lef5501

We recently had a situation where the physician ordered Irradiated units on a new patient through CPOE. He placed a comment in CPOE in all capital letters to give Irradiated units. Even with the comment in all caps, we had 2 techs miss the fact that he wanted irradiated. It was a new patient to us so no history in SoftBank. We now need to figure out a way to make sure it does not happen again. Does anyone have anything in SoftBank that may work that is not a manual process, such as us just adding the Irradiated into the history once the physician orders it. I don't know how 2 techs missed the all caps comment but here we are. How does everyone else make sure they don't miss special product needs?

My director would like to store dry ice for occasional sample send outs. Does anyone have a good, small storage container that they would recommend. If you do, approximately how many days does the dry ice last?

Our policy states that albumin may be given concurrently with red blood cells. My old Tech Manual from 2011 specifically says 5% albumin may be used. However, pharmacy is telling us that usually the 25% albumin is given. Any references available about what concentration albumin may transfused concurrently with red cells?

How far out from a transfusion would you perform a reaction workup for a fever? We had a transfusion where vials were fine throughout the transfusion, including a normal temp on the post 15 minute vitals. Almost wo hours later when they did baseline vials for the second unit, the temp had increased from 98.7 (1st unit post temp @1845) to 101.2. (Second unit baseline @2015 .) Would you have performed the workup, told them fever wasn't related, etc. There were no othere symptoms present and the bag had already been discarded so nothing left to culture.

During a recent inspection, the surveyor wanted to see the results of the transfusion reaction workup on the patient's chart. We had the pathologist's interpretation on the chart, but not the actual results of the workup. She wanted to see that on the chart. Just wondering what everyone else is doing, are you just placing the interpretation on the chart or is the entire workup on the chart including clerical check, hemolysis, DAT, etc.

We have RN's asking this every couple of months and don't know whay we tell them what we do. We always get asked how long after a transfusion can we draw a CBC, PTT, Plt count? We usually tell them to wait at least 30 minutes, but an hour would be better for accurate results. We had a nurse today ask us to draw a PTT during a blood transfusion. Does anyone have any referneces that we could show the nurses, etc how and why blood transfuions may affect lab results? We've always told them to wait a little bit after, but have never really been able to show them why. Just looking for a little info to help back us up.

Sorry, I guess I should have been clearer. I am going to keep the ABO/Rh reagents. That's what we use for unit retypes and "Stat" ABO's. I'm looking more at the over $20,000 worth of screening cells and QC material that we waste every month. I'm thinking primarily of getting rid of the tube screening cells, etc. Just wondering if anyone has a second set of screening cells?

Just curious. I am trying to set up my standing order for BB reagents for next year. We primarily use gel technique for type and screens and antibody screens/panels. We have tube reagents as a backup. Something doesn't look right in gel, the techs will run a tube screen. If a physician orders just a blood type, they will use tube reagents instead of waiting on the gel card to spin. However, we are spending 4X more on our tube reagents than our gel reagents and most of the time, they are not being used except to QC them every morning. Just wondering if anyone else has a different technique as a "backup" or not? I'm considering doing a way with the tube reagents and just wanted other opinions. Thnaks.

The only time they are allowed to restart the transfusion is for an allergic reaction, ex. hives, rash, etc. With a temperature increase, I would be concerned about a contamination risk as well as a hemolytic reaction.

Scary situation: An OR doc decided our plt pheresis were taking too long to arrive so he himself called another area hospital and told them to send him their plts. Only way we found out was because the other hopitals tech couldn't remember which hospital had called and was checking before sending them. So much for that units final disposition. Same OR doc and same patient also decided our PRBC's were taking too long and "hijacked" our units when the courier delivered them. The OR tech grabbed them from the courier and was bringing the ARC box into the OR. Didn't matter to the OR team that their patient was an A Pos with an antibody and that box also had some B units in it, as well as the A units.(not antigen typed yet, mind you)

Sounds just like my last CAP inspector!

Question says "If laboratory uses more than one instument/method to test, are the instruments/methods checked against each other at least twice a year for correlation". Just wondering if this would apply to hospitals using both gel and tube methods. We mainly use gel (manual), but on occasion will use our tubes as backup or just to do a quick blood type. Do we need to be doing correlations between these methods or is this more for instrumentation?

