carolyn swickard

Plasma is hard to keep track of just by temperature alone.  If you are in a hurry - there is a good chance the plasma is going to be warmer that 1-6C when it leaves the Blood Bank to start with.  Even in a separate cooler, that means the temperature monitoring tabs won't work and there is no way to know what happens to the plasma that way.  Data loggers wouldn't work either.  Difficult situation. 
We will only accept plasma back if it is cold and in it's own cooler and will only keep it for 24 hours.  We do not extend FFP (any type) that was issued and returned into a Thawed Plasma product either.
 

Plasma is hard to keep track of just by temperature alone.  If you are in a hurry - there is a good chance the plasma is going to be warmer that 1-6C when it leaves the Blood Bank to start with.  Even in a separate cooler, that means the temperature monitoring tabs won't work and there is no way to know what happens to the plasma that way.  Data loggers wouldn't work either.  Difficult situation. 
We will only accept plasma back if it is cold and in it's own cooler and will only keep it for 24 hours.  We do not extend FFP (any type) that was issued and returned into a Thawed Plasma product either.
 

Plasma is hard to keep track of just by temperature alone.  If you are in a hurry - there is a good chance the plasma is going to be warmer that 1-6C when it leaves the Blood Bank to start with.  Even in a separate cooler, that means the temperature monitoring tabs won't work and there is no way to know what happens to the plasma that way.  Data loggers wouldn't work either.  Difficult situation. 
We will only accept plasma back if it is cold and in it's own cooler and will only keep it for 24 hours.  We do not extend FFP (any type) that was issued and returned into a Thawed Plasma product either.
 

Dear God, you have my deepest sympathy. 
1.  Push the company to give details on their benchmark standards and where they come from.  Chances are, you are not in the same boat.  We had a similar problem here because our Micro and BB staffing for the weekends did not meet corporate standards (desires), but we were unable to cut staff because of the physical layout of our facility and the distance between the departments. 
2.  Your situation matches one hospital I know of, if you could contact them - University Medical Center, El Paso, TX.  The Blood Bank is in the Main hospital and the main lab is way across the parking lot.  They are a level 1 trauma center and a big surgical hospital, but the NICU is in a separate hospital next to them and did have it's own Blood Bank staff.
3.  Do you have current FTE numbers that justify your current staffing?  What is the difference in the "factors" in the staffing equations that are being used that lead to this new company coming up with their figures vs. your current FTE figures?
Good luck.  Patient safety arguments sometimes sway Administrations when nothing else will.  If you can make a case for how dangerous it is for the staff of a Trauma center to be too little, too late - maybe it could help.
 

Dear God, you have my deepest sympathy. 
1.  Push the company to give details on their benchmark standards and where they come from.  Chances are, you are not in the same boat.  We had a similar problem here because our Micro and BB staffing for the weekends did not meet corporate standards (desires), but we were unable to cut staff because of the physical layout of our facility and the distance between the departments. 
2.  Your situation matches one hospital I know of, if you could contact them - University Medical Center, El Paso, TX.  The Blood Bank is in the Main hospital and the main lab is way across the parking lot.  They are a level 1 trauma center and a big surgical hospital, but the NICU is in a separate hospital next to them and did have it's own Blood Bank staff.
3.  Do you have current FTE numbers that justify your current staffing?  What is the difference in the "factors" in the staffing equations that are being used that lead to this new company coming up with their figures vs. your current FTE figures?
Good luck.  Patient safety arguments sometimes sway Administrations when nothing else will.  If you can make a case for how dangerous it is for the staff of a Trauma center to be too little, too late - maybe it could help.
 

Dear God, you have my deepest sympathy. 
1.  Push the company to give details on their benchmark standards and where they come from.  Chances are, you are not in the same boat.  We had a similar problem here because our Micro and BB staffing for the weekends did not meet corporate standards (desires), but we were unable to cut staff because of the physical layout of our facility and the distance between the departments. 
2.  Your situation matches one hospital I know of, if you could contact them - University Medical Center, El Paso, TX.  The Blood Bank is in the Main hospital and the main lab is way across the parking lot.  They are a level 1 trauma center and a big surgical hospital, but the NICU is in a separate hospital next to them and did have it's own Blood Bank staff.
3.  Do you have current FTE numbers that justify your current staffing?  What is the difference in the "factors" in the staffing equations that are being used that lead to this new company coming up with their figures vs. your current FTE figures?
Good luck.  Patient safety arguments sometimes sway Administrations when nothing else will.  If you can make a case for how dangerous it is for the staff of a Trauma center to be too little, too late - maybe it could help.
 

