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AMcCord

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AMcCord last won the day on December 26 2019

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About AMcCord

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    Seasoned poster
  • Birthday May 8

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  • Location
    Nebraska
  • Occupation
    Blood Bank Section Supervisor

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  1. I used to be able to access the Commendable Practices as an individual AABB member, but not anymore. I did find some very helpful information when I could access them.
  2. It snowed outside my window Saturday. I prefer the snow in this window actually.
  3. And Happy New Year! If you are off on New Year's Eve....please celebrate, but responsibly so that you are not one of those dreaded MTPs!!!
  4. I would agree completely with these statements (especially #1). If it was me I would remove the requirement to check the pH from your SOP.
  5. The pH indicator used in the Buffering Solution would be specific for the desired pH range. If you see a blue color, the solution is in that fairly narrow range - chemistry at work. There is no requirement in the insert (or in standards that I'm aware of) to check the pH by a method other than eyeballing the color.
  6. In any open system I believe that expiration would be 24 hours.
  7. The Immucor package insert for PeG says that tubes 'may' be examined after the 37C incubation for hemolysis w/o centrifugation.
  8. Fibrinogen testing is up to the clinician here. I agree with David - draw the specimen soon after infusion.
  9. Thanks for the info on the MaxQ MTP cooler. We do keep liquid plasma on hand to issue with our first MTP cooler, but would switch to thawed plasma after that.
  10. We are using the Credo ProMed line rather than the ones that look like the Igloo cooler. The ProMed inserts for the smaller coolers are cubes w/ a lid (TIC). The outer nylon shell has a vacuum sealed dense foam insert w/ lid that the TIC fits into. The entire TIC goes in the refrig for the red cell transporter. The entire cube for the Plt transporter sits on a shelf at room temp (monitored). We also have large coolers in the ProMed line that have individual liquid filled 'slabs' that build the TIC cube in the cooler (separate pieces for 4 sides, top and bottom). We chose the ProMed line because the nylon shells have shoulder straps plus a short strap over the lid to make carrying them easier. We send quite a lot of blood product across our campus to a cancer center and wanted to find something that would work well for them. They are also OK for the ED and MTPs on the floors. That nylon outer shell would not work well for surgery - can't be cleaned as well/easily as a hard shell on the Igloo type. (We don't send blood products to the OR in coolers.) I suspect the Credo igloo type cooler would hold temp well. It looks like they have an insert similar to the ProMed line, but we haven't tried one of theirs. Our Igloo types were not Credos. Replacement inserts are available. The vacuum sealed inserts have an expiration date, so they must be replaced every 4 (?) years. We ordered ours from Pelican BioThermal. I clicked on the 'contact us' button on their website and someone in sales got back to me with the information I needed. Credo coolers are expensive. I believe that the small one (holds 2 RC) cost us over $400 in 2017. We ordered an extra TIC for each cooler, so once we get a cooler back from the cancer center we can sanitize the cooler, swap TICs and send out blood for another patient. The nylon shells are still holding up very well and I haven't yet needed to replace a TIC or insert because of damage or temp failures. If/when I add more coolers, I am going to look at MaxQ. They prices have been lower than Credo in the past. I've been in contact with their sales people directly. They are coming out with some combo coolers that look great for MTPs - wheels and a separate platelet pouch. They have a very basic cooler that we might use when we transfer red cells with patients that was less than $200 when I priced it last. If one of those didn't make its way home we wouldn't be out as much money as if we lost a Credo cooler. MaxQ coolers also have an exterior that would be easy to clean.
  11. We didn't have very good luck with our Igloo coolers holding temp. so we always used plenty of wet ice. Could have been the specific cooler type that was the problem, however. Our current coolers are Credo and they use cooler inserts (with different liquids inside) that are specific for the temp maintained. The inserts for red cells are conditioned in the refrigerator. The inserts for platelets are conditioned at 22C. As long as someone doesn't leave the lids of the coolers open and remove the tops of the inserts, they will hold temp for 8 hours easily. (When I validate them I let the data logger run for 24 hours and they are all still holding temps at the end of that time.)
  12. I would suspect that very few critical access hospitals would have tranexamic acid and DDAVP in stock in their pharmacies. This type of patient would be a very rare event for them. Treatment would be limited to stabilizing as much as possible and transfer as soon as humanly possible. Then that patient might well become my problem, but we are better equipped to handle it.
  13. When the reason for a deviation is determined we can decide how it needs to be addressed. In some cases, the deviation was an acceptable response to a given situation. No follow up required. If education or training is required, that is provided and documented on the same form. If the deviation is the result of continued 'bad behavior', training/education issues, or egregious disregard for policy, then our next step is an 'Opportunity for Improvement'. This is something we use throughout our lab. The tech and a lead sit down together to discuss the deviations and the problems identified to determine what the tech needs to do to remedy the problem. The tech is also asked what he/she feels is needed to help him/her resolve the problem. Once the lead and the tech have come to an agreement, the resolution to the problem is spelled out, including any education/training the lead will provide and the expectations for the tech's future performance. An end date for the required improvement is also determined. When that date is reached, the lead evaluates the tech's progress. If all is well, that is documented. The End. If there are still issues, the lead can re-evalute the situation. Additional training or education can be provided, with another periord of evaluation. If need be, the problem can be referred to the lab manager for possible disciplinary action.
  14. Our Deviation from SOP form is pretty simple.: Tracking # (a sequential # which I add when I review the form) Patient ID information Date/time of occurrence Description Reason for Deviation Action Taken - this is most often information completed by the tech who is responsible for the deviation or who discovered/corrected the deviation. Sometimes it is more appropriate for me to complete this part. I may add information to Description/Reason/Action sections. The medical director may add to any of these sections, though usually doesn't. Reported To/By/Date and Time Tech - person completing the report. This is usually the person who reports the occurrence, but not always. Signature lines for Supervisor and Medical Director Comment section - used for additional information or comments regarding the occurrence. This section is not always needed but is completed by myself (supervisor) and/or the Medical Director when necessary. This would be where I note retraining, disciplinary actions, whether or not a hospital occurrence report or safety huddle report was made, BPDR# if filed, calls to providers, etc. The Medical Director will comment on appropriateness of the deviation or contacts with providers as he sees fit. Example would be if the event was due to something like emergency release of uncrossmatched blood to a patient with an antibody. This form is one page and most of the events reported don't fill up all the spaces provided for entries. Once reviewed and addressed, I file them. I think if I was at a larger facility I would think about using a form online or at least a from that could be completed on our shared drive and emailed to me and the medical director. One of my goals is to build a spread sheet to track/trend by occurrence type - good quality project for my abundant spare time .
  15. We bill the antibody ID and the second screen. Our primary method is solid phase. If the screen is positive we run the panel. If the panel is all positive/inconclusive we run a screen with PeG (and/or LISS and/or saline) to see if we can resolve the screen. We have seen antibodies in solid phase that are undetectable in tube, so that's why we run the panel. How we report it depends on what we see w/ the panel and screens.
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