We have quite a few surgeons who always seem to have very high Crossmatch-to-Transfusion ratios, some are upwards of 6.0. Does anyone have a letter that they send to physicians who have high CT ratios that they would be willing to share? I just want to send a "gentle" reminder and try to get our CT ratios within range. Thanks.

Just wondering how often everyone is getting their NIST thermometer recertified? I can't tell that ours has been done since it was bought long ago. This is the thermometer that we use to check all our other thermometers in-house. Some people are thinking that the certified NIST is good forever, however I feel that is should be recertified at some point.

Does anyone have good ideas for making up some fake samples for my students? I have already done weak D, positive fetal bleeds, multiple antibodies, etc. We have been really slow on real samples, I'm running out of "fake" ones to give them. Any ideas on how to make up a sample with a warm auto? Thanks for any ideas.

We haven't seen too many false positives recently. We had quite a few in the past though. Our biggest concern at the moment is that the positive control is not positive. It's just as negative as the negative control.

We actually used gel and tubes. We have been trying everything to get an antibody to come up.

We have an interesting case that we could use some help on. We have a patient that has been getting transfusions for the past two years for anemia. No known cause for the anemia per the physician. Last week, he came in and screen adn crossmatches all neg. About 50 cc's into the transfusion, he spiked a fever. They stopped the unit and transfusion reaction workup was normal, including culture and gram stain.(no growth even after 5 days). They started the second unit after giving tylenol and Benadryl, about 15 cc's into the unit, he spiked a fever again. He walked out AMA after second reaction. Again everything normal. Today he came back in and his sample is icteric(previoulsy it was not). We did DAT, screen and full crossmatches. Everything is negative. According to the physician, there is no reason clinically why he should be hemolytic, nor does he have any known liver problems. They still want to transfuse tomorrow. Any ideas on why his serum would suddenly be icteric?

How are you doing QC of the HemoTemp II blood temperature monitors? Are you just taking temps and recording flower blue, 4-6 visible? Just wondering what everyone else is doing to QC these things.

We are checking cell button, dryness, etc on a weekly basis. However, I am thinking of changing this to monthly since we hardly ever use our cell washer. Does the owner's manual mention anything about the frequency of these checks? Our manual only says to wash rotor and flush with bleach weekly.

We've had some consent questions recently that I wanted some opinions on. First, when do you get consent for the transfsuions? Is it before a sample is drawn, right before the transfusion, etc. We recently had a physician order a type and cross on a patient that had an antibody. The workup was extensive and required our reference lab. We stuck this lady twice to get samples for the workup. Once the blood was ready, the RN calls back and says the patient is not consenting to the transfusion. I feel that the consent should have been gotten long before any units were ready. How ais your facility handling consent? Second, do you draw samples on a person that refuses blood products, ie. Jehovah's witnesses? We have had several JW's come in through our OP lab and say they would refuse blood products. I have told our phlebotomists not to draw the sample. I feel no need to charge a patient for a workup if they are going to refuse blood. However, one of the OP nurses feels that the sample should be drawn anyway as a precaution. Any feelings on this? :confused:

We have the MTS gel cards, both ABO and IgG. We use the MTS2 diluent as our negative control for both the ABO and IgG cards. This way, we can also check to see if the diluent has been contaminated.

Because of the incorrectly labeled(WBIT) samples we were getting from RN draws, our director figured it would be safer to only allow the phlebotomists to stick for BB samples. For any line draw, etc where a RN would be getting a sample, a phleb must be present. We do not accept any RN draws for BB. I never really like this process, but it came down from higher up. Just last week, we proved how even having two sets of initials on the tube does not necessarily mean we have a correctly labeled sample. I received a sample with the RN initials and a phlebs initials and the wrong unique BB #. So having two sets of intials on a tube doesn't always mean anything either.

Regina, I would also like a copy. Thanks in advance. lisa.foster@lnrmc.hma-corp.com

Does anyone know of another company besides Helmer that sells plt agitators? We are looking to purchase a new one and the higher ups would like two quotes.