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Posts posted by Patty
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How large of inventory?
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When you switched to the STAT Centrifuge did you validate? Detailed info would be appreciated.
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There's a new Record Retention CAP standard for Inspection of Weld for Completeness QC. Does this only apply to donor/component processing? We are a transfusion service hospital and I've never done weld checking.
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Correct, needs FDA registration and I believe you will need to get something that will re-label the 5 day plasma as a new product using ISBT coding.
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When we do not have AB plasma or platelets we use type A on patients of unknown blood type but document the physician was notified on a deviation Form as it is not our normal protocol. In MTP we notify the nurse who picks up the blood and she documents in the chart that she notified the physician. Same when using O Pos instead of O Neg RBCs.
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When issuing multiple uncrossmatched RBC, FFP, Plat for MTPs do you read the name, MR, donor numbers, donor type, expiration date/time for each unit? It takes a long time to do on a unit that is not crossmatched or even type specific. We do not have trauma packs in the ER and rarely use them except for drills. There are 2 Nurses checking at bedside but our policy is to check everything in the BB at time of dispense.
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Our computer system (Cerner) updates the patient record with the antibody, antigen typing, any comments-problems, etc. which is available each time we enter the patient record for testing. Our past 2 computer systems have been uploaded with the patient history files so they are available indefinitely. We keep the patient ABID paper work-ups alphabetically by year in a file. We keep patient antigram worksheets for 10 years as required by CAP then discard.
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We use them both at time of draw and time of issue.
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Congrats Malcolm!!
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Is there any standard that states blood should be started within 30 minutes from time of issue? We have that statement in our Nursing transfusion procedure but since the 30 minute return time is no longer in place we want the unit to be used after 30 minutes if it is delayed due to IV problems, etc. as long as it can be completed within 4 hours. Nursing does not want to use if it is past the 30 minute timeframe.
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We are looking to streamline our documentation for patients who are receiving Massive Transfusions. Currently Nursing documents each unit given individually on its own Blood Administration Form in Cerner. The form is 3 parts that includes pre-vitals, Unit info and patient verification, start-stop times, volume infused, post reactions or lack of. Does anyone document differently when using MTPs? What is the minimum Nursing documentation required for transfusion? We were thinking of making a form that includes multiple donor numbers. Do the start and stop times need documented per unit or could we do it as a group? We are level 3 trauma center and rarely get patient's that require MTPs. Looking for a good method in case we need to stabilize in OR/ER before transporting.
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Thawing FFP is not considered preparing components so I would mark it NA. FYI.. You need an FDA license/inspection if you prepare components.
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We check for a 3 month RHIG history (probably could be longer but we chose 3 months). If the ABSC is + we do a mini panel (Ortho panel has cells marked with * - Immucor has cells with brackets; if negative rule out significant antibodies other than D. We then call it Anti-D RHIG. This Anti-D only requires a full AHG crossmatch while it is demonstrating. If patient returns ABSC Neg we can go back to electronic XM.
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20 hours ago, AMcCord said:
I'm the only dedicated blood banker at my facility. All our new hires are generalists, almost all of them are fresh grads or have minimal blood bank experience at much smaller facilities. They all have to be competent for antibody ID and corresponding antigen negative crossmatches, emergency release, mass transfusion, neonate transfusion, basic troubleshooting for the instrument, etc. My training period for staff is far longer than anywhere else in our lab and my competency assessments are a very lengthy ordeal to ensure that all staff members are performing at an acceptable level. I spend a lot of time reinforcing the concept of 'patient safety comes first'. I send out a lot of informational emails to reinforce policy and procedure. I work one-on-one with staff members if they have questions or problems. Automation and blood bank information systems help when you are dealing with non-dedicated staff to standardize and lock down your processes. You've got to have excellent SOPs that have exhaustive detail. Hiring smart, motivated people helps. I make myself available, even when I'm on vacation.
