Baby Banker

O how I wish I could convince people here of that!  

Ok, here we go.  First is from a personnel stand point.  When promoted from with in you are no longer "one of the guys".  This means that some of the staff will try to leverage your close friendship which in turn will cause problems with others.  Both you and the rest of the staff need to recognize that things have changed on a personal level, at least in the work place.  This does not have to be dramatic and should not be, but it is real.  Some can do this and some find it very difficult.  Now, when coming from outside your are exactly that, an outsider.  Now the level of this can vary immensely depending on the situation.  One time when I changed facilities it was just across town and I new many of the staff at the new facility so a lot of the unknowns were minimized.  On the other hand, I also moved to another facility out of state and pretty much walked into an unknown from a staffing standpoint except for what little I could glean from the interview.   As I noted in my previous post, be very judicious when using the phrase, "this is how we did it."  I've had new employees who would say this at every opportunity and then go into detail about how we were either doing it wrong and that their way was just much better.  This became very trying to everyone else on the staff and we finally just tuned them out.  Because of that we probably did miss out on some good ideas.  One last point, in either case be aware of any others staff who may have either applied  for the position or simply been over looked.  Depending on their personality they can either be a great help or a significant hinderance.  Do everything you can to get them involved and engaged.  They can be your greatest asset but it may take a little extra work on your part.  For me, the personnel issues were always the most difficult. 
I'm assuming that you are new to the lead position and not knowing your previous experience here a couple of generalizations.  Unless something is an obvious hazard to either patients, staff or the ability to pass an impending inspection/assessment don't be in a big hurry to make changes.  As they say in the military, you need to understand the lay of the land.  Become familiar with the blood bank/transfusion service medical director and let them have the chance to become familiar with and confident in you.  They can and should be your greatest allies.  Ultimately most of what you want to change will have to be approved by them.  You need to understand the current processes before trying to change them.   At one of the facilities I moved to I noticed that many of the staff were not following their procedures "to the letter".  The way I dealt with this was at the monthly staff meeting we would go through a procedure as a group, line by line and I would ask the questions, "Is this how you are really doing it?  If not, why not and how are you actually doing it?"  This is when I would make suggestions for changes and generally a lively discussion would ensue.  It took quite awhile to go through the procedure manual but by picking, what I considered the most important  one first it was time well spent.  
This is getting a little long so I'll end with how I described my position as Transfusion Service Supervisor at a 350 bed level ll trauma center.  My job was to provide the staff with the tools (equipment, knowledge, material and support) for them to do their jobs at the highest level possible.  All this while keeping the dragons (administration) away from the door.  Good luck and if I can think and anything else that others may miss I share a few more golden nuggets of wisdom with you.  Above all else have faith in your self.  
     Wow I think that's the longest post I've ever made. 

There can be back pain in an HTR, although there are LOTS of other things that can cause back pain.

Just a thought but why must the acute pain be associated with the transfusion?  Why was the patient being transfused, trauma, chronic anemia, etc.?  It makes a difference.  Where was the pain, at the site the blood was going in, along the same vein, some other part of the body?  I know that it is a natural reaction for us to associate anything unexpected which occurs during or shortly after a transfusion to associate it with the transfusion but that is not always the case.  It is worth the effort to also look elsewhere for the cause.  As I've mentioned in other threads, I've seen a temp rise post transfusion that was caused by the window blinds being open and the sun shining directly on the patient.  Bottom line is that it is not always the transfusion causing what you are seeing.  Keep an open mind.

Could be platelet clumps..

It is best from an operational standpoint to do the same thing every time.  If you always do a second type on patients without a history, you won't forget to do one.

It is best from an operational standpoint to do the same thing every time.  If you always do a second type on patients without a history, you won't forget to do one.

It is best from an operational standpoint to do the same thing every time.  If you always do a second type on patients without a history, you won't forget to do one.

We have dedicated blood bankers on each shift.  This was suggested to us by an FDA inspector.  We supplement with generalists on evenings and nights.

There are many plasma proteins that can cause allergic reactions. Transfusing washed cellular products frequently prevents additional reactions.  In addition, there have been several case reports of a donor consuming an allergen (peanut butter is classic) before donating. The recipient who is sensitive subsequently has an allergic reaction.  One that comes to mind was well documented in the NEJM. And of course don’t forget the controversial IgA deficient patient allergic reactions. 

If you are talking about tube tests, I label  A,B,D,Dct, a,b.  ABSC:  1, 2, 3.  With the pt initials underneath.

