kate murphy
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Posts posted by kate murphy
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I'm still searching - there are a couple of companies coming to show me what they've got, File Net included. I did look into NEAT - but the files are cloud based - something we frown on. I will keep you posted as to what turns up!
thanks! Kate
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I'm looking to see if anyone is currently scanning AB ID workups into a searchable database.
We're are losing space and I will have no home for the file cabinets with all our past panel workups.
We use these frequently when a patient comes back in and we'd like to know how the current panel compares to past panels.
A cursory search has not shown any software/database that might meet our needs.
So before I drive myself any crazier than I already am - is anyone using anything like this and maybe recommend something?
Thanks!
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The NBE and I'm assuming Gen'l Blood use AABB members, FDA licensed facilities - they must be to ship over state lines.
We have never had a problem with a hemoylzed unit, a mislabeled unit, or other quallity issue.
All suppliers that we've dealt with are ISBT and have been for many years.
Shelf life varies. You will know before your blood arrives what the dating is. Some centers give a discount for units with short dates (5 days or less).
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I've not heard of any benchmarks to compare. As DPruden stated, finance would be your best bet.
But, we don't transfuse a diagnosis or acuity. We transfuse individuals - not everyone with the same Dx and acuity will use the same amount of products.
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We use the NBE as our general supplier and have been for about 15 years. Moderate sized (550 beds), very active trauma. General blood did contact us, and analysis showed no savings over using the NBE.
David, you are correct that once you get the blood, it's yours. No returns. We're in Boston, so we have many neighbors and we share well. We do tend to outdate more A's than the norm. But we still save LOTS - about $1M annually.
Using a broker, like NBE or Gen'l Blood, gives you multiple suppliers. We find we are less liklely to experience shortages, regional or seasonal. It does take a little planning and time - your blood & components will come in tomorrow, not today.
My advice is if you are interested, start small - about 10% of your usage. It takes a bit of work to get your computer system in sync. You can increase as you like over time.
Any you always need a contract with your local supplier for those emergencies or disasters.
And I'll definitely plug for the NBE - open to AABB members, great knowledgeable people, always available, they've been doing this for years and know what's going on!
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I am a big fan of using standardization. Especially in this age of generalists.
That said, we do the exact same thing for every reaction workup - clerical check, post ABO/Rh, DAT, visual hemolysis inspection, other tests as indicated by reaction.
Less confusion for the techs - a reaction is a reaction.
- L106, David Saikin, Dansket and 3 others
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For the blood bank, we're also going to issue group O rbc and AB FFP.
We are fortunate to have a BSL3 lab in our Micro dept. We see a lot of TB and virology. We have purchased iStats and a Piccolo - point of care instruments - for stat chemistries, H/H and blood gases done under the hood in the BSL3. We have Tyvek suits and PAPR hoods. Signature Elite for PT/PTT in the hood. No testing done outside of the hood. Very limited lab menu, testing time coordinated with the lab - not on-demand.
Convalescent plasma is another issue. We will do A and B slide testing in the hood only. Rh(D) slide testing only for an OB patient. No centrifugation of any blood specimen. My director and I are going back/forth on even that. 1 unit of incompatible convalescent plasma is less risky to the patient than testing is for us. That amount of plasma is in a bag of pheresis platelets that are given out of type all the time. But it's not my license on the line. Convalescent plasma is not an FDA approved product, investigational compassionate use.
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I'm in a teaching hospital and have the luxury of a board cert Trans Med Hematologist as our Medical Director. She is actively involved in reviewing all workups, and teaching path residents at the same time. It's a group effort sometimes! That said, there is no special documentation in the computer system. Techs interpret and enter results. Our medical director is involved (through the residents) to communicate to ordering docs (more residents) of extended delays in screening for compatible rbc, or teaching all residents when to defer transfusions.
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We also do this, but not in response to 8.2.
I think your assessor interpreted the standard. It does not state that you need to observe.
You need an audit for 'patient identification' but that also includes specimen collection. 'Blood admin policies' need to be audited.
If you have a way to effectively audit all the points listed in 8.2, then I would say that you meet the standard.
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I agree - in the middle of a massive or while the patient is on the table in the OR is a bad time. We've successfully lobbied Admitting to wait till the patient is in a bed on the floor (usually SICU) and merge ONLY after speaking with the bedside people. Small concession - but the impact could be large downstream. Since most of these traumas end up in SICU, we've got them trained now to draw a new BB spec when they put the new armband on.
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We do much the same as everyone else for merges - get a new spec ASAP. If the need is urgent, we will continue with emergency release and make the doc sign.
The hospital wants to merge - there are bigger requirements than ours. Joint Comm has a requirement to check past records for allergies, drug histories and diagnoses. So we need to think of the big picture and fit ourselves into the puzzle.
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I'm sad that we're not the only ones with trying to convince Admissions to follow a protocol when changing Med Rec #s! Seems like a universal problem! I think we've finally gotten them to stop changing numbers while the patient is still on the table in the OR. Shudder...
We usually merge when a "real" identity is known - a real name and a real birthdate. If the patient is in our system with older data, we use the older #. If not, then a new MRN is assigned. Either way - we merge when the wristband changes. Then we need a new spec, as the old spec doesn't match any longer.
