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April 2024 Challenge

estiner

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Everything posted by estiner

  1. estiner
    P.S. Both OR and ED are also using TAR so it is available in both of those modules.
  2. estiner
    We are going LIVE with 6.0 on June 1 and have TAR set up with nursing. It is working very well and we are very excited to finally hand transfusion administration documentation back to nursing where it belongs (no more issue/transfusion forms that have to be entered by us). The vitals signs are calculated from the initial set and alert the nurse to when the next set is due. Transfusion reaction symptoms can be documented and the information sent back to BB as a SUSPECT reaction. Then if the physician wants a workup, a reflex order is entered.
  3. estiner
    We have had our ECHO for 4yrs now and we love it. Yes, there are some reactions that the instrument calls "?". If it appears to be negative visually, we check the reading for the strength of the reaction (Highlight the specimen<Right click<Result file<then scroll down to REACTIONS) The Assay cutoffs are on page D-6 of the ECHO manual. It helps us decide how strong the instrument feels the reaction is. Then if we question, we go to PeG as our backup. If we get positive screen, then negative or inconclusive panel, we repeat screen in PeG. If negative, then we crossmatch on the ECHO and if compatible, consider our reactions due to capture technology. Otherwise we address whatever specificity is determined. You must keep in mind that some antibodies react stronger on the ECHO while others react better in PeG. That is why it is good to have two different methodologies available.
  4. estiner
    Shaundrey - why do you not charge nursing for wasted products where they did not follow established protocol? You should.
  5. estiner
    We are looking at instituting barcode scanners at the bedside and my vendor is telling me we no longer need to have two nurses at the bedside verification of units for transfusion. What are others doing with this? Are you eliminating that second nurse requirement if the unit and armband are scanned?
  6. estiner
    Immucor tells me that if I get reactions on the ECHO screen but negative or inconclusive (panagglutination) on panel cells, the best way to determine if reactions are due to stroma is to do a major crossmatch on the ECHO. A negative crossmatch on the ECHO with no stroma in the well would indicate the reactions are due to an interference with the stroma (often caused by HLA antibodies) and not a true red cell antibody. To confirm a negative screen, we test with PeG and crossmatch on the ECHO since our initial reactions are on the ECHO. Best to keep with the methodology that gives the strongest reaction especially when using an ECHO. I too have found anti-E and anti-Jka antibodies that react on the ECHO but not in PeG so be very careful!!!!
  7. estiner
    Dr. Pepper, I would like the information on that report - my pathologist has been requesting that and IS has not created it to his satisfaction. Yours sounds like it might. Please send info to edie.stiner@parrishmed.com.
  8. estiner
    Just returned from AABB where this was discussed in length. CLIA is putting lots of pressure on TJC, CAP and AABB to comply with their guidelines so if you are to be inspected anytime this year, expect this to garner much focus. Yes, the requirement is every test, every tech, every year. And if you are a BB, then your processes (i.e. issuing blood, thawing plasma, emergency release, etc.) also need competency assessment per AABB.
  9. estiner
    We have an ECHO and we use PEG as our backup. It works great because I have two different methodologies to work with and it saved me lots of money on reagents by using the same manufacturer. Gel gave us way too many nonspecific reactions and it was just too expensive to keep two lines of reagents.
  10. estiner
    Our Translogic system has a process called "secure send" where we use a code to send the pneumatic tube and the nurse must use that code to retrieve the tube when it arrives. If retrieval is not within 3 minutes, it is returned to the Laboratory. In addition our tube system has a tracking program to show where & when a tube is sent and then received.
  11. estiner
    We accept a copy of the lab results from a state certified laboratory for the 28wk dose. Interestingly we only get the Rh negatives and would not see the weak D's if reported as Rh positive. Giving Rhogam to a weak D patient is the decision of the attending physician. We recommend giving it to weak D patients but not all our physicians agree. If there is no certified report we perform the T&S prior to giving the Rhogam. Since we do not perform weak D testing on adults, those patients would be reported as Rh negative. Upon admission for delivery, Rh negative moms only have a standard T&S ordered.
  12. estiner