Dear God, you have my deepest sympathy. 
1.  Push the company to give details on their benchmark standards and where they come from.  Chances are, you are not in the same boat.  We had a similar problem here because our Micro and BB staffing for the weekends did not meet corporate standards (desires), but we were unable to cut staff because of the physical layout of our facility and the distance between the departments. 
2.  Your situation matches one hospital I know of, if you could contact them - University Medical Center, El Paso, TX.  The Blood Bank is in the Main hospital and the main lab is way across the parking lot.  They are a level 1 trauma center and a big surgical hospital, but the NICU is in a separate hospital next to them and did have it's own Blood Bank staff.
3.  Do you have current FTE numbers that justify your current staffing?  What is the difference in the "factors" in the staffing equations that are being used that lead to this new company coming up with their figures vs. your current FTE figures?
Good luck.  Patient safety arguments sometimes sway Administrations when nothing else will.  If you can make a case for how dangerous it is for the staff of a Trauma center to be too little, too late - maybe it could help.
 

"Tube testing is notoriously variable, while gel testing is believed to reduce some of those nuances. "
Yes, but it is also - according to years of CAP survey results - routinely 1-2 endpoints higher on every titration run.  So, make sure you are telling your physicians that your facility is doing titers with gel and that the actionable titers for their patients might be at higher endpoints than those historically with tube testing.
"It does need to be reliable/robust and give the same end point each time, even with the acknowledged variations in serological tests (reagents, test cells, techs, etc.)"
I wonder if the inspector would have been OK with procedures with this kind of control if it was used when there was no retained sample (no control avail) and not used when the new specimen was run in parallel with it's retained pair (internal control avail)??  I guess we will have to see, because that is what we are going to try doing.
 
 
 

While I would not use leukoreduction as the primary method of preventing transfusion associated graft versus host disease in high risk patients, there is evidence that it reduces the incidence of this complication in patients not conventionally thought to be immunosuppressed.  These data are from the UK haemovigilance reports.  Lymphocytes are not killed by irradiation, but they cannot successfully proliferate, which is necessary for graft versus host disease to occur.  These  UK data make one wonder what the heck the USA experts (AABB and FDA) are thinking in not mandating universal leukoreduction 20 years after it was implemented in France, UK, Canada, etc.  So little cost, so many benefits. Three FDA committees have voted overwhelmingly that universal leukoreduction is clinically sound policy.  No action.  Many pleas to the AABB. No action.  This is one of the most cost-effective and important innovations in transfusion safety in the last half century.  It reduces suffering, morbidity and mortality.  It's cheap and easy.
 
The impact of universal leukodepletion of the blood supply on hemovigilance reports of posttransfusion purpura and transfusion-associated graft-versus-host disease.
Williamson LM, Stainsby D, Jones H, Love E, Chapman CE, Navarrete C, Lucas G, Beatty C, Casbard A, Cohen H.
Transfusion. 2007 Aug;47(8):1455-67.

Our hospital did a good job of sequestering the available saline and saving it for specific uses last time this happened.  Pharmacy kept track of it and did a good job keeping enough available for transfusion and other saline specific uses.  They used some of the other solutions to replace saline use for reasons other than transfusion where they could.  Maybe that would be a better/safer way to go?

Just curious but did they indicate what the penalty would be for not complying?   

Yeah - those darker ones are sneaky...

Yeah - those darker ones are sneaky...

http://nybloodcenter.org/media/filer_public/2017/10/04/2017aabbpostervelliquetteserological_observationsfinalcp246.pdf
Apparently, weakly pos to negative DATs are common. Because the antibody covers cd47, the body sees the lack of cd47 and targets the cell for destruction. 

We are a similar size hospital as you with a Level 3 Trauma. We use Sunquest with electronic crossmatch. What you are describing as performing the crossmatch at the time of order defeats the biggest advantage of electronic crossmatch ... inventory control. For patients who are electronic crossmatch eligible we only crossmatch the unit at the time the unit is requested to be issued for transfusion. So that clinical staff know that we are not "ignoring" the crossmatch order we created a comment "Blood will be crossmatched when the order to transfuse is released. Contact the blood bank when ready to transfuse." This comment is resulted on the crossmatch order and goes to the patient chart. We have a box on the counter where we issue units that we keep the original crossmatch order in so we know what patients are currently electronic crossmatch. The tech that works that bench goes through it every morning to weed out the ones that are expired. When we receive the transfuse notice we pull the order out, match it to the transfuse order, do the electronic crossmatch and immediately issue the unit to the location (we tube units). If the original order was for more than one unit, we update the number of units on the paper order to reflect how many units are left on the order. The computer of course keeps track of it automatically as units are crossmatched and issued. Works well for us.

