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Bdawley

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Everything posted by Bdawley

  1. Any labs out there allow their techs to perform manual differential counts by high dry (50x) objective as opposed to oil immersion (100x) as a routine? An internet search would seem to indicate that some labs, by policy, do allow the use of 50x. Anyone willing to share their thoughts on this subject?
  2. We are also interested in knowing what experiences other Blood Banks have had during their most recent CAP inspections relative to satisfying common checklist question COM.30450. Are the inspectors writing deficiencies if Blood Banks are not doing lot-to-lot verification studies? I'm not talking about correlation studies between methodologies. And I'm not talking about the usual reagent QC that we've all been doing for years. I'm strictly referring to lot-to-lot verifications.
  3. To put this in perspective, the order set is specifically for ED patients on anticoagulants who present with a major life threatening bleed. I'm sure the physician is most interested in controlling the bleed as quickly as possible without delays. I still don't feel comfortable with this for reasons stated in your responses but the thought of a reflex order might have some merit. I am taking this discussion to our Blood Utilization Committee meeting in May and your responses will certainly be included as part of that.
  4. Our hospital recently implemented CPOM for physician order entry (which includes Blood Bank ordering). At present we are accustomed to getting orders to transfuse that specifically state, as an example, to "Transfuse 2 units of RBC". We now have an ED physician who would like have the Blood Bank staff automatically send blood components to ED for transfusion based upon written parameters within the order set. In this situation the responsibility would fall upon the Blood Bank to monitor Hgb, Hct, Plt Ct, INR, etc to decide whether an ED patient needed to be transfused. I feel uncomfortable with this arrangement because then it becomes Blood Bank's responsibility to make sure that the patient gets transfused. An example of what such an order would look like is: Transfuse 2 units of pheresis platelets if platelet count is <50,000/uL (this would be for a bleeding patient in ED) Is anyone else facing this issue in your hospitals? Opinions are welcome!
  5. Our Blood Bank is faced with a potentially new patient identification dilemma. I’m hoping someone out there can offer some advice or at least some anecdotal experiences of their own. Our hospital is participating in a new state-wide (Michigan) agreement to standardize wristband colors for patients. Currently our preadmit Blood Bank patients have a red wristband which is attached prior to specimen collection. The wristband is barcoded and the specimen label is generated from the wristband. Our Blood Bank will use these samples for up to 7 days post collection for pretransfusion testing providing the patient has not received blood or been pregnant in the past 3 months. We currently use these wristbands even after the patient is admitted for transfusion purposes. It seems a decision will soon be made to cut off any wristbands that a patient may have upon admission so that a single (white) wristband can be attached to the patient. This, of course, means that the Blood Bank wristband will be taken off. We would no longer be able to use the preadmit specimen for transfusion purposes since the “chain of custody†would be broken. We have 2 options to consider: Repeat all preadmit T&S testing with a new sample collected after the patient is admitted. This would add cost and additional tech time to repeat the testing as well as delays for surgery. Devise some documentable mechanism that would require accountability on the part of nurses who cut off the BB wristband and replace it with a new (white) wristband. The nurses could scan their ID badges as witnesses whenever a wristband is replaced. They could also scan the red wristband ID and the new white wristband ID before placing the new band on the patient to make sure there is a match. This could potentially all be documented in our HIS (Cerner Millenium). With this accountability in place, we would feel comfortable that the patient is being properly identified and we could continue to use our preadmit specimen for transfusion purposes. Question: Has anyone else encountered a similar situation? Are there alternatives that other Blood Banks are using that I have not considered? Obviously any other wristband systems like Hollister, Typhenex, Securelink are not the solution either since these too would all be cut off upon admission.
  6. This is the form that we use. It is a Word template with dropdown boxes for easy editing of several fields. To: From: XXXXXX MD, Director of Transfusion services Date: 6/18/2008 Subject: Blood Product Transfusion Audit Outlier XXXXXXXXXXXXXXXXXX Hospital is required to monitor transfusion practices to determine justification and appropriateness of blood usage consistent with established criteria. The Joint Commission requires peer review of transfusion therapy and physician ordering practices. The following transfusion failed review criteria. The reason for the transfusion may have been unclear to the auditor or there may have been missing documentation. Please review the patient’s chart and clarify the needed information for this transfusion audit. Patient Name: MR#: Admission Date: Transfused Blood Product: Transfused Blood Product Number: Transfusion Date: Reason for audit: MSBOS Guideline: Other comments: Submit your response within 3 weeks of receipt to: XXXXXXXXXXXXXXX Medical Staff Office XXXXXXXXXXXXXXXX Hospital cc: XXXXXXXXXXXXXXXX, Physician Peer Review Coordinator Transfusion Audit File, Pathology
  7. Because of our remoteness from our blood supplier and because we've found ourselves without in-date pheresis platelets in critical situations, we did opt to use our pheresis plts up to 2 days after the original 5 day outdate. We will use these outdated pheresis plts only upon approval by the ordering physician and by one of our pathologists and only if no in-date platelets are available. We also do pH &/or glucose &/or gram stain on the platelets before dispensing to check for evidence of bacterial contamination. If we use outdated platelets the occurrence is documented as a deviation from SOP which is signed by our pathologist. Naturally, these outdated platelets are stored at the proper temp with rotation until they are disposed 7 days after collection.
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