Thank you for the information!  Very helpful and will be passed along!

 

31 minutes ago, jshepherd said:

 I would push back on your medical director if you can. To Dr. Blumberg's point, low-yield platelets are an FDA approved product, so there's no real reason to require notification to providers, especially if half the infusions are just topping up people for a procedure, but I won't rant about that one right now.  

I agree, I hate arbitrary lvls for surgery.  I'll see who is requesting the notification specifically and see if I can get some data to them.  I know the medical director is being the messenger in this scenario.  I have it a feeling it's OR docs... it's always OR docs.

@Neil Blumberg What indications are you using these half-doses for mainly?  All indications?

I ask because the main reason our med director wants the provider notified is that around half of our platelet transfusion is pre-procedure to meet platelet count requirements.  The other half goes to our infusion center.  

Our medical director wants us to document notification to provider that the product is low yield.  Having to set up a trigger point for a  required comment box.

Problem with vitalant is they cut off all the yield tags before they get to us so there's nothing really to flag to staff that these are low yield.  Its hard to expect generalists that work blood bank 1-2 days a month to memorize the codes.  

And to your point about cost... Vitalant is charging the same for low yield vs standard PLTs.

Anyone else using Vitalant?  We do partially.  Wanted to know if you've gotten any information on how frequent this low-yield supply will be?

I get why they're supplementing inventory with these, but I'm having trouble getting information from my account rep.

This involves a lot more than just turning on product codes for us, so putting out feelers.  We're so remote I don't have a good network of other users.

I am pushing for my lab to define "lab experience" for the purpose of qualifying for job postings.  I know CLIA doesn't fully define anything regarding this.  Wondering if any of you have this defined at your facility?  We are getting all kinds of things being claimed and it seems like HR doesn't know what should and shouldn't count.  Case by case basis brings us back to the same discussion every time.

My assumption is it has to be clinical in nature?

What about internships/clinical rotations?

Volunteer work?  Paid/unpaid?

Does 1 day a month for a year count the same as full-time?

College research labs? Vet lab?

This was the clarification I got from AABB...   so looks like at least one high/low check of the monitoring system as a whole would be wise?

Quote

Here is the clarification to your request pertaining to Standard 3.9 - Alarm Systems, in the AABB Standards for Blood Banks and Transfusion Services, 34th Edition.

Response (from the BB/TS Workgroup):

Standard 3.9.1 requires that alarms be set to activate under conditions that will allow proper action to be taken before blood, blood components, tissue, derivatives, or reagents reach unacceptable conditions. To ensure your facility is meeting this requirement your alarm testing should verify that alarms are activating when the temperature in storage units is moving towards unacceptable temperatures, either too high or too low. It is important to ensure the alarms activate before the temperature in the storage unit becomes unacceptable so that you have sufficient time to move products to an appropriate alternate storage unit. This would necessitate testing of both high and low temperature alarms and documenting that alarms have been triggered at the appropriate temperatures as described in your procedures.

Standard 3.9 Alarm Systems is also annotated with a pen symbol (!) which means users have to maintain a record of the activity in order to meet the AABB BB/TS Standards.  

I sincerely appreciate your patience and understanding throughout this process.

Best Regards, Jason

 

Perfect!  We are currently on Rees as well.  We have a fridge that recommends quarterly alarm checks but that is being replaced soon and that would be the last shred of alarm check suggestion that I see.  It is hard to let go of the CAP overlord since JC is so streamlined and often vague.  I appreciate your anecdote!

Maybe I'm crazy (likely), but I don't see high/low temp alarm checks in AABB or JC standards..  Is this only a CAP thing?  Still adjusting to the move away from CAP and trying to determine what is and isn't required now.

AABB only has settings checks.  JC has records checks of alarms taking place and the response to them.  Am I missing something here?

My experience with safetrace is pretty poor.  We switched off of it for a long list of reasons, one being the lack of audit trail, especially when it came to settings/rules changes.  I can't believe it is still as popular as it is. 

@BldBnker Yes, Ortho did tell us that and we have more than 4mm on each side, closer to 8-10mm.  Even some barcodes that don't have the white space, say because of date/initials in the way or blood smear, will often read when the perfectly printed and clean labels will not.  It's making me crazy.