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We've had tissue for 5-6 yrs now. 21 CFR 1270 generally applies to recovery and manufacture of tissue and tissue products.
Most of the standards for storage/dispensing are Joint Comm and AATB.
For lookback, we use the same policy as for blood.
For adverse events however, there is a larger emphasis on post-op infections, which the Joint Comm is VERY interested in. You will need to convince Inf Control that they MUST be involved. Most of the reporting necessary has to go through Inf Control as it also involves the OR and the method of preparation and implantation. I'm sure they are already following infection rates for all the ORs and each surgeon and reporting these to the state DPH and perhaps as well as CDC on line. At least in my state (MA) there is a requirement to report and the DPH is using the CDC National Healthcare Safety Network for all adverse events and infection rates. This is just another aspect of that.
Joint Comm has a whole chapter on human and non-human tissue.
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I agree with Malcolm. Exsanguinating patients with known antibodies is a clinical decision - we explain that there is a risk of hemolysis at the most. It's their decision. Sometimes the risk of bleeding to death outweighs the risk of hemolysis. Our medical director is always available to answer questions if needed. In these cases, we make sure to get the doc's name if not his/her signature before issuing.
We also do the "happy meals" scenario - 2 O Negs and 2 O Pos always tagged ready to go on a fictitious patient only in the lab computer system. We're a very busy trauma service - we need a billing or account number at the minimum which we scribble on the unit tag. Takes 2 seconds. Frequently we send units to the ED while the patient is en route. Often we have multiple patients at the same time. We complete paperwork after the fact and merge our fictitious patient with the real patient. Occasionally, we need chart reviews to verify who got what when. But by and large, our ED staff is pretty good - the trauma rooms are separate from the ED main rooms, so keeping all the paperwork in one place is easier
If your ED is not routinely dealing with traumas, it's hard to maintain units tagged and ready to go.
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There are now a few more choices available to us. And you do not have to do all the leg work.
AABB runs the National Blood Exchange is a clearinghouse and is open to all AABB members.
General Blood Exchange (exchange.generalblood.com) is another independent exchange started in the last few years.
Blood Buy (bloodbuy.com) has just contacted us as another possible source. I think they are new, I don't know their track record.
We have been getting 99% of our blood through the AABB NBE for the past 15 years. It takes a little bit of time to establish your routine and build up some relationships. Currently we have standing orders with 3 suppliers and ad hoc the remainder. We are able to flex up and down, and rarely have shortages. We have never canceled surgeries due to a shortage.
One caveat: we tend to outdate more platelets than a benchmark.
You can start small - 10% of your needs. See how it goes.
We still maintain a small standing order and a contract with our local supplier.
We save on average $1 M annually over our local supplier. There is money to be saved, especially if you are in an area with a single supplier. As noted above, no competetion tends to inflate prices.
Worth the time and effort.
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Prices do vary across the country. If you or your institution is an AABB member, you can access the National Blood Exchange. Blood centers or hospital collectors post inventory they are willing to share and ship. There are some that will contract a standing order. Price varies and includes shipping. I will say that we do save alot of money annually using NBE. Also, using several suppliers through NBE leaves us less vulnerable to seasonal and regional shortages.
It takes a little bit of planning and we carry a slightly larger inventory for our size, as blood is shipped overnight. We are a >500 bed incredibly busy level I trauma center.
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We require a separate spec from a separate draw.
We use a small white top, no additive, that is not used for anything else.
The tube is not orderable from supplies by anyone other than the BB.
The BB controls the process. We order an ABORH and send the tube and label to the floor for patients with no history. If it's a floor where phlebotomy draws, we'll page them to draw it. If not (ICU's, PACU..) we'll call as ask them to draw.
We do not use another other spec from any other lab.
We started this several years ago, way before we did EXM.
We wanted the nursing/resident staff to know the process, even though we control it.
Even traumas, there is a process when the 1st spec is delivered, we automatically give them a white top.
We've seen our WBITs drop significantly. Not a large number to start, but much smaller now.
- Malcolm Needs and tbostock
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We use leukoreduced as CMV safe for everyone, including neonates.
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Yes, there is. In BMA (Blood bank maintenance), option 4 Testing definitions, option 4 Reaction result patterns, option 1 Reactions.
This is where all reaction patterns are defined and you can define a MF equals a Pos reaction or a H (hemolysis) equals a Pos reaction.
There are Reactions, Phases and Tests. Think of the Reactions as 1 test tube, then the Phases the readings you make at different steps, then all these results make up a Test.
A Blood Type Test includes an Anti-A, Anti-B, Anti-D, A cells, B cells.
There is only 1 Phase, IS reading for a Blood Type.
Screens will have more than one phase.
But the basic MF is defined in Reactions.
Hope this helps.
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We did the same thing 2 years ago, though the service is provided by the Dialysis contract nurses. All our inspections (AABB, CAP, FACT) want to see that the BB Medical Director is involved in policy and procedure making. We amended our quality plan with a statement to that effect.
Malcolm is coming to town.......
in Education / Quality
Posted
Wooohooo - road trip from Boston!