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Posts posted by RRay
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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.
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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.
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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.
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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.
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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.
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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.
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I was finally able to get a new tube sealer! Been ages since this facility has had one and I can't find any guidance from manufacturer. Does anyone have a validation protocol for a heat/tube sealer they'd be willing to share? I can do one from scratch but that's not bandwidth I have at the moment. Pretty please and thank you.
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We don't use them up after 5 days but with the low humidity here the suspension is quite thick after 5 days even with the evap caps. You can tell a difference in the cell button size from day 1 to day 5 but it must be minimal enough that the system doesn't flag it. If someone forgets to change them, you're guaranteed to get TMC errors "too much cells."
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I'm curious to know as well, since I will likely be in the same situation sooner or later. Switching some of my stock to ARC delivery to Cheyenne.
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7 minutes ago, Malcolm Needs said:
Thanks. Now I can see from where you are coming, and that all makes it plain, and I was being stupid!
The problem is, in the UK, every unit has the Rh phenotype on the bag label (see the attached photograph), and I keep forgetting that is not the same in all countries (I am being parochial in my old age!).That would be nice. Blood centers here want to charge us for that. They may keep it on file, but won't provide the info unless you pay... especially lookin' at you Red Cross!
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21 hours ago, Malcolm Needs said:
May I ask if you are talking about positive controls or negative controls?
The reason I ask is that, if you are talking about positive controls, you should not be using R1R1 or R2R2 red cells anyway, as they have homozygous expression of the C and e, and the c and E antigens (unless, of course, they are from a donor with a VERY rare type, such as R1/D-- or R1/Rhnull). Should you be using unit segments from a presumed R1R2 donor. On the other hand, if you are talking about negative controls, then even if you did find it easier to get r"r or r'r units, they, of course, would have heterozygous expression of the E and e antigens, and the C and c antigens, and so would be unsuitable for negative controls for those antisera.
I'm sorry if I am sounding like I am trying to "teach my Grandmother to suck eggs" (and it is probably me getting entirely the "wrong end of the stick"), but I am totally confused.I don't understand the problem. We use the R1R1, R2R2, r'r, r"r set simply because those are most readily available/abundant from our reagent red cell sets.
C: positive control- r'r , negative control- R2R2
c: positive control- r'r , negative control- R1R1
E: positive control- r"r , negative control- R1R1
e: positive control- r"r , negative control-R2R2
I know there are other options more readily available within the general population, and likely our inventory too... but then there's a conundrum. How do you test units you hope to use for controls without the method being QC'd in the first place? It's a tight cycle to upkeep for a small group of generalists. We don't have full antigen information disclosed from our blood supplier either.
Personally, I can use my own blood for several of the controls... but I don't want an extra monthly poke! Haha!
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1 hour ago, Bet'naSBB said:
We use Immucor's WBcorQC product....it was actually recommended to us by the service rep that installed / trained us on our VisonMax's .......(on the sly since it's an Immucor product) - but they work great!
In the IFU it states the Rh phenotypes of each tube....and the types are consistent from lot to lot so you don't have to re-program your QC with every new lot.
The kit contains 8 tubes (2 each of 4 controls.) good for about a month.
Fabulous! Thank you!
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If you are doing CcEe antigen typing on the Vision, what are you using for QC?
I had been using extra tube panel cells spun down for my controls, but it seems that the cell % has been reduced by the manufacturer to around half and I don't get enough cells after spin down. Cutting corners maybe?? I'm having to double the amount of tube reagent cells I need to spin down. I can alternatively use unit segs for R1R1 and R2R2, but with my inventory size I have trouble getting r"r and r'r. Ortho has only recommended that we use unit segments as they didn't have any other commercial QC to offer. Vision will only accept centrifuged blood as a control type for this, so no 3% suspension and it can't convert from 0.8% to 3% on board.
Any suggestions?
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Rewriting a blood bank specific LIS policy for AABB compliance. Would anyone have an example they'd be willing to share? There's so many non-Lab pieces to this requirement (3.9) that I'm afraid something will fall through the cracks.
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Inspection proof is a section of MediaLab where you can upload accreditation checklists and track how you are meeting them. Similar to AABB Apex self inspection but more robust. You can link and quote SOPs if you use the document control feature and flag any deficiencies and document corrective action like uploading an SOP revision. Makes inspecting a breeze for both sides. Only caveat is you have to upload in excel format and I’ve never seen joint commission provided that way. I have an email out to my medialab rep.
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Does anyone use these together? With CAP and other agencies you can get an excel file of standards to upload into inspectionproof. MediaLab says the support JC standards but we can't get those in excel format. Any advise?
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Building Soft to join with Epic at the moment. I have the same issues mentioned above. The traceability work arounds are a huge issue for us. Epic allows for "Other collector" and it will time out and autofill the collect time as the current time instead of forcing an entered result that will match the written time on the tube. I feel comfortable with the WBIT being minimize, but since the tracking to phleb ID and correct collect time is an issue I am requiring a second tube for compliance sake. We are dropping blood bands with the Soft go live because the security features added to BPAM are leaps beyond what we currently have. Blood bands at current have only caused problems and patient delays, never stopped a patient ID issue.
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I agree @jayinsat that the additional screen is redundant. Building a new LIS, and planning to get rid of the antibody screen.
I'm just questioning because it is strange that all of my experience and IRL peers has had a post partum workup that included a screen. Seems like one of those "always been" situations.
Thanks folks!
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In the post-partum workup that has the fetal screen in it... I've never seen the battery NOT include at least a screen as well. I can't find any requirements for what it does or doesn't have to include. Do you include a screen as well, or just the fetal bleed screen? Am I missing some sort of accreditation checklist item?
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And....... of course it's a tie.
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29 minutes ago, Malcolm Needs said:
The UK has...
Thanks for the link! I found the full version and it is now bookmarked.
I wish the US would come out and pick a side. They should know us lab folk enjoy the comfort of the black and white. Grey is for those making the rules. Haha!
The only thing offered by the manufacturer is a very basic IQ. It's the Genesis sealer. I emailed customer support twice and they only reply with the same user manual with basic IQ.
Temp indicators for blood products
in Equipment
Posted
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.