Ensis01

Here's to hoping your life has taken a turn for the better going forward and there are brighter days ahead.  

My deepest condolences for your loss.

I have not been around lately. A lot has happened in the last few years.  My 12 year old daughter was diagnosed with orbital rhabdomyosarcoma in October of 2018. I spent a lot of time out of town because our hospital here in Windsor could not handle pediatric radiation so she was at the Children's Hospital in London, Ontario off and on for several months. There was a point when her scans were clear but a few months later they found a tumor in her brain. They removed it surgically but she developed an infection which prevented them from doing radiation so the tumor returned. She passed away October of 2019. 
My father had been ill at the same time with interstitial lung disease. It progressed very quickly after my granddaughter died.  He was at the point where he needed home care but with covid he lost his homecare because of my job as a tech in Detroit.  I was the only one who could care for him so I changed my work schedule to just weekends so that I would limit my own exposure at the hospital (only 3 techs work on the weekends) and so that I could be there with him during the week. My father passed away May31 of 2020.
My husband and I both decided to retire early with all that had happened, so October 31, 2020 was our last day worked.  He became a permanent deacon in the Catholic Church in November 2019 so he has been very busy with the church. I am a personal trainer besides being a med tech so I did a certification in senior fitness. I am just waiting for things to open up so that I can do some work with seniors.  I have been spending a lot of time with my 5 year old twin grandchildren while they do online school. I will be glad when they can be back in the classroom.
 
 

Several years ago we had a call from the OR asking if there was any history on a patient X to determine if one collection or two separate collections were required. The BB tech who answered the call did a history search and said we have no BB history on patient X. Ten minutes later two samples for a patient Y arrived. The same BB tech called the OR to clarify why samples on patient Y were delivered when we were expecting patient X. The OR said patient X samples had been delivered. Not said the BB tech; and demanded two recollections by different people.
What had happened was patient X was moved to a different OR and whoever collected the samples used the labels in the new OR, patient Y (the labels for patient X  were in the old OR).  As whoever drew the samples recorded them as different collections; they were written up with two Wrong Blood in Tube events, which resulted in their termination.  
We typed the incorrect samples from curiosity and an O+ patient would have received A+ blood!!!!!!

I just answered this question.

My Score PASS  

True, but, as I said above, strong examples can, and do, react with enzyme-treated red cells.

Agree with Malcolm and OkayestSBB. The process I would suggest is to only investigate then call Ch/Rg once the following criteria are met: there should be reactivity on phenosimilar cells, which should titer out to your HTLA defined policy. Reactivity should be negative with Ficin treated cells and positive with 0.2M DTT treated cells. Then neutralize with plasma (and saline controls). Hope that helps.  

Agree with Malcolm and OkayestSBB. The process I would suggest is to only investigate then call Ch/Rg once the following criteria are met: there should be reactivity on phenosimilar cells, which should titer out to your HTLA defined policy. Reactivity should be negative with Ficin treated cells and positive with 0.2M DTT treated cells. Then neutralize with plasma (and saline controls). Hope that helps.  

BB.rick, I would have no problem retiring the card system in your case provided that you are regularly (daily) downloading a copy of the records to a secure, accessible file for downtime. Also, make sure all staff know how to access that data for prolonged downtime. There is no reason to have a card system with Meditech.
BTW, my previous position was in a place where the manager refused to stop using the card system. It was mainly because they were not familiar with how to access the information during Meditech downtime. Even when shown how, they still refused. It is still in use today at that site. Some battles you can't win.

Even if you don't store RhIG in BB, you need to check the storage requirements of your BB reagents. We assume all reagents are 1-8C or 1-10C but there are some that are 2-8C. We borrowed some Anti-E from a local hospital that was from a different manufacturer  that we use. I happened to look at the package insert just before our recent CAP inspection. I had to adjust the fridge until the reagent was used up. Just be aware.
 

I just answered this question.

My Score PASS  

I would be absolutely terrified, especially as a patient.
Sadly, the figures you quote are quoted in the UK Transfusion Laboratory Collaborative: minimum standards for staff qualifications, training, competency and the use of information technology in hospital transfusion laboratories 2014, which are recognised by such people as UKAS and the MHRA.
These standards are in the process of being rewritten (for a short time, I was the IBMS representative on the group, so I know this for a fact), and I am hoping, for the sake of everyone, that these figures are tightened up.  In the meantime, expect either an increase in the number of telephone calls you get for help when you are officially off duty and/or more reports to SHOT!

