carolyn swickard

We still do our Transfusion Reactions all on paper (due to the fact we got a little too fancy with our computer attempt in Meditech and could never get it to work!) and I do a single, flat manual charge for the procedure at the end when the pathologists are done. The paper work is then sent back to the chart (I keep a copy) and we scan the papers into the new EMR. If someone could share the CPT code (or whatever code) for the pathologist part, I would appreciate that. I'm sure my pathologists could use the charges. Thanks.

"Be aware that after rbc's are issued uncrossmatched, Meditech does not allow computer crossmatch of those unit(s) regardless of a negative antibody screen, no history of clinically significant antibody and two blood types done." Quote I'm not sure I understand this last statement. Our Meditech system (not set for electronic crossmatch) will allow us to input crossmatch results on units that were released under Emergency Issue Units. The units will be on the correct Type and Crossmatch specimen if you are careful while releasing (and the specimen does already exist) or you can move the Type and Cross to the specimen the units were relesed under. Again, this can be one specimen if you take the time to override NEW and find your specimen. After that, the units, which are already in "Issued" status, can be opened on the Result Entry Screen with a <shift> <right arrow> and the results entered so you an complete the crossmatch results. Your Meditech system doesn't work that way? Because of the electronic crossmatch setup? Just curious.

We used to use a slightly modified UBS transport box for our in-house transport needs - used them for years and never validated them. Now we would have to validate them or anything else we chose to use exactly as we have rigorously validated the Credo coolers we do use now.

I think you will have to put the FFP in a different cooler than the RBCs. FFP is frequently just too warm to put with RBCs. You never know what temp the FFP is going to start out at - fresh out of the thawer or stored in the refrig awhile or somewhere in between. I think the best FFP could be validated for is that it comes back as cool or cooler than it left - nothing else will work if you are thawing at need for O.R. You could use the BioSynergy, Inc Hemptemp IIs to monitor the return temp, but the "irreversible" temp flower will be worthless if the FFP leaves warm. We put a one hour return time on FFP and do not convert any returned FFP to Thawed Plasma (we maintain the original 24 hour expiration time) - those would be my only suggestions. Good Luck

I am with the others - you need a specimen as soon as possible. We have become a "Stabilize and Ship" hospital and I am beginning the have troubles getting a specimen from ER when the patient leaves in a hurry. Still ridiculous - our last patient was here over 1 hour and took 8 units here and 2 units to go and they still couldn't get me a specimen! If your hospital is Joint Commission accredited, look their standards over and see if you can find something to pound on them with, AABB recommendations are very clear on the subject and it does endanger the hospital as a whole if you can't prove the blood did not contribute to the death or injury of the patient. That said, maybe your Risk Management dept. could help you out.

The X-ray irradiators (one manufacturer is Best Theratronics of Canada) don't require the same level of security as the gamma irradiators. They are not an active " radioactive source" that could be stolen, like the gamma sources are. Security requirements on gamma irradiators are very extensive. Both are very expensive (>$200,000) and the x-ray irradiators have a very expensive maintenance contract also. Both are easy to run and easy to train on. Both are very heavy and require proper floor support (if you are not on ground level). The x-ray irradiator from Best Theratronics requires a good, cool water supply for cooling also. There may be another x-ray unit out there by now that doesn't need the water cooling, but I don't know the manufacturer. We have the Best Theratronics x-ray unit - Raycell - and irradiate approx 100+ units a month. We are barely breaking even on the investment, so don't know if you could manage it with your current volumes. No way to tell where the volumes are going on this either. We have a new set of oncologists here who hardly irradiate anything for their patients. They are following different guidelines, I guess. In the US, if nothing else qualifies you for it already, the step of irradiating your own units makes you a manufacturer and the FDA will start to visit. That makes for it's own set of headaches. I would recommend a lot of research first - and a good look at what your blood distributor does - they should have good, current information on the topic. Good luck - it is a complex choice.

Just a further question on this subject, please. We are expecting Joint Comm for our first inspection with them in Oct - (now that I have this to worry about too) - can anyone tell me what kind of opaque, plastic ziplock bags they are using?? Which manufacturers? Might as well solve all the problems at once.

I'm just going to say - I really don't ever want to work in a hospital without a Blood Band ID banding system. Unless you have gone to one of the new (very expensive) systems that allow the patient to be identified by barcode scanners at every point of the procedure (and again, how many "shortcuts" can be found even to those procedures?) - the separate BB ID band is the only thing that closes the circle between the draw - the pt, and the unit that goes back up to the pt. Yes, they are complex (we use the new Typenex barcoded band even though we do not yet have a BB qualified bedside barcode ID scanning system) and yes, we have redraws because the draw are not always completely correct (requires a redraw), but because we also require the RN to go back to the bedside and obtain that barcode number before they come down to pick up a unit and we compare the barcode numbers before releasing the unit, we have been alerted to errors several times that could have lead to a wrong patient getting the wrong unit. In the more than 20 years I have been here - we have not had that error make it to the point of transfusion - for which I am infinitely grateful! Yes - someone could still give the wrong unit to the wrong pt, but in order to do so, they are going to have to break a lot of rules - probably deliberately and I would have no trouble getting rid of someone who was willing to make that many "shortcuts" in the transfusion/patient ID processes. Just my 2 cents worth.

I don't know if this will make sense or not, but our Meditech ABSC (a ABS test) is made up of the T tests that allow us to result the screening cells into the computer and then the calculation interprets the screening cell results and results the ABS test "ABSC". Only the ABSC interpretation transmits to the chart, so that will probably be like the piece needed by the computer to allow the system to see a "positive" or "negative" ABSC. We have not tried for elexctronic crosmatching yet, but that is how our system handles the ABSC. Good luck - ain't Meditech fun!