@John C. Staley  I totally agree and am currently in that process.  We have other demo analyzers coming in a couple weeks and the first thing I'm going to do is throw on some barcodes that I know the Vision won't read.  I'm very nervous though that if they don't read on other BB analyzers then I HAVE to figure this out.

Vision is easy because a lot of techs have had exposure to it (at least in this general area), but that's the extent of the pros.  I'm pretty tired of shipping and stock issues and generally poor customer service compared to other companies I have experience with.  

I have the official conversion guide from Ortho and it doesn't recommend any specific QC apart from the general QC of the method it alludes to (the general MTS procedure manual).  I mention visual inspection of cell button size in my SOP.  Has always covered it in the past, but you know how it goes...

Quick Reference Quide - Conversion.pdf

Reaching out as a last resort here...

We have an Ortho Vision that reads patient barcodes at ~50% rate.  I have opened many tickets throughout the years of having this specific Vision and never get far with trying to resolve. Completely unacceptable.  50% is a lot to manually assign.  So now that we are evaluating analyzers for next year, Ortho is pressing to solve this issue but is still at a dead end with the information they can provide.  Every experiment I do leads me in a different direction.

Has anyone else had issues with barcodes reading on the Vision?

I'll list all the information I can remember at the moment but nothing makes sense here.  This is the biggest rock in the shoes of our techs and has been so for far too long.

• Issue is ~98% with patient labels, not usually reagents or units
• Brand new label printers did not increase the read %
• New barcode reader installed within the Vision, and later recalibrated with no change
• Handheld scanner and all other analyzers (even Vitros) have no issue with these labels
• I can print the same label on 5 different printers (old and new) and either they all read or they all reject
• Ortho is saying that labels we sent in for analysis are less than A-C grade in quality but they look perfect and the printers meet Zebra and Epic specs (even junky labels will read 50% of time)
• Tried matte and shiny tape covering the barcode as well as different heights on the tube
• A batch of labels that wouldn't read on our Vision were put on a demo Vision where they also wouldn't read (these labels were visibly perfect to the naked eye, no dead lines from the printer)
• Reached out to Zebra and they verified that label printer settings and format received from Epic are standard and within spec

Building an epic test make our send outs easier.  I have a CPT code for this as 81403.  My billing guy is asking for a DEX Z code.  This is going to Vitalant for workup but they're not located in the DEX website.  I've reached out to Vitalant directly but nothing yet.   How do you have your HEAs set up to bill in Epic?

Would this be something an IQCP could take care of?

MaxQ also provides validation plans on their website for each cooler type.

The latest MTP cooler is much more hassle then the previous version.  I have 1 of the new ones and no one chooses to use it over the older one.  Change my mind!

I'm not looking at staying with Ortho long enough to warrant messing with their new QC set.  I am phasing out gel antigen and going back to tube.  We do maybe 5 antigen types per month so it's generally faster to do in tube for what we use and techs prefer the simplicity.

I would recommend against trying to use tube reagent on the vision.  Firstly, it's against manufacturer's instructions.  Second, you'd have to rig the vision to use the proper reagent and buffer cards, if you can even make this happen.  If you do this you will need a whole validation study to prove your method outside of what the manufacturer recommends.  And if you're AABB, there are new validation and risk analysis studies you'd have to provide.  Just buy the cards.

Another update:

After I sent the experiment results I got an email for the rep to refund me of all my hemo-trac purchases and for me to find another product being that their product is not performing as intended and for my needs.  They also emphasized that these are mainly for transport and not intended to be left on its in storage (although that is allowed per the manuf. insert).  I think they should adjust their marketing strategy.

 

So, @JOJOER I think at this point I am going to look at cooler temp loggers instead.  Possibly Max Connect or LogTag.  In the long run, these are one time purchase +annual recal and that will be a fraction of the price we're currently spending having to replace sticker indicators or switching back to safeTvues.

 

*Rant incoming* Is it just me or has options for blood bank specific products in general really dwindled across the past 10 years?  Now, it's almost "This is what you get, you have to use THIS."  Want a blood irradiator?  Here's your 2 options.  Want a blood kiosk?  Hate haemonetics? Too bad, this is what you get.  

On 4/16/2024 at 11:41 AM, applejw said:

This scanning into Epic sounded intriguing.... I don't think it is unique to your build.  Are you scanning in all of the paper generated during an antibody investigation or do you have an algorithm that you follow?  We send large volumes of patient workups to be stored off-site forever and have multiple file cabinets for the most recent 2-3 years worth of records.

