BBKT

We are a smaller Level 1 Trauma Center, 600 beds, 13,000 transfusions last year with1 Vision. We do not irradiate or wash blood. We are lucky in that all techs work only in Blood Bank (which includes the Coag lab). We like an 8 week training period.

We are a level I trauma center about 5 miles from our supplier. Minimum daily stock level is 3 platelet pheresis products. I'd be interested to know what everyone's expiration rate is for platelets.

We've written our policy to state that we run a "positive" cell on each panel we run each day. For example, if we have Fya patient, then we run the patient sample on a FYa positive cell on each rule out panel run. This way we are testing stability of panels throughout the life of each panel. In addition, we are testing different antigens throughout the week because we are a large facility with lots of antibody identifications being done. I know it seems a bit of a simple interpretation of the rule. We are currently in our CAP inspection window, so hopefully this is acceptable to our next inspector.

Has anyone started using Psoralen-treated platelets? Since psoralen inactivates CMV and AABB allows psoralen treated products to take the place of irradiation, I'm wondering if anyone using Cerner Pathnet has figured out how to allow these products to be dispensed to patients that require CMV- and irradiation.

Has anyone been running Cord Blood testing on the Vision? I'm curious to know how that is working.

Ortho says it is OK as long as you perform you own validation, however, they are not willing to give any recommendations. We rarely do prewarm techniques, and our reference lab recommended prewarm for a patient with a strong cold autoantibody. I would like to use gel instead of tube testing if possible. Granted, it would be hard to come up with enough patients with cold autoantibodies for a validation study. Any thoughts or experiences anyone would like to share?

Is your Vision interfaced and if so is Cerner your LIS system?

I work at two hospitals (100+ beds and 250+ beds) - one has Echo and one does gel. Personally, I prefer gel. There seems to be less "false positive" reactions with gel.

We have been using Bridge Transfusion for about 6 months. On the whole nursing likes it. The positive patient ID scanning process than occurs at bedside, has allowed us to remove the second RN check before starting transfusions. Most common problems we have encountered: 1. Scanners - wireless scanners seem to lose configuration often. Reseting scanners occurs frequently but it is done with a barcode scan being place on each scanner base so it doesn't take long to reset. 2. Nurses often scan wrong thing in wrong prompt are - lots of training and retraining needed to occur. 3. Nurses forget to end transfusion in Bridge. We were on paper before Bridge so needing to end a transfusion in the computer is new to them and something we are still working on getting better compliance. Things BB likes about Bridge: Better Postive Patient ID, computer doesn't allow transfusion to start if error occurs in scanning process. Better documentation in patient chart with accurate start and end times and vitals all recorded on same summary page. End times from Bridge flow to Cerner pathnet so more accurate transfusion time tracking on BB side.

We've recently received a new blood product refrigerator. It has the ability to perform the hi and low alarm checks electronically. Is this an acceptable way to perfrom alarm checks for AABB/CAP requirements? Or do you still check alarms using ice/water mixture to manually lower/raise temps for alarm checks?

We have an infant who has was tested with Lectins and was found to have Tk-transformed polyagglutination, most likely due to necrotizing enterocolitis. Any recommendations for transfusions? Infant is O positive, and seems to get a better bump in lab values when transfused with washed RBCs vs unwashed RBCs. The problem, of course is the increased donor exposure for this patient due to the fact that washed cells expire every 24 hours. Patient also needs platelet transfusions. Any thoughts on if washed products are indicated and if so for how long do you continue to give washed products?

I'm curious how other facilities handle verifying that an "order to transfuse" was placed by physician before issuing blood to be transfused to said patient. We've always relied on nursing to verify physician transfuse order before requesting product be sent to the floor (and this check is documented by nursing on their blood administration form). We have had recent incidents where patients have been transfused with out a transfuse order - varied list of reasons were found during RCA investigations. Nursing is requesting that blood bank be responsible for verifying transfuse order before issuing blood. We are a 300 bed hospital that transfuses 1200 products each month, and the transfuse order is not placed in the same computer system that the blood bank uses. This seems like a daunting task and am looking for insight from other facilities.

We allow verbal orders for MTPs and additional products from OR and ER. We are able to place this order in our computer system (Cerner) as a verbal order. This order then get sents to the ordering physicians message center for signature.

One more scary story - we've used the additional armband for blood bank samples for years and haven't had a problem until last week. The transfusing nurse realized the patient didn't have the armband on but chose to transfuse anyway because they needed to "hurry up and infuse FFP so the patient could go to surgery". Not good - A pos patient received type O plasma, we were lucky and I'm still not sure why the patient didn't have a transfusion reaction. So, it really does come down to compliance with established policy.

I'm curious, has anyone established (or been able to control) plt pheresis transfusion guidelines for patients having open heart surgery while on plavix?