kate murphy

Thank you so much! is there any calibration that you need to perform? Does using a Rad-Sure or something comparable per-batch show the proper dosage? There is a model out that has a self-contained water source. Anyone have any experience with that?

Our current cesium source irradiator is nearing its' usuable life span, where the time to irradiate will be getting too long. We are exploring our options to replace with either another cesium source or an x-ray irradiator in the next 5-8 yrs. Does anyone have experience with an x-ray irradiator that you'd be willing to share? What are the downsides, if any? What calibration/QC is necessary? Any additional regulatory burden? Training issues? thank you for your help!

There is a CAP requirement TRM.40690 about verification of correct data entry AND documentation of computer system alerts. How are you documenting that the techs are verifying data entry?

We've always been in the same boat at John Staley - a range, but need to average. Our performance tool includes the list mentioned as well as compliance with hospital requirements (timely TB, flu, annual safety training, etc) and BB requirements (timely manual sign off, completion of training, reveiw of new procedures, etc). We have a lab specific one that the lab managers developed and includes some section specific stuff: BB inventory control, Micro sterile technique, Chem/Heme instrument work. We look at quality and quantity of work. Troubleshooting, problem solving, willingness to help co-workers. And a whole lot of subjective comments. Not an easy task. One good thing that comes out of this is putting the responsibility for compliance is placed squarely back on the employee.

We do the same thing with Sunquest and our EMR (soon to be Epic). A fake patient in Sunquest, a paper form. We merge the fake patient with the real patient after the fact in Sunquest, so that the history is accurate. We are currently setting up Epic to go live in May 2014 and replace our current EMR. There will be an emergency release order in there. But all MDs agree that they want to continue to use the paper form and do the computer after the fact. In our experience, the FDA likes to see the signed paper forms. Not sure how we could show an inspector that if the only order for un-Xm was in Epic.

We've had an Immucor Galileo since 2006 - like it very much. We will be upgrading as the Galileo is sunsetting Dec 2014. I do like the Neo - several upgrades on the Galileo that should make life even easier. We did have an Echo for a short period of time. it did validate, but it missed some known antibodies, E, K FYa after about 4 months. It was removed. A Bio Rad Tango just came in yesterday to replace the Echo. No experience as yet. Though some local hospitals here love it. We do have 2 sites. If you cannot implement automation, try for electronic crossmatch at least. Automation is like having another tech, and electronic XM reduces stress while better controlling your inventory.

Hi goodchild, we use Sunquest. In the past, we've look at TAT for the ED only. Identify yesterday's specs, then look them up individually in Sunquest to see when that first ABO and screen result was done. Time consuming, but realistic for the location that really needs a Stat TAT. We found about 40 minutes for these specs. The ED is satisfied with the TAT, so it was just a baseline. I'll only look at it again if there is a problem or a complaint of a delay. Complaints of delay in the past usually involved a patient with an antibody. The trauma docs have a healthy respect for antibodies!

1. University hospital ~ 500 beds. Full range of service - level 1 trauma, cancer care, L/D, peds, NICU. Ave 1500 specs/mo and 1000 rbc/mo. Separate ABO confirmation spec required on all new patients - BB orders upon receipt of 1st spec, sends unique tube for this draw. Use electronic XM for most patients. 2. Stated Stat TAT is 60 minutes. 3. TAT from collect to results. Specs delivered to BB usually by p-tube, BB spins. 4. Primary method is Galileo, but stats usually done manual PeG tube. 5. No longer monitor TAT - difficult to do as specs are good for 3 days. Lab computer system TAT counts every new Xm as a new results, so TAT are unrealistically skewed. Hard to get the initially Type/Screen TAT.

The info we were getting was not much - the wounded came in so fast, there really wasn't time to get details. We got 7 critically injured in 15 minutes. Within 45 minutes, all the badly wounded were at some ER in the city. We learned we need to practice more with the ER - a REAL practice, with REAL coolers, runners, emergency release forms, wristbands. The ER staff was so focused on the patients, but so chaotic, that even getting a disaster wristband on a patient was not the priority for them. We've done 1 "live action" drill but others have been table top. Even the live action drill was not REAL - nurses stuck post-it notes on the victims - "transfused 2 rbc" but did not get the BB into the act. Not a real test of the system. On Monday, at the first disaster page, we got coolers ready - we had no idea how many injured or how badly they were injured. We set up 10 coolers of 4 units of O's. We have 4 AB FFP thawed at all times (our trauma center is always busy), but immediately started thawing 16 more. The ER wanted the coolers immediately - before the patients hit the door even. They had no patient name, med record number, disaster number, nothing. They thought we were unresponsive when we would not send just a cooler of O's. So we need to work with them on a system that meets both our responsibilities - theirs treating the patients and ours tracking the units/patients. Our path residents were a helpful liason with the ER. In 30 minutes, all critical injured were in the OR - each with dedicated team. Incredibly fast - and much smoother there, At this point we had good info on all the patients - how many amputations, bowel resects, vascular shrapnel injuries. So the real lesson we learned is that practice really does help, and the more "real" the practice is, the better. Develop contacts in the ER and work with them, so they know you and trust you - you WANT to give them the blood, but you NEED some info to do it! We are all on the same team!