This can be done in Media Manager and scanned as a lab result.  We do this for signed uncrossmatched product forms and off-site transfer tracking and you can attach it to transfuse/prepare and test orders.

In case anyone needed an update, you can contact mediaLab and they will ask for certain proofs before they will add in the JC checklist .  A pain but doable.

We currently use OnBase for this.  Fortunately, my facility was trying to keep transcriptionists in a job so they have been reassigned as scanners.  They've been able to scan and load all of our indefinite keep items and they link to epic encounters.  The only downfall was that pre-Epic workups had to be scanned into a shared drive type file because they could not be linked in OnBase.  Let me know if you have any questions regarding this and I can find out.  It is backed up routinely and is read-only for those allowed access.  You do need an audit system in place to be compliant with AABB, so we put one in place and I added it to the SOP.

 

At another facility I helped us go full digital, not even paper antigrams.  It was a bit more messy tho because it utilized a shared drive.  OnBase feels more secure and tamper proof.

Just wanted to follow up about this.  I was put in a virtual meeting with the folks who actually create the BT10 indicators (and relabel them for fisher to sell).  It was the most demeaning  meeting I've been part of in a while. 

I was told that any or all of the following HAD to be true:

-The refrigerator temps had to be at 8C or above -- I have 4 continuous monitor probes that have not been over 5.7C in years with an average of 3.4C

-The blood must be over 8C when the indicators are placed -- I have tested this many times with a contact IR thermometer and units very from 5.6-6.7C out of the supplier transport box, they are then left in the fridge at least 30min to acclimate before attaching the indicator which puts them at 5C or less.  I have even placed them on glycerol bags with a probe inside and there is no reason why these things should activate.

-The indicators are not fully attached to the bag -- there is a ring on the indicator that has no adhesive, so getting a full adhesion is challenging but I have more that alert that are fully attached and more than do not alarm that are NOT fully attached.

-I need to activate these, then freeze them until ready for use -- I have to follow manufacturer's written instruction so says the standards (which does not include this) and the product touts that it requires NO pre conditioning at all.  This is crazy.

 

They explained how these work to me about 10 times, when I have no issue understanding the physics.  It just doesn't work like they claim.  I tried an experiment by testing a unit at 5.7C straight out of the shipping box, placed an indicator at 0 min, 15min, 30min, 1hr, 2 hr,while placed in the fridge (3.8C).  Only at day 3, did I get alerts on the 0, 15min and 2 hr indicator.  Then at the 1 week mark, all indicators had alerted.  

I have yet to get further feedback from the manufacturer but at this point my experience with them is so poor that I'm going back to my old vendor.  At no time is anything in the process >7C, much less the 10C at which these are supposed to alert.  Nevertheless... we're doing something wrong. Feel free to poke holes in my experiments. 

1 hour ago, Kelly Guenthner said:

Not the original poster, but we use them in coolers to the OR and shipping boxes we send to outlying clients.  An electronic data logger accompanies units in the cooler to ensure the cooler has remained at temp; Safe-T-Vue ensures that the unit has remained at temp.  In our shipping boxes, clients have the option of using the Safe-T-Vue as the sole indicator; though most back it up with a temp gun/thermometer reading on arrival.

This is our process except we don't do a data logger with each cooler.  The indicators are considered an FDA approved device so we don't do both.  We don't use them on every unit, just cooler units, and use the temp gun upon return.

I loathe the indicators and I think they are borderline worthless.  But I'm a bit gunshy of not using them for coolers after being cited many years ago.  That was when there was that hot debate over coolers being transport vs storage.  I was told at that time that the temp gun alone wasn't adequate because it doesn't detect if a unit was out of temp and then back in the cooler long enough to acclimate.

Was previously using Safe-T-Vues but the price is >$2.50 each after last increase.  We are trying Hemo-Tracs from Fisher but having a lot of issues with them.  They relocate on their own and we've had lot specific issues where they will slightly activate having never left the fridge (average temp of 3.6C).  I've troubleshot til I can't anymore.

Anyone know of any that work well and consistently, preferably with no conditioning?  I've used the timestrip ones in the past so I have samples of those on the way for comparison.