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?

We are two hospitals with two blood banks and two different CAP numbers. Both hospitals are owned by same facility, and have the same computer system, same medical director and same supervisors. Can we transfer blood between the facilities without re-confirming unit blood type and/or unit antigen type if an antigen negative unit is at one blood bank and the other blood bank needs it?

We have started electronic documentation by nursing, it has not been easy. Here are the problems so far: 1. We don't have ability to utilize barcode entry yet, so nursing can enter anything they like in the donor number (unit number) field, which makes it really hard to track which unit was actually transfused when entry errors are made. Also can enter anything they like in the BB armband # field. 2. Took awhile to get nursing to understand they needed to include the aliquot letter when entering the unit number. 3. We had to designate result fields as mandatory so that it required nursing to enter results or they would skip fields. 4. Vitals are documented in a different place in electronic record and nursing did not want to have duplicate documentation steps for vitals. It is a challenge to link pre and post vitals for transfusions in electronic medical record. 5. ER and OR will not utilize electronic documentation, therefore we are still requiring paper documentation for all transfusions at this point, until we can get ER and OR on board. These are the problems that come to mind immediately. I'm sure there were more. It has been a real challenge and we are currently looking at other ways (with Cerner) to make this process more user friendly.

We have been running our eluates in gel for about 5 years. Rarely we do see the mixed field type reaction, however, for the majority of the tests the reactions look truly negative or truly positive.

We recently had this conversation in our lab after reading the proposed changes to 28th edition of standards. I've copied below. 6.23 Pretransfusion Testing of Patient Blood Pretransfusion testing for allogeneic transfusion shall include ABO group, and Rh type. For Whole Blood, Red Blood Cell and Granulocyte components, pretransfusion testing for unexepected antibodies to redcell antigens shall be performed. This standard was edited for clarity. Currently we accept historical type for plt transfusions only (consider the fact that we don't require type specific in adults anyway). However, the change in wording of the new standards makes it seem like we will need to start requiring a pretranfusion sample for ABO Rh type.

This is similiar to our process. We have convinced the hospital to not merge patient info until discharge, however, they do update the patients name to the real name when known. We use the spearate blood bank armband and this way we have our two unique identifiers still in place, Medical Record # and the number from the blood bank armband.

In perusing the 17th ed. AABB Technical Manual, (page 283) it says: "If a serile connecting device is used to prepare the aliquot, the expiration date is dependent on the storage container used for the aliquot. Cellular compnents stored in syringes have an expiration of 4 hours, but if stored in an FDA-approved transfer bag, the expiration remains the same as that of the mother unit". I've contacted a few other labs that prepare neonatal syringe aliquots and we are all still using a 24 hour expiration date for rbc aliquots and a 4 hour expiration date for plt aliquots. This is the recommnedation from the product insert from the syringe manufacturer used. I'm curious to know what other facilities are assigning for syringe aliquots made using a sterile connection device.

It is helpful to know how other institutions are handling things like this. We will need to train nursing that the MRN on the unit tag will not match the MRN on the admission armband, but it will match the MRN on the BB armband and they should verify that this patient has both MRNS in the computer system. Thanks again everyone.

Please bear with me, this will be confusing to explain. We provide transfusion services for 2 different institutions - owned by the same corporation. These two institutions utilize separate Medical Records Numbers, one is an outpatient cancer center and one is and inpatient hospital. Often times, the patients will be drawn at the outpatient facility, and then due to their status, be admitted to the inpatient facility for transfusion. We've devised a policy, that when the patient sample is drawn they will put both Medical Record Numbers on the patient sample, so when they get the CBC results and dependent on patient status, the patient can be transfused at either facility. We just need to know which Medical Record Number to perform the workup under. This policy has worked reasonable well. However, recently we have had instances, where due to patient time constraints, or deterioration in status, they will transfuse one RBC as an outpatient, and then want to admit the patient as an inpatient the next day and continue to use the same blood bank sample. In this circumstance, we feel the patient should be redrawn. The workup was performed under one Medical Record Number, the patient was transfused under that Med Record Number, and then is admitted with a different Med Record Number and visit number. The facility does not understand why we are having the patient redrawn under these circumstances. We base our decision solely on the fact that the patient was transfused. If a patient were discharged and then re-admitted the next day, we would require a knew sample, and this seems to be a similiar scenario. Does anyone have an opinion, or function in a similiar situation where you are the transfusion service for places that utlize different Med record numbers? I cannot find any regulatory standards that address this type of problem. (We use a separate Blood Bank armband system for all blood bank samples and the patients know to keep this armband on.)

Has anyone started doing titers on platelets pheresis products before issuing out of group platelets to patients? If so, could you share your process? Our blood supplier has no immediated plans to supply titer results on products.

I've heard stories of phlebotomists and nursing drawing 2 tubes for blood bank samples and they put the second tube in their pocket so when they get the call that a second tube needs to be drawn for ABO verification they pull the tube out of their pocket instead of drawing the patient a second time. YIKES!