There is a very good reason why "generalists" avoid Blood Bank and transfusion medicine - it's complicated and you need a lot of specific training to do it well. Even today, with a significant level of automation, a warm body is often needed to interpret results and give recommendations. And then add the fact that there is a seemingly endless list of "exceptions", "equivocal", "indeterminate", and other levels of results that confound even a trained (SBB) person, let alone an "every other weekend, third shift" employee.
Cross-training is a must for very small, low volume facilities. No question. However, once work gets to a certain level of complexity and volume, institutions should seriously consider having dedicated staff.
I don't know how "generalists" manage to maintain their legally-required competency levels.

We switched to Rhophylac here in the hospital because 'everyone' likes having the option of giving the dose IM or IV.
The MD's are still using RhoGam (no IV option) for their office injections (IM Only), e.g. Antenatal/Antepartum dose.

Ditto for us. It was actually nurse driven for patient satisfaction. The providers didn't care one way or the other except they weren't going to sign off on it if it cost more than RhoGAM. The only kicker is that the IVs are not discontinued as soon as they were when IM RhoGAM was administered. If the patient wants the IV out NOW, then they get the Rhophylac IM - their choice. We've had no issues.

I wish we could afford BloodTrack.

Our Deviation from SOP form is pretty simple.:
Tracking # (a sequential # which I add when I review the form) Patient ID information Date/time of occurrence Description Reason for Deviation Action Taken - this is most often information completed by the tech who is responsible for the deviation or who discovered/corrected the deviation. Sometimes it is more appropriate for me to complete this part. I may add information to Description/Reason/Action sections. The medical director may add to any of these sections, though usually doesn't. Reported To/By/Date and Time Tech - person completing the report. This is usually the person who reports the occurrence, but not always. Signature lines for Supervisor and Medical Director Comment section - used for additional information or comments regarding the occurrence. This section is not always needed but is completed by myself (supervisor) and/or the Medical Director when necessary. This would be where I note retraining, disciplinary actions, whether or not a hospital occurrence report or safety huddle report was made, BPDR# if filed, calls to providers, etc.  The Medical Director will comment on appropriateness of the deviation or contacts with providers as he sees fit. Example would be if the event was due to something like emergency release of uncrossmatched blood to a patient with an antibody. This form is one page and most of the events reported don't fill up all the spaces provided for entries. Once reviewed and addressed, I file them. I think if I was at a larger facility I would think about using a form online or at least a from that could be completed on our shared drive and emailed to me and the medical director. One of my goals is to build a spread sheet to track/trend by occurrence type - good quality project for my abundant spare time .
 

FDA inspectors have told me that they have jurisdiction over all transfusion services.  They just choose to restrict themselves to sites that perform certain modifications (e.g. washing and/or irradiating).

I was going to suggest that you check with the manufacturer.  If you haven't already, look at the package insert.  

When I worked in a major trauma hospital a few years back (early 2000s!), we simply started out converting the FFP to thawed plasma at the outset, to prevent issues with forgetting to relabel, confusion over dates, etc, as stated above, in our busy transfusion service.  If I were directing the transfusion service there now, I would definitely have made the switch from AB to A as well.

We've been converting FFP to TP directly for some time now.  All of our thawed units start with a 5-day outdate.
 
Scott

And it is a whole lot easier to say. 
By the way, the U stands for Underwood; this is the name of one of the early patients identified with a partial D.

I work at a blood center and I can tell you that though super rare, mislabeling does happen. Not sub-groups, or variants, but actual wrong blood in the wrong bag situations.  I have only seen a very small number of these and they always involve the most unbelievable, bizarre, "were they TRYING to mess up" situations. These situations usually result in 2 first time donors having their blood drawn into a bag labeled with one number and the tubes labeled another number, now both bags have the wrong blood/label.  First time donors do not have history to catch these discrepancies. I would never suggest the confirmation step at the hospital be removed, especially with electronic XM so prevalent now.  I guess it's been at least 6 or 7 years since we had one of these. 

I realize what you say is correct Malcolm, but that is what my supervisor called it and that is the way it was reported back in then.

We retype the units as they come in because like CSP0102, I have personally found units mislabeled at the blood center, so better safe than sorry I like to say.

My only thought is, "What is the motivation for such a change?"  The retesting will still have to be done and you will pay for it one way or another so what, exactly are you hoping to accomplish??  A little convenience for the transfusion staff?