Believe it or not - if you are in a hospital - check with your own pharmacy.  Ours stocked glycerol in the pharmacy for use on dry skin.

Also - examine your Joint Commission Standards if your Lab happens to be under Joint Commission accreditation. 
QSA .05.18.01 - section 2 and 3 state in part:
 2.  The requirement that suspected transfusion reaction-related adverse events are reported immediately to the laboratory, whether or not the physician responsible for the patient deems it necessary to report the event.
3.  Policies and procedures for nursing services related to blood and blood component administration do not conflict with the laboratory's policies and procedures.
That is fairly definitive about what they want to see and it differs from CAP.  We had to change from " what does the physician want to do" to "we need the Transfusion Reaction Workup" if we hear about it at all.
Curious as to what Hospital Joint standards say about the whole thing - I have never seen that set of standards.  And most hospitals are accredited by Joint Commission, even if their Labs are not.
 
 

Also - examine your Joint Commission Standards if your Lab happens to be under Joint Commission accreditation. 
QSA .05.18.01 - section 2 and 3 state in part:
 2.  The requirement that suspected transfusion reaction-related adverse events are reported immediately to the laboratory, whether or not the physician responsible for the patient deems it necessary to report the event.
3.  Policies and procedures for nursing services related to blood and blood component administration do not conflict with the laboratory's policies and procedures.
That is fairly definitive about what they want to see and it differs from CAP.  We had to change from " what does the physician want to do" to "we need the Transfusion Reaction Workup" if we hear about it at all.
Curious as to what Hospital Joint standards say about the whole thing - I have never seen that set of standards.  And most hospitals are accredited by Joint Commission, even if their Labs are not.
 
 

Some of our cancer patients are transfused while febrile.  They can go with a fever for days, so rarely, they have to transfuse in the face of the fever.  Impossible to determine if they might have a febrile reactions on top of the fever.  The RNs look for the rest of the signs and symptoms possible in transfusion reactions.

We have a canned comment that says " Anti-D detected is presumed (you might want to make that "possibly" or something less) to be due to Rh immune globulin given...." and then we input whatever date is given to us from phone calls, computer searches, questions to the pt, etc.  Some of my techs are now also putting in the source we receive the information from ("chart", "computer", RN's or clerk"s name, etc.)  The computer puts the comment on the chart.
hope this helps.  

We always get or have an historical Blood Type and frequently get the (roughly) 28 week antibody screens from our outpatients, but we do not require the antibody screen results before giving antenatal RhIG.   On any of the numerous(!) positive antibody screens on Rh Neg moms, we always have to call and ask about the last known RhIG injections.  With an ECHO - you can detect RhIG for months.  We almost always get a Type and Screen for all new admits on L&D too - almost all of them who are Rh Neg have a positive antibody screen for anti-D.  Much of our Rhig is now given in the Dr's offices and clinics. 
In the ER, we have a computer reflex test that adds the Antibody screen to any ABORh ordered in the ER that comes out Rh Neg.   This has worked out well for our OBs because otherwise, by the time they see the pt and ask for the antibody screen - it is positive from the RhIG given in ER.  We went to the hospital OB committee and asked to do this (once we could get the computer programmed to guarantee it would happen) and they happily agreed.

We transfuse febrile patients regularly. The nurses look for an elevation in temperature (1.5 C) above the starting temp to call a febrile reaction. I don't feel that we are doing a large number of workups simply because the patient transfusion started with an elevated temp.

Some of our cancer patients are transfused while febrile.  They can go with a fever for days, so rarely, they have to transfuse in the face of the fever.  Impossible to determine if they might have a febrile reactions on top of the fever.  The RNs look for the rest of the signs and symptoms possible in transfusion reactions.

We use the Fisher Scientific borosilicate glass tube cat # 14-961-26.  it does not have this statement anywhere on the individual box, the carton or the website catalog description.   We also write on them with Sharpies.
Anyway - what does that statement "For Research use only. Not for use in diagnostic procedures."  even mean?  What context/use does the manufacturer mean?  Have you found anyone to ask?

Mabel, ours is a little different than our emergency release, in that the provider has to sign it prior to issuance of the blood.  We even had to create an order in patient keeper, which is our electronic provider ordering system, in case the provider was at home and too lazy to come in and sign it...
We also added the comment that the provider needed to discuss the additional risk with the patient.  I've attached a copy.
HIGH RISK TRANSFUSION FORM.doc