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Jessica A

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    Blood Bank Technical Specialist

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  1. This is what I would tell them to do if it came to it. I think I'll update our procedure and start by saying "in a true emergency" we'll use our freshest O Neg and give it as uncrossmatched. We already have the procedure written that they will take the whole unit and give what they need, discarding the rest. We of course had a situation recently where a large maternal fetal hemorrhage nearly killed the baby and someone said "we don't do that here" (the RN I believe) when the MD asked about transfusing before lifelining. So as part of the CAPA I'm having to look at our policies which admittedly need updating.
  2. So my hospital hasn't transfused a pediatric patient, let alone neonate, in at least a decade. We don't stock splitting or syringe supplies and we don't keep an irradiated fresh pedi unit either. The rational is that the nursing staff and lab staff lack the experience to do such transfusions and by the time everyone read their procedures the baby could be lifelined to a facility with a NICU (we have a helicopter available 24/7). Even by road during traffic the drive would only be about an hour. Our blood supplier is about an hour away (2 if they take their time getting it ready during rush hour) so again, it is faster to transfer the baby than wait for the blood to arrive and prepare it. We have a special care nursery but it's really not that "special", I've never actually seen a baby with worse than some mild breathing or blood sugar issues stay here. What does everyone else without a proper NICU do for the extremely rare pediatric patient?
  3. blood confusion! Ha ha, that's probably a typo but it is definitely how I feel about our LIS/BBIS conversion! The number of acronyms used by EPIC are in the hundreds, it is overwhelming. And every employee in the company appears to be under the age of 28 so they have plenty of mental resources available to remember them all whereas all of us in the hospital are staring in wide eyed fear.
  4. We are going to Softbank and I used Soft over a decade ago at another facility. We never used a dummy patient for our emergency release. I can't remember the exact process now, but we always released the units to the real patient. Maybe you can tweak your emergency release process to make things easier for the first MTP cooler?
  5. It was my understanding that the emergency transfusion option was really just an Is/Os flow sheet that doesn't perform the patient/unit safety check that BPAM performs. How in the world are you surviving without a BBIS? Can you even use BPAM without any information crossing back to EPIC?
  6. We are going to Softbank and I really wish hospital administration would seriously consider purchasing the SoftIDTX module which works similar to BPAM but WAY better. For example, it looks a lot more like the anesthesia BPAM module than the nursing BPAM module. You can see every unit available for the patient on one screen and simply click "start" or "stop" when you begin and end the transfusion. It does a better job of prompting for vitals as well. It would work fabulously well in an MTP situation. For those of you who don't use BBID armbands, how do you meet the CAP requirement for a secondary method of patient identification? I get that rover does the ID at the time of draw and BPAM does it at the time of transfusion but do we just get a pass for MTP situations? As I brought up with EPIC and nursing, it is not out of the realm of possibility to have 2 MTPs going at the same time who are different blood types. This terrifies me. For those that DO use BBID armbands, how do you get EPIC to acknowledge the armband as a patient identifier? Can they add a field in BPAM to scan or type the armband number and bounce it back to something? I feel like we need to keep the BBID armband for MTP situations since I will have literally nothing else to make sure the correct patient gets the blood.
  7. Does anyone have experience with MTP documentation in EPIC with or without concurrently documenting in BPAM? My facility is going to EPIC and we'd like to get rid of the BB armbands since Rover and BPAM will allow us the necessary patient identification steps but I am told that MTP is not usually documented in real time which means there would be no scanning of the patient armband prior to transfusion. I would be fine with this if we were not issuing type specific blood and sticking with group O RBCs/AB or A FFP but we routinely give type specific in our MTP protocol. It makes me very nervous to think about crossmatched blood not being appropriately checked against the patient. We have been told to document MTP on paper which to me seems like it would be more labor intensive than scanning the units. We are also eliminated paper transfusion records with the exception of computer downtimes and MTP. To me it seems like the RNs would be less competent using a form that they rarely see (we do MTP once a quarter or less) than using the computer which they will become accustomed to quickly. Plus we are going to a new BBIS so our paper transfusion records will look completely different than they do today. Is it weird to any other EPIC users that EPIC suggests going back to the middle ages for the most critical transfusions? In general I am completely unhappy with BPAM and how immature and unfinished it feels despite being released several years ago. I'm very tempted to continue to use paper transfusion records until they can figure out how to make it better.
  8. I want to implement Verax but I'm waiting until we change computer systems in 2019 because our current system does not work for us at all. That will help a lot. I've only been at my hospital for about 6 months and we are not currently inspected by the FDA but I'm still trying to get us cleaned up to my standards before I invite them in. The closest hospitals don't have any sort of critical care or cancer center so they will rarely need a platelet. I have requested that they call us before the blood supplier since the are even farther from the blood center than we are. The one hospital that we could pawn them off on wasn't interested when I suggested it. We discard an average of 50-60 per year. As a former platelet donor, I would be devastated to know that the units I spent hours donating every few weeks were thrown out.
  9. We do not routinely stock apheresis platelets because we only give 10-15 per month. We perform a variable number of CABG procedures in our cardiovascular OR. Our current physicians require 2 platelets on hold in case they are needed but they rarely get used by the patient. If we are lucky we can use the same 2 platelets for multiple CABG procedures in a week or use them on our other inpatients but mostly they get discarded. We are at least an hour from our blood supplier so by the time we place a STAT order it usually takes 2-3 to get the product. My question is for other facilities that don't stock platelets but do perform CABGs. How many units of apheresis platelets do your surgeons want on hold? Do you end up discarding them? I'm wondering if I can convince my surgeons to only request 1 and if they need to use it, we can order another on a STAT run.
  10. We do our screens in gel but all of our ABO/Rh and rare antisera testing is in tube. So we wouldn't be changing methodology, just clones. I know each clone has it's own quirks. I'm hoping with our patient population that we wouldn't see a lot of discrepancies by switching clones. When we move to automation in a few years, I'm a little more concerned about discrepancies.
  11. Currently, my 200 bed regional hospital 45 minutes outside a metropolitan city uses Immucor Series 4 which contains MS201 and MS26 clones. I'd like to change vendors due to pricing. We only do weak D testing on cord samples or the rare investigation into a strong positive Fetalscreen sample or prior type discrepancy. I want to make sure we choose the most appropriate cost effective reagent for our hospital population. Does anyone have any suggestions on what to choose in the hospital setting? Maybe some pro's and con's for the different clones? Feedback on reactivity strength, etc? I'm considering the Bio-Rad blend.
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