Meanwhile - the ECHO is a good, small volume instrument that is being well supported by Immucor. We have had one for 4 1/2 years now and it is still going strong. Not perfect - no platform or testing system is - but strong, reliable and enables us to keep up with testing even during staff shortages. Easy to use and easy to work on - just make sure you can get a high-speed internet connection for Immucor so they can do the remote diagnostics.

When I click on my name - all I get is half of a box that says "What's on your mind?" - nothing else and the box will not open any farther. Any other suggestions?

Hi Cliff - Just another question - I logged on and clicked on my name in the upper right corner - but all I see is a question box "What's on your mind?". i don't see a Settings box and can't get the field to do anything else or open farther. The system recognized me still (always a surprise to me!), but I can't seem to get to My Settings to put my Avatar back up - I miss him. Thanks, Carolyn Swickard

We have a specific Blood Bank ID band and we also follow the Medical record number and the hospital account number (encounter number). If they stay the same during the name change - we reprint tags and are OK to issue. (also on Meditech) The only time the medical record number may also change is if the pt comes in as an "unidentified" and is sssigned the next MR# in line and then they find the pt has an older number - still have the BB ID # and the Hospital's number to keep the pt straight. Even given all that - as soon as possible - if there is no emergency event going on - we will redraw with the new name and use the new ID for as long as it lasts. Admissions is tasked with making sure all of the alias names are rechanged to the real name after the pt is discharged so the records will be all together, but I have seen many instances were it doesn't happen. All in all, alias names are a real mess and I do wish they would avoid them on Blood Bank pts - but might as well wish for the moon.

If the antibody is detected on our ECHO, we run a panel on our ECHO (just one). If that doesn't give us all we need, additional work is done in tubes with PEG (which is as close as you are going to get to solid phase in tubes, but is generally weaker.) Solid phase Warm autoimmune antibodies we attempt to see under by gradually reducing the strength of the enhancement medias - we use PEG, then LISS, then a 1 hour 37C incubation with no enhancement medias - usually just with the trio to see how it is going. If the Warm auto is still reacting - off it goes to the reference lab for adsorbtion studies and all the rest of that wonderful hard work they do. Whether or not we are going to be successful usually depends on the strength of the DAT - which we still do in tubes. We do the IgG only DAT on the ECHO too, just to see what the pt is doing and because there is no auto ct on the solid phase panels, but repeat the whole thing in tubes to report the complement DAT. Hope this helps.

We just started with a company that might be able to help you if you are in the States. Calibrate, Inc. 800-253-7064 They come on site and do your pipettes (gravimetrically). They have mostly done private labs in the past and are just starting to see the market in hospitals. See what they say.

If you haven't started a blood management program (lower transfusion triggers, etc), try to push for that too while trying to get a transfusion committee started - or just make it a blood/blood products management committee to begin with! The money saved with true blood management practices completely dwarfs any reagent savings you can even think about and(!) puts some of the onus for cost cutting back on administration and the Drs - where it truly belongs. Good luck and let us know how you do - the rest of us will probably need the help soon too!

recommended by the wonderful SBB who has been my mentor and friend for several years now.

I'm getting the impression (as we transistion from CAP to Joint Comm) that this is the way they feel about it too. Looks like you (the supervisor) can to be deemed "competent" only by someone who is also deemed "competent" in your department. That is usually not the Lab Director and may not even be the Technical Supervisor (for Immunohematology this is the MD in charge of Blood Bank) over Blood Bank. Does that mean you establish the competency of some senior team members (if you have any) and that they then establish your competency - sort of peer review? Has anyone been inspected by Joint and addressed this?

Blood Systems Inc - (also know as United Blood Sevices) has a Blood Management program they are offering to hospitals also. If you happen to be one of their hospitals, they can help with startup and maintenence - but it is expensive. Also - even with the data from their program, you are going nowhere without a strong physician advocate and training/monitoring program pushed by Administration. Once Administration sees the monetary figures involved in Blood Management programs, they are excited - but if they expect the Blood Bank team to enforce the "expected rules/ranges" without a lot of support, your team is in for a miserable time.

Did it go out high or low - what were your temps when it aborted?

We just repeated the daily QC and 2 pts we had done just before the upgrade - put it all together and filed it. Makes us feel better.

Don't really know what half of this means - but for our system, when we changed from Cerner Classic to Meditech we kept acces to Cerner data for Pathology and Blood Bank on the original alpha drive. It is completely separate and has to be accessed independently, there was no crossover to the new system. Any history from the old system to the new system has to be moved manually. Our archive has recently been moved to a more modern storage system but is still completely separate. We access it as needed. Would have loved to have been able to transfer all of our historical data to the new system, but that did not seem to be an option. I'm sure most Blood Bank systems would love to be able to incorporate all original data into a new system, but the hospitals would have to be able to afford it too. They would also have to know the option exists and the big Lab software vendors would have to work with it on their individual platforms.

No pH meter here either - but our pH paper gives a reaction of 5 and it is tested against a stable "set pH" fluid from pathology, so I think it is OK. Never though of the UA dipsticks. Good idea.

Yikes! Nasty surprise! Good luck in the future on this pt - should be about done with new antibodies by now.

W use phosphate buffer saline because that is also what we need for Immucor solid phase reagents and strips. Check the pH of your unbuffered saline and see where it comes in. Ours comes in at a pH of 5 before we buffer it. That was a surprise.