BUT... doing all of that is just making it work with what you've got. It expects a great deal from your generalists. It doesn't solve the problem. It's an enormous problem and it's not going to get better unless something changes. Training programs are closing every year. The average age of blood bankers is increasing. Our profession is invisible to the world at large. Smart people can get better paying (and maybe less stressful) jobs in other areas of healthcare and other occupations. Administrations everywhere are expending a lot of energy and financial resources to attract and retain nursing staff. Do that do that for lab staff at your facility? Sigh!
I too am the only dedicated Blood Banker . I have found it more and more challenging as staff is quickly retiring and being replaced with young grad generalists. I try to reinforce the theory behind all of the blood bank tests in order for them to grasp the whole picture for trouble shooting those patient's that are the exceptions to the rules but there is only so much new grads can absorb during training. They are learning our processes, a new computer system, and often have not been in Blood Bank for over a year and that was only for a rotation during school. It takes years to become a seasoned tech. Between training new techs, 6 month competencies, annual competencies, meeting changing standards, and dealing with shortages I find it a little overwhelming. Unfortunately I believe this is the new Norm and agree we are in a staffing crisis which needs addressed now.
- AMcCord, John C. Staley, frenchie and 1 other
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We now use MediaLab. We loaded all of our current procedures into it. To edit you download and make the change. Once the new version is uploaded and approved by manager/Med Director major changes are sent to all personnel that use the procedure for review. Each step is documented electronically along with a note that you can add to describe the update. The person making the change is notified to remove old paper copies from whatever manuals you have it living in. You can make links available to the Intranet for nursing, etc. Every 2 years if no changes are made each procedure is sent to manager/Med director for review. It is a great system and user friendly. The old procedures are archived.
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I have struggled with this too. I keep mine because of the ARC statement: All products in the shipment have been inspected and found suitable for distribution. We document inspection on receipt in the computer when entering into our system. I keep mine for 5 years?? Maybe this should be changed to 10 if it is needed at all. ARC was suppose to go to an electronic Packing slip but for some reason never perfected. I figure at that point I will be able to stop keeping. Hoping someone finds a definitive answer to this and posts it.
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We validated our blood cooler to store blood at 1-6C, train the staff to not remove blood unless it is to be transfused, and take a return temp of the units when they are returned. No indicators are used since we had trouble validating them and we rarely transport/store blood outside of the Blood Bank.
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On 6/17/2018 at 1:17 AM, Dansket said:
Our SOP requires that newborns, who test negative with anti-D by immediate-spin test, must be tested for Weak D using anti-D antiserum formulated for Weak D testing. If the Weak D Control is agglutinated, we report Rh type of the newborn as "Indeterminate" and "RhIG indicated" for the mother if the mother is Rh negative.
Same here!
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I am trying to find a current reference for completing a red cell transfusion within 4 hours of the time of issue. I could not find it in the current CAP Standards and was wondering if this is still a requirement. Does anyone monitor Blood Administration for this?
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Biohazard Bags
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Here is the MAXQ Contact. He is very helpful with any questions you might have.
Will Mitchell
MaxQ Research LLC
(c) 918.798.9606 | (e) willm@packmaxq.com
(w) www.packmaxq.com
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If I validate the MAXQ cooler for 12 hours am I required to take/record a temp every 4 hours since it is considered Blood Storage? I doubt the cooler would ever be used for more than 4 hours but I suppose I should have something in place in case.
How much validation would you suggest since it comes with a validation report?
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It is my understanding that CAP requires Lot to Lot on Fetal screen Kits only, not commercial reagents since it is not a kit. You must compare the old QC with the new lot of reagents and the New QC with the old lot of reagents before use. Kit tests in the rest of the lab are handled the same way per CAP.
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Ortho On Demand has a three part series on Titrations that you might like.
Ortho Clinical Diagnostics is pleased to present a Spotlight Series focusing on Standardization and Validation of Titrations in Perinatal Clinical Situations.
https://presentations.akamaized.net/Shows/OrthoONDEMAND/Microsite/LoginPage.html
COM.30450 New Reagent Lot Verification
in Accrediting Agencies
Posted
We only parallel check the fetal screen kit by testing the previous lot QC with the new kit and vise versa. This is the only kit we use.