Ensis01

We vertically audit ten transfusions a month, reflecting different departments and floors. We ticked each criteria box as it was done correctly. If missed or done incorrectly another box was ticked and we educated the RN. The form was signed by us and RN. The BB kept a copy and original went to the RN supervisor. Not sure what they did with it. Not ideal system but showed us willing.

I suggest discussing this with the powers to be, QA, and any committee involved in transfusions, budgets, unnecessary, wrong collections etc. Present your concerns and suggestions and if you are overruled you have evidence of your due diligence. While I see arguments for both sides; finding the most efficient and safe process that everyone can agree with is the important concern. If this means extra draws, cost and BB time so be it. Biggest risk maybe drawing two tubes at the same time (one draw) and writing different times (two separate draws)!!

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How are the phone numbers checked to ensure correct information goes to right patient?

While I understand the convenience of making MTPs and emergency release a paperless process. I regard the physical signature a good reminder that issuing uncrossmatched blood must not be taken lightly.

To my understanding the process of having to sign a document made the patient think and take the questions seriously. Obtaining and documenting accurate information is the objective.

Fill out and sign form during sample collection. Phlebotomist is responsible the form is filled out. Patient label goes in box, patient ticks boxes to transfusion and pregnant questions with yes / no option, signs at bottom. Form goes to BB and is then scanned into record.

My understanding is the antigen charge(s) are applied for the ordered number of units crossmatched. If keep ahead: then charge subsequent units that are issued. This keeps a consistent process. Especially if the units have to come from the reference lab. Usually in-house screening for units have no additional charge. I do not know the documentation reference though I am sure others will.

Part time / guest lecturer at your nearest Med Tech school?

How often do you check / restock the fridge? As that could be your documented inspection.

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The policy at all places I have worked; to find antigen negative units in our inventory requires testing two different segments sequentially (not parallel). First segment is a screen and second is confirmation.

To quote my first BB manager “first rule of BB; get the ABO right, last rule of BB; get the ABO right. “

If you are screening unknown units in your inventory then a second confirmatory test on that unit is strongly advised. If you receive labeled antigen negative units from your reference lab then believe their process and the label. Retesting because a tech does not trust someone else’s work due to “comfort” seems to be a waste of time and money.

I seemed to use a bad example to show why I think front and back type ABO resolution is important.

My experience has always been that blood products given during an MTP were a stop gap while the cause(s)of the bleed were dealt with, continuing for as long as it takes. As described above this can involve a huge number of products. What situations during a MTP can cause more harm than good?

I am in the resolve the Backtype at a minimum of once for every patient. I have had two Bombay phenotype patients in labs I have worked in.

Four drops of plasma to resolve back type ABO discrepancies (with an auto control) has been part of procedures in all places I have worked. My concern is that your techs are using a technique that is not part of your labs procedures. WRT ISXM: if you resolve the backtype using 4’C (RT) incubation do your procedures require you to do the ISXM at 4’C (RT)?

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For many hospitals; once an anti-M is identified, at any phase, M neg units are required. This is usually due to reluctance, or inability to over-ride the BB LIS especially if the BB is primarily staffed by generalists.

To my understanding: if you are referring to PAS (PR) platelets, which are being, or have been phased in by blood suppliers; then give any ABO type as 60-70% of plasma has been replaced with crystalloid nutrient media. The pathogen reduction (PR) negates the CMV and irradiated necessity. Other BB may have a different policy though platelet availability may give you no choice.

Medical directors REVIEW policies every two years to ensure they are current and appropriate then sign, which is evidence of review. Staff read and sign when changes have been made.

I have frequently seen Rh discrepancies like this with hospital hoppers. If we have (or can get) last hospital history one phone call resolves issue (plus weak D test). However We have had problems when the patient is adamant they are Rh pos (or neg) and we report the other. This has caused long delays for patients to get or accept the explanations and give consent (or re-consent) to be transfused. The added tech time for these situations can be frustrating on occasion.

Use manufacture instructions as your starting point; but review and subsequently increase or decrease requirements as appropriate to your lab.

Keep paper long enough to ensure correctly billed from supplier.