working on the same patient.  Until we get some kind of system that fewer people (I won't say none!) can screw up - I prefer the use of an independent BB ID wristband where the Draw - to XM -  to Transfuse circle has the best chance of not being corrupted.  We also require a second specimen (independent draw) for all ABORH confirmations.  Doing the best we can to not make a mistake.

We do the same.  Ours is setup to print the transfuse order both to the blood bank and to the nursing printers.

There is a pick up slip that can be printed out of Epic. It is a blood requisition form. We also have a downtime form that nurses use when Epic is down. I am attaching the downtime form
Blood Product Pickup Form - revised 10.29.20.docx

My two penneth for what it's worth; when the patient is in the OR the anesthesiologist determines blood product requirements (often by verbal order) so all an OR runner needs is name and MR#. It seems your, very valid, concern is avoiding WBIT from the outset due to the issues you outlined above. I suggest the solution is that the OR processes need to be cleaned up (literally). Therefore get QA involved. I am not a manager so others here will be way better at giving suggestions on how to proceed down that path and ensure changes are made, and just as importantly maintained. 

What do you do with a syringe aliquot that is made from a unit that has had bacterial testing?

I like HemoTemp II.  They display a current internal temp and have a blue indicator (flower) which irreversibly turns black if the unit has gotten warmer than 10C.  Easy to attach; easy to validate.

Helmer has new platelet agitator and incubator coming out in September.  I would get a quote for the new one and wait if you can.  I am looking to replace mine and am downsizing to the smallest one.  I attached the spec sheets and brochure that Helmer just sent to me.  Looks like a lot of great features to the incubator!  Continual temp monitoring so no need for every 4 hour temps!
Helmer Pro-Line Platelet Brochure 380450-1.pdf Helmer TDS-PC100-Pro Platelet Incubator Spec sheet.pdf Helmer TDS-PF15-Pro Platelet Agitator Spec sheet.pdf