You have to change your refrigerator alarm settings to activate at 2.2C (or whatever you choose).  It doesn't matter that your refrigerator never gets too cold;  if you are going to store reagents (and RhIg) in a BB refrig, it has to be able to alert you when then temp is out of prescribed range.

Somebody was sure digging through the archives to find this one!  Glad to see.  This was probably one of my first posts.
To be honest, I don't remember if we ever went with the second type but I imagine we did knowing the corporate QA team at the time.  I do believe that anything short of a second draw is little more than smoke and mirrors to show compliance with some mandate.

Finish the unit.

I just answered this question.

My Score PASS  

Our requirement (at Blood Bank insistence) is that the infusion has to begin within 15 minutes of checkout. We had problems with nurses checking out blood products before they made sure that the IV was good and without taking vitals, then wanting to bring the unit back 45 - 60 minutes later. Their policy says check IV and vitals before coming to Blood Bank to pick up units and the short time allowed to start the infusion kind of reinforces that. The number of wasted units dropped significantly after this policy was in place. 
We also use the policy shared by slsmith. If there is a delay and they bring it back after 15 minutes, we check the temp. It will probably be over, so they are asked to give in 4 hours or its wasted. An Occurrence report is filed.

We are going to put a hang tag with a fluorescent green label on our pathogen reduced platelets using the language suggested by Cerus - FDA approved as a substitute for irradiated product, meets AABB requirements for CMV neg, etc. etc. I'm not optimistic about many people actually reading the education materials.

I just answered this question.

My Score PASS  

At one of my facilities we had a group of O neg donors that would come in on a regular basis and these folks were designated as out Neonate Donors.  I think at the time we would set them aside exclusively for the neonates for a week and if they were not needed during that week we would move them to the general population.  We would ask regular O neg donors if they could come in on a schedule so they could be used for the babies.  When most understood that their blood would be designated for the newborns little else had to be said to get them on board.  

Just a thought.  With an issue like this you have to come to a point of realizing that you can only do so much especially when much of the process is out of your control.  You can drive yourself crazy playing the "what if " game!  Once you've done the best you can for your situation then accept that there will probably be a fallible human somewhere in the process who will come up with a creative work around.  A nurse will put a unit in the medication refrigerator until she's ready for it or they will put it back in the cooler in OR after it's been setting next to the patient during the procedure, just in case!  Accept that you don't have complete control and never will, you'll live longer!  

I just had to share this story...When I worked in a large teaching hospital we had a team of Transfusion Nurses who were responsible for drawing most samples and administering the transfusions. Occasionally, however, physicians (or interns/residents) would draw the samples. One afternoon we received an unlabeled sample drawn by a physician via courier. We contacted the physician and informed him a new sample would have to be drawn. He said he would come to the transfusion service and label it right away. We told him that was unacceptable, however, he insisted. While he was on his way, we put together several samples without labels and placed them in a rack. When he arrived, we presented the rack to him and told him to select the sample to label. He actually tried to feel each tube to find the warmest one and said that was the sample he sent. Obviously we did not allow the sample to be labeled.  The story has been told many times!!! 

I think we need to add an OMG emoji to our selections!

Definitely enough story lines for a mini-series!
These are all possible stories that could happen to any of us. 
Being in direct contact with physicians (who know everything) and nurses (who believe policy is not practice) and providing products that could be life saving or harmful to patients and parts of the process is out of BBs control can be very stressful for technologists.  And sometimes is hard to get new technologists to work in our field.
With providing administration with some of these "real" scenarios and the possible medical-legal-pr implications I was able to acquire an additional salary % for techs working full time in the transfusion service.  When other department techs thought it was unfair, I asked them to apply for a BB position (no takers).  Might be worth a try if you need techs.
Thanks to all who are sharing your experiences. 

Several years ago we had a call from the OR asking if there was any history on a patient X to determine if one collection or two separate collections were required. The BB tech who answered the call did a history search and said we have no BB history on patient X. Ten minutes later two samples for a patient Y arrived. The same BB tech called the OR to clarify why samples on patient Y were delivered when we were expecting patient X. The OR said patient X samples had been delivered. Not said the BB tech; and demanded two recollections by different people.
What had happened was patient X was moved to a different OR and whoever collected the samples used the labels in the new OR, patient Y (the labels for patient X  were in the old OR).  As whoever drew the samples recorded them as different collections; they were written up with two Wrong Blood in Tube events, which resulted in their termination.  
We typed the incorrect samples from curiosity and an O+ patient would have received A+ blood!!!!!!