Thanks to all for your thoughts. I'm at Boston Medical Center, we received 23 severely injured. Cliff is at Brigham and Women's and I think they got a similar number. As others have said, you never think it's going to be in your own backyard. All the Boston hospitals were terrific - you are right that no one died after the fact once we got them. But the real saving grace was the medical tent and a fleet of waiting ambulances at the finish line of the marathon. All the emergency rooms in Boston brace for dehydrated and hypothermic runners at the end of the race. Without the immediate response of these EMTs, RNs, MDs, many more would have died. We used 72 units of red cells that first night. Somewhat more than our trauma room normally uses! One great point - we practice at least a couple of times a year for a mass casualty event. Our system was not perfect, but better than anyone anticipated due to the disaster training and planning. Plan for the worst, hope for the best. The outpouring of support from everyone has been asstounding and humbling. We utilize the AABB National Blood Exchange for 99% of our blood products. Blood centers across the country were calling us and offering us O's. Our sports teams - Red Sox, Bruins, Celtics - have had incredible receptions at other city arenas. Incredible!! THANK YOU!! We are not alone. You are with us. We are BOSTON STRONG!!

Thanks Cliff!! You've outdone yourself! Raining hearts!!

It's not a CAP requirement, but a Joint Commission requirement. I would imagine that somebody on staff is knowledgable about JC requirements. You need to be able to track the unit to a particular patient. So you need some identifier. The FDA requires that all blood be tracked to a "final disposition" - transfusion into a patient is a final disposition. We're a large trauma center, so we use trauma packs described here by others.

Lalamb - Very nice!! Particulary liked the competency! Thank you for sharing!

There's several choices. E2984 = Apher Plt Open Irrad ResLeuk <5log6 Plasma reduced E2999 = Apher Plt Open Irrad Plasma reduced E3015 = Apher Plt Open Red Leuk <5log6 Plasma reduced E3030 = Apher Plt Open Plasma reduced

We use saline when we wash platelets. The final ISBT code depends on what you start with. Apheresis? Irradiated? Leukoreduced? You can search the database for what matches your product. We use strictly apheresis platelets, all are irradiated, all are leukoreduced. We use code E4493 = Washed Apheresis Platelets/Irradiated/RedLeu < 5log6/count not encoded.

We require 2 specs on every new patient. And a spec from this admission before giving plasma products or platelets.

We also result them as "electronically compatible".

I agree. Standards are effective 11/1. Just as a note: my AABB window is Oct-Dec. This year, the assessors tried to come in Oct, but were delayed due to hurricane Sandy. They came 11/7. And held us to the NEW standards. It pays to do your homework and be on top! We did okay!

We call most orders. We use electronic XM, so unless there is an antibody, no units show in the EMR that they are ready. P-tube is the primary method of getting units to the floors. The nurse sends a "Blood Products Requested" slip with pt info and what product they'd like and the destination tube station. The BB has red canisters that are used only for blood transport. Nursing must send back the Request slip to verify receipt. We call to track them if the slip isn't returned in 15 minutes. The same Request slip is also used for manual pickups, as we will not tube rare units. Nursing, residents, transport personnel are approved to pick up units. We used the AABB booklet to validate the p-tube. EMR has separate "nurse to transfuse" orders. The BB audits some every week. Nursing responsibility for ensuring that consent is obtained. We assume every product that is issued is transfused. Again, audits of a small percentage every week show (mostly) proper documentation. Good luck!!

I'm in a moderately sized place (500beds) and we do protocols: BB staff enter the protocols right into the computer when we first see a patient. We do not rely on physician orders, many residents have no clue about transfusion medicine. I agree that it's safer for the patients, but much depends on how knowledgeable your clinical staff is.

We are also using MediaLab. Quite economical and compentency is also possible with the same system.

We plan to use isotonic saline. As we have with the old FMH. No issues.

Hi Jana, Completed the survey. Good luck and have fun!!

Just an FYI - we are am extremely busy level 1 trauma center - at least 5 emergency release patients per day. We were cited by FDA and AABB 2 years for having a "designee" (RN) sign the form. Both FDA and AABB stated that the ORDERING licensed provider (MD, PA, NP) MUST sign the form. A time frame was not stated - both agencies agreed that before or shortly after is okay, but the ORDERING person must sign.

We do the same, even though we are all computerized, electronic med record, auto-generated printed labels - no additions, corrections, deletions once the spec is in our paws. Spec/requisition must match. Two signatures - person drawing, person verifying identity of patient. One question, why do you insist on the middle name? We use Last, First name and MRN.