    I would like the reference from TJC that states the "designee" for review has to be a Technical Supervisor. Both AABB and CAP state the medical director can assign a designee for the review but all new and revised procedures must be signed by the medical director. There is nothing in either documentation that defines the designee to only be a "Technical Supervisor" which I agree is defined by TJC to be MD with pathology credentials. I have never had an AABB or a CAP inspector question the designee status for reviews. Since they supercede TJC, I am curious where this idea originated. FYI - the new guidelines now require review every 2 years, not annually - YEAH!!
  13. estiner
    We have the ECHO interfaced with Meditech Magic and it works great - no problems. The results come over to Meditech and the techs review and finalize there. We also interfaced with McKesson HBB and it worked fine with that as well.
  14. estiner
    Our hospital has the same policy of starting within 30 min and transfused within 4 hrs - if not a variance is written and an investigation is made as to why the policy was not followed.
  15. estiner
    We also require a second specimen from a second venipuncture if there is no history. If unable to obtain a 2nd specimen, we give type O red cells and AB plasma. We usually can find an EDTA from Hematology to use and rarely have to actually draw a 2nd specimen or give O blood. We have been doing this for 3 years and have had excellent results. Parrish Medical Center in Titusville, FL 210-bed hospital.
  16. estiner
    The speed depends upon your method. We have an ECHO and have to spin specimens 5-10 min at 3300-3500 rpms. Manual technique used to be 3500 if I remember correctly.
  17. estiner
    Our nursing procedure states to start the transfusion slowly (5ml/min or less) and observe patient carefully for symptoms (direct observation) for the first 15 min. After 15 min, recheck the vitals and if okay, speed up the rate to finish within the 2-4 hr timeframe.
  18. estiner
    The CAP requirement came from TJC recommendation that the transfusion guidelines should be given to all recipients (inpatient and outpatient) due to the fact that all of us are trying to reduce length of stay so most inpatients need the guidelines as well. Our transfusion guidelines are signed along with the consent for transfusion and then are put into the discharge packet so the patient will take them home for reference.
  19. estiner
    Our hospital requires a circle around the medical record number as documentation that the patient wristband matches the specimen label (name and MR#). All specimens are required to have this documentation. Then in the Blood Bank we only transfuse type specific if we have two matching blood types on two different venipunctures (BB history can be one of these). For our pre-admits, a wristband is placed on the patient arm for the blood draw and then removed and placed in the chart. Upon admission, the wristband is then rechecked and reapplied. Currently our outpatients do not have wristbands but must state their name, date of birth and ordering physician. Photo ID is required at registration.
  20. estiner
    We require an antibody screeen within 7 days and a blood type for current pregnancy for the prophylactic dose per National OB-GYN guidelines. The State of Florida allows us to accept results from a state-certified laboratory so we require a copy of the prenatal report with the blood type and the original antibody screen plus a copy if the 2nd antibody screen was performed elsewhere - if not, we test before releasing the Rhogam.
  21. estiner
    As an assessor I would want the temperature of the product documented more than the cooler temperature.
  22. estiner
    No we have had our ECHO up and running since Feb 2010 and have not seen this at all. We love our ECHO - it is so sensitive that sometimes we get positives that cannot be duplicated in PeG but not the other way around. We have a lot less problems than we did with gel. We do daily check on bubbles in the reagents when they are loaded onto the instrument. However, we usually get invalid if bubbles occur.
  23. estiner
    Time limits such as 30 min or 15 min must be validated if you state them in your procedure per CAP and AABB so the best process in my opinion is to set temperature guidelines and then you do not need to validate. However, if you use 1-10 for thawed FFP that has not been refrigerated for very long, it will never pass - might want to revisit that guideline for those units that have just come out of the thawer.
  24. estiner
    I do order antigen-negative units from my supplier - what I am asking is how do you QC the selected cells that you do not have antisera for when you are trying to ID an antibody???
  25. estiner
    How do you QC those antigens for which you do not stock the antisera? Most of small laboratories like ours do not have the budget to keep a large inventory of all the antisera.
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