Karen Olsen

Yes, we do hand label our specimens. Yet another reason for the 100% success rate. We document the two ID's on the requistition. We are not completely paperless - for good reason. We also still have a paper trail of the issue event. This has saved us a lot of headaches when the inventory doesn't match in the AM! It is usually because someone issued a unit but did not accept the computer screen.

I agree that the most common error with misidentification is when the wrong patient is drawn or the tubes are mislabeled. However, rare as it it would be, there could possibly be an error in testing the correct specimen by the Technologist! Re-typing would catch those rare instances. Obviously the best solution to catch the most common of errors would be in typing a second specimen drawn at a separate time. But then there has been much discussion on how this process could be "cheated on" so we come back to the fact that everyone needs to do their job correctly! No system is fool proof. We use a BB armband more-so to be sure that nursing is giving the correct unit to the correct patient than anything else. We have two people ID the patient before the draw and document such. We have been 100% successful with this process- that we know of. We are all waiting to be able to afford the hand held electronic patient ID systems - but to be sure there will be a way for human involvment to muck that up also!

We transport our blood products in white paper bags - our emphasis is on not having visitors pass out in the elevators when they see a unit of blood! "Knock on wood" we have never had a unit of blood drop and break! Perhaps we will change to colored zip-lock plastic bags (with out biohazard labeling) when that day comes!

We use a base label with all of the appropriate labels on it and then wrap it around the syringe. There is just enough room for the label without covering up the graduation marks on the syringe.

I hadn't seen the new CAP phase I requirement, but I guess we have it covered by having two people identify the patient at the time of draw. I'm sure what they are leaning toward is performing a second blood type, from a new draw, on the patient if you don't have any history. We have the patient state their name and DOB prior to draw. We use the Hollister Ident-a-band system and only write the patients full name and MR# on it as it appears on their hospital band and the date. All of the other required information is on the requisition and tubes. (Patient's full name, MR#, Collector, second ID person's initials, date and time of draw. I agree that there are no specific requirements for the information on the BB band, since a separate band is not required they can't really insist on specific requirements to be on it.

The Nurse calls a reaction at the first sign of symptoms, stops the unit, calls transfusion service, and then calls the physician to let them know. Now, does that mean it never happens that the Nurse calls the physician and the physician tells the Nurse to medicate and keep the transfusion going- I doubt it!

We do a variety of things and try to change it up some from year to year. One thing I have found that works really well and kills two birds with one stone is a procedure manual competency test. I include a question on any changes that have been made to the P&P manual to be sure they are truely aware of the changes and then I throw in questions that pertain to things that I feel they may need a refresher on. If you have had staff asking questions on something recently or several of them making the same error - things like that usually help more than just the person asking the question. In addition I may use the CAP survey or additional wet samples or even just make a copy of a complete Ab workup that they have completed in the year. I also have competencies on all of the major testing performed that list out each individual step in the process - these are used for first time competency assessment but occasionally I will pull them out for the seasoned staff. Every once in a while you find one little step that they did not realize was part of the procedure even though they have been performing it for years! Have fun!

The colored chart I have for grading of reactions is from Gamma - now Immucor/Gamma. It is very old (dated Nov 1992) but I would think they would still have something available. The chart also includes mixed field descriptions. I just do a serial dilution of Anti-A and have them add a drop of A1 cells and spin and read.

As part of our competency on each employee, we include a strength of reaction grading exercise. Just a simple dilutional wet sample that they read the reactions and grade them to make sure they are somewhat close to the expected results. I have never found anyone in 25 years that was variant enough in their grading to make me ponder even for a second. You may find it not to be an issue. On the other hand, maybe you need to do a competency on grading of reactions. You may have a bigger issue with that than the variation between a red top and pink top tube. Just something to think about. I would think you would want your reactions to be extremely close with the two tubes, unless of course you were getting consistantly stronger reactions with the pink top tubes you are going to. Then that may be a good reason to switch! Good Luck!

Can anyone with experience with the Transfusion portion of MediSolution Computer System share input with me? Is it a user friendly system? Is is similar to any of the other systems out there? How is the report functionality? Thanks for your help:)

We have a combination rule of one homozygous if possible or two heterozygous if there are no homozygous available to rule out and then three positives and three negatives reacting appropriately. We never rule out Duffy's or Kidd's with heterozygous cells. We use gel to eliminate as much of the junky IS stuff as possible. It does still have some of it's own issues - but as stated above Peg usually resolves it.

Our last CAP inspection was at the end of the last month in the cycle. We did an inspection recently and it was at the end of their cycle. I don't know if it usually works out that way or not. I'm wishing I could do an inspection in upstate NY about now!! I miss the snow and one day would be about enough of a fix!!

