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AMcCord

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AMcCord last won the day on October 5

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About AMcCord

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  • Birthday May 8

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    Nebraska
  • Occupation
    Blood Bank Section Supervisor

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  1. Anyone have any good ideas about how to deal with the section in red that would work at a smaller facility? We don't have the centrifuge needed to perform volume reduction on platelet units. We don't have the capability to relabel units if we split them except with rolls of labels - no Digitrax, no ISBT128 registration. Our BB LIS is not set up for splitting units. No tube welder. We would have a very small number of patients that would fall into this category each year, so the whole process would be performed very infrequently at most. Competencies would be a nightmare even if only 2 or 3 of us were designated to perform this task. Historically if we've gotten a request for split red cells units, we've recommended that a volume equivalent to a split unit be infused slowly, then discontinue the infusion. If more red cells are required another unit is set up and a small volume is infused from it. It is wasteful, but it is an extremely infrequent event. I've received maybe two requests over many years to volume reduce platelets for a neonate, but we have no way to do that.
  2. We had stopped doing cord blood panels on O Pos moms for several years. Then a Family Practice physician took over as chair of OB/Peds and insisted that we resume cord blood testing on all O Pos moms. Why? ... because his children were born with elevated bili levels and his spouse is O Pos. Was there a difference in the treatment of these infants because their DAT was positive? ... probably not. We need to revisit this issue because we do a lot of cord blood panels on O Pos moms and it adds to their bill w/o adding much, if any, benefit to the infants care.
  3. With monoclonal reagents I have seen maybe 3 or 4 cord bloods that surprised me with a positive result for the weak D test. One of those, mom and baby were IS negative and weak D positive very weakly. We don't send those patients out for molecular testing at this time. We also don't do weak D testing on adults unless a fetal bleed screen is strongly positive, the sample is from the Rh negative male partner of an OB with anti-D, or it's part of a preliminary workup for an potential organ/stemcell donor. We routinely perform weak D testing on cord bloods and newborns.
  4. Our lab has purchased the software. It does seem to make the process easier. Used a lot by our micro department.
  5. pHix is supposed to be guaranteed to maintain a pH of 6.9 to 7.2 for a month. Our saline never lasts that long, so no worries there. We are using pHix buffered saline on the Echo, as recommended by Immucor. Whatever you choose to do you would need to do validation testing for your method(s) of course, in addition to whatever you do for saline QC.
  6. Level 3 trauma designation here. We issue MTP products from SafeTrace Tx, both known and unknown patients. Very quick and easy to use. For unknown release if we have other lab orders, or can get info from the ED, we input patient 'name', MR#, birthdate (if known), account # if we have it. When we receive an actual order from Epic or a specimen, they will easily match up with that patient record in SafeTrace Tx, If we need to very quickly send units to the ED for patients that haven't yet arrived, we photocopy the unit face labels. Once we have patient info (and have time), we emergency release the units from SafeTrace Tx using the photocopied units, making sure to change the release date/time to the actual time the units were sent to the ED. The ED does sometimes use an emergency transfusion module in Epic for documentation that lets them scan donor info and free text any other information. I've been told by the trauma coordinator that it can be pretty easy to use. If we have a really massive blood release that is going quickly I'm not sure if they would use that module or not - if the staff members who are familiar with using it are working, they might. Other staff probably wouldn't. Surgery doesn't give a lot of blood products here so large volume/emergency/MTP is going to be on paper and probably documented after the fact.
  7. We use a training/competency sign off initially. Then follow up at 6 months and one year with repeat competency assessments. I think that you need to have documentation that training has been completed satisfactorily, which is best demonstrated by an acceptable performance on a competency assessment. The individual may not be performing at as a high level of competency as they hopefully will be at 6 months or a year, but they should demonstrate a minimum level of competency, as determined by your facility, before performing patient testing.
  8. We use biohazard bags that are part of the FinalCheck lock system.
  9. We see a positive DAT from time to time that we attribute to RhoGAM, but no indication that any of these babies had elevated bilirubin levels from the anti-D immunoglobulin. There are a number of physiologic reasons for elevated bilirubin in neonates. If mom is a smoker, they have a lot of red cells on board that they don't need after birth. As Malcolm says, they are switching to HbA production. If the baby is not hydrated well the bili can become elevated, Etc... If anti-D has been identified in mother's sample and can be reasonably attributed to antenatal RhIG, we don't perform a titer on Rh positive baby cord blood samples unless there is some indication that something else is happening (strongly positive DAT or unexpectedly high bilirubin).
  10. One of our neighboring facilities is inspected by Joint Commission and AABB. No CAP. We are CAP inspected and Joint Commission is perfectly happy with that. They look at a small number of very specific things in our lab - how we handle our bone/tissue implants and how pathology handles surgical specimens and biopsies.
  11. We've seen a patient like that. We ID'd a clear cut but weak anti-C w/ solid phase on one specimen, not there with the next specimen, back again w/ a 3rd specimen, We discovered that she had been transfused somewhere else between our visits. That lab used gel and they had not detected the anti-C. We suspect that she received C positive blood, which pushed her titer up again.
  12. Nursing policy for blood administration should include those type of guidelines, They have references available for infusion rate, etc. The medical director of blood bank should (ideally) then review all of those polices to make sure that what they have included is good practice. In other words, a collaborative procedure. We struggle with getting blood/blood product nursing policies reviewed when written. There is a constant rotation of new nursing admin staff writing policies who never seem to know that our medical director should review those new policies and they don't understand what the lab has to do with administration. I just tell them it's an FDA requirement and TJC expects those requirements to be followed. Our nursing policies are accessible on-line so I search periodically for blood related policies to see if anything has been added. I put all of those policies in my SOP manual under blood administration. When I do biannual review, I check to see if the policy has been revised so I can upload a new version if necessary. I usually check at least annually as well. The policy format used by my facility assigns 'ownership', which is the VP of nursing, 'authorship' and also includes a line which indicates people who must review the policy. TJC requires policy review every 3 years, so that's why I include those policies in my manuals - to make sure they are reviewed often enough for CAP requirements. If I find a policy that does not have the medical director's name on it as a required reviewer, I reach out to the 'author' or the 'owner' to see about getting it added. I've also made a point of knowing who is responsible for the facility policy manuals and who is responsible for the Joint Commission compliance book. I have those 2 ladies on speed dial and they are very helpful. It can be painfully slow to deal with all the committees/councils that direct nursing policy. I tell myself that persistence and patience is key (and patience is not necessarily one of my virtues!).
  13. Appreciate this information Mabel. We are not currently providing blood for our contracted air service except for transfers for our patients, but I can see the day coming where this might change. What you've described would work very well for us I think.
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