Our Biomed dept does it semiannually. I agree with John - why are we always held responsible for everyone. My theory is that you go to the person you know will do it - that attention to detail thing! That's what we get for being so good!

I didn't specify in my original post - but we do not use the cord blood for transfusion purposes. They are not labeled or collected as per our strict P&P. Our NICU nurses draw the baby and apply the BB armband to baby's ankle.

If you would be willing to give me your e-mail address, I would be willing to send you my SOP. Thanks

We perform a type and Rh and DAT on baby and give O Neg blood. If we have to give type specific or compatible non O we would perform the compatibility studies by taking the reverse cells through coombs as appropriate. We do not perform a screen on baby unless we have nothing on Mom or Mom has antibodies. In the latter case we would crossmatch with Mom's serum.

Personally, I wish someone would come up with a new version of the Baxter Immufuge II. I just love them! What a workhorse. I have used the Helmer EBA 21 and feel it is an OK piece of equipment, but I don't like the larger footprint of it. Also, for limited routine spinning it is sometimes faster to punch in a time and hit go, rather than scrolling through menus. I know - I am showing my age! A company in N.J. took on the project of duplicating the Immufuge, a number of years ago, but it never really took off. I am still hanging on to two very old Immufuge II's in hopes of some company out there realizing the need!

That is just about the saddest story I've heard in a long time! Good luck in getting some new blood in to turn things around. Our Profusionist was instrumental in pushing the TEG through and essentially forcing them to use it when they were leary. He is the one that trained on it an does all the testing and interpretations. Without him ours would probably be in BioMed under plastic also! Good Luck

I just received a call today from Precision Dynamics and they informed me that their machines are up and running. We can now order the old original Hollister Identa-a-Bands from them. She did not say anything about the Hollister Cards - so I assume they are not available yet. I know they were originally targeted to be available sometime in Feb. Or of course they also have their own bands and cards available.

Welcome! I have not used this software myself, but have heard from others that it works quite well. We also will be selecting a new BB computer system in the near future, Soft being in the running. I am hopeful that this forum will be helpful in the entire process. It has been very helpful in so many other areas of Blood Banking!

Our profusionist has been using the TEG instrument during OHS for about 7 years now. We have noticed a drastic reduction in product usage since they started using TEG. One particular week in the middle of this 7 year period they were back to using tons(in our opinion) of blood products. We later found out that the TEG instrument was down that week due to a computer issue. "VERY INTERESTING!" What TEG does for you is allows you to know whether the patient is bleeding due to a Coag issue or a bleeder in the heart, so they can fix the exact problem rather than throwing all kinds of blood products at the patient and hoping for the best. We do use a fair number of platelets when we have an emergent OHS and the patient was on Plavix, sometimes as many as 9 or 10. I don't want to give the impression that since TEG we do not ever have an OHS go "bad". We do still have those patients that for whatever reason go through quite a few products. I would also be interested in seeing some average useage data. We collected a lot of data when we were doing the initial study for the TEG instrument, but it just proved that usage went down drastically with TEG, there was no comparison to other facilities.

Just to complicate things even further. I think there are really three things involved. The original physician order in the chart, the nurse request taken from the Dr's order in the chart and sent to BB, and then finally what I believe started this whole discussion is the patient identification used to pick up the blood product to ensure positive patient identification. This last piece of the puzzle is what we keep for one month and then pitch- and as I have said above, we have never had the need to go back and look at one of them - ever.

We do not test specifically for cold agglutinins on anyone. If we do identify a cold agglutinin even though we use Gel Methodology to get rid of them, we would report it out. Coincidently we are discussing this very topic with our OHS surgeons and profusionists right now. They would like us to report all cold agglutinins by phone to the profusionist. Our dilema is that we don't always know at the time of our initial work-up that the patient is going to OHS. AND- since we use Gel the number of cold agglutinins identified is minimal - will we remember the procedure and call them??!!! This topic always resurfaces after a patient has an issue with a cold agglutinin that they did not know about prior to chilling them down. Blame the Blood Bank!

We currently use the Hollister Ident-a-Band. Precision Dynamics will continue to carry both the Hollister style and their own style of band. We were trying out the Hollister cards with the Precision Dynamics Bands just as a trial for a while. There are pro's and con's to the Precision Dynamics bands. We have found that they are much easier to insert the cardboard identification strip, easier to snap, and are more legible. However, they are not as waterproof, some of them are defective and hard to use, and I don't like the Cards that go with them. We have not made a final decision as to which bands we will be using.

AABB standard 5.11.1 is referring to the original request for the crossmatch, and yes they must be retained for 5 years - sorry. We are discussing the simple form of patient identification that the floor brings/sends to the BB to pick up the actual product. Unless your facility has a more official purpose for this item, like reason for transfusion, required hematology lab results, issue record, etc., I don't really see any reason to keep this slip of paper any extended time period at all.