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AMcCord

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Everything posted by AMcCord

  1. My Echo is 13 going on 14 years old. It's been very reliable, service has been good. I will be upgrading to a new instrument next year to avoid a surcharge on our contract because we are running such an elderly analyzer. I switched us from manual gel (which we used for about 8 years) because I was tired of weak antibody reactions that required PeG/tube to resolve. Solid phase has worked well with our patient population.
  2. Our PAT specimens are good for 14 days. The patients sign a pregnancy/transfusion statement when the PAT specimen is collected. If they don't answer NO to both questions, no PAT collection. The phleb signs as a witness. We use a FinalCheck armband system for Blood Bank specimens. When the PAT specimen is drawn the patient is wearing an outpatient hospital band with name, MR#, BD for positive patient ID. We assign a Blood Bank armband to the patient and label it with that patient ID information from the OP band. An ID sticker from the BB armband is placed on the patient specimen and on a PAT ID card. The PAT ID card is an 8.5 x 11 inch sheet of card stock that is fluorescent yellow. It says in a LARGE font that the patient must bring the card with them the day of surgery and present it to their admitting nurse and it tells the nurse to call lab. The card also tells the patient that failure to return the ID card means we redraw the patient and retest, possibly delaying surgery. We put the card in an official hospital folder and instruct them twice on the importance of bringing the card/folder back. The specimen, the preg/transfusion statement form and the specimen come to Blood Bank. Once we get the call from Pre-Op we take the preg/transfusion statement form and the appropriate armband to Pre-Op to ID the patient verbally and with their hospital band, then apply the BB band. The patient then signs the PAT card and that signature is verified with the signature on the preg/transfusion statement form. We used to use a pocket sized PAT ID card, but discovered that about half the patients forgot to bring them back the day of surgery even though they had received verbal instructions twice the day the specimen was drawn and were reminded during their Pre-OP call from surgery. With the large electric yellow form very few patients forget to bring them back. We feel this gives us solid patient ID without asking the patient to wear an armband.
  3. I'm not concerned with how full the tubes are as long as I have enough specimen to work with for required tests. I would reject an expired tube unless it was some kind of emergency situation that pretty much prevented redraw. And if I did make an exception, it would be as a deviation from SOP that would require an explanation as to why the tube was used and a signature from the BB medical director.
  4. Depends on the beer . My Belhaven Black better not be ice cold.
  5. The suggestion I got was to make it a routine maintenance task. Connect your backup computer once a week to the network and load the backup file. I talked with our IT people and they said they could set that up so it was a matter of accessing a file on a server and downloading it. The hows and whys are all magic to me, but the IT analyst I talked to wasn't at all concerned about any difficulty doing it. Then, of course, the computer has to be totally disconnected from the network or you risk exposure to bugs and hackers. WiFi shut off and/or cable disconnected.
  6. We routinely stock 2 O Pos, 2 A Pos and 2 O Neg Irrad units for oncology patients, so would have Irrad units available if ordered for a neonate. I think we average 1 or 2 neonate transfusions in a years time. Our irradiated units are rotated for restock about every 2 weeks and restocked when used. We do not stock CMV neg units. All our blood supply is leukoreduced, which is considered CMV safe. If we are planning a transfusion or have an anticipated birth of a baby who might need transfused we order a fresh unit or two.
  7. You could use a barrier method like FinalCheck armbands and locks for patient safety. If the band is applied to the patient when the specimen is drawn and then the armband code opens the lock on the bag the unit is issued in, then at least you know that the specimen came from the patient who is going to be transfused. Code doesn't match = wrong patient. We use both electronic ID and the FinalCheck system and do two types on one specimen. We closely monitor phleb performance with direct observation multiple times per year to make sure their process isn't creeping from policy. We have buy in from nursing management and administration which means there is disciplinary action if the barrier system is bypassed (armband removed, armband code found written down somewhere, bags cut, etc.). The only patient specimens that aren't lab draw are from the OR and those are collected by anesthesia with banding and proper labeling required or the ED where collection has to be directly observed by a tech or phleb or we won't accept it. The big IF would be whether or not the nurses would use the lock system correctly and since you can't get them to use the electronic ID system correctly it doesn't sound like a good bet. If you can't enforce correct use - patient banded when drawn and locks opened at bedside from the band instead of cutting the bag, then it gets you nowhere. It sounds like there is a culture change needed, top down, if safety practices are routinely ignored. That's a huge lawsuit waiting to happen. Do you have a quality department that could intervene? Can you get your medical director involved?
  8. Thanks all - that's what I suspected. My patient's antibody is still reacting fairly strong in solid phase, so I'm relying on crossmatch for Cob donors. Think I"ll freeze some plasma for screening purposes in case his titer drops.
  9. Is anyone aware of a vendor who has antisera for Cob (US)?
  10. Of course its Friday afternoon! That's when all the run stuff comes in.
  11. And what are you going to do if your entire HIS/LIS/BBLIS network is down? - think hackers and ransom. You may not be able to access any of your computers/records until each and every one of them has been checked and cleared by your IT folks, individually...which is going to take time, especially if your facility is large. Unless you have something that is not connected to the network, but is backed up regularly, you are going to have to have some alternative. We are working on getting a laptop set up that is off the network but backed up periodically to supplement our 'normal' downtime records. Until that is in place we are printing a patient history from SafeTrace for every patient with antibodies, special needs, testing issues, etc. and putting them in a notebook alphabetically. Learned this the hard way.
  12. Our requirement (at Blood Bank insistence) is that the infusion has to begin within 15 minutes of checkout. We had problems with nurses checking out blood products before they made sure that the IV was good and without taking vitals, then wanting to bring the unit back 45 - 60 minutes later. Their policy says check IV and vitals before coming to Blood Bank to pick up units and the short time allowed to start the infusion kind of reinforces that. The number of wasted units dropped significantly after this policy was in place. We also use the policy shared by slsmith. If there is a delay and they bring it back after 15 minutes, we check the temp. It will probably be over, so they are asked to give in 4 hours or its wasted. An Occurrence report is filed.
  13. We are going to put a hang tag with a fluorescent green label on our pathogen reduced platelets using the language suggested by Cerus - FDA approved as a substitute for irradiated product, meets AABB requirements for CMV neg, etc. etc. I'm not optimistic about many people actually reading the education materials.
  14. I liked their competency assessment tool. Definitely labor intensive, but very good documentation. Will be working to replicate it in MediaLab.
  15. Makes you wonder how often they clean up their fridges, doesn't it?
  16. Sounds like a couple of the FDA inspectors I've experienced.
  17. In the U.S. we are required to confirm donor types at the hospital.
  18. We also use BPAM and collect all specimens with electronic ID. I don't believe either of these two methods is regarded as a barrier method, though they are certainly an improvement for patient safety.
  19. Ours are EBA 21s. That is an older model but I was told by a rep that they had a new model that was equivalent. Sorry, I don't know what model #.
  20. We've been using 2 Hettich centrifuges for quite a few years now. They have been very reliable and run quiet. The down side is that I find them a little tricky to program, which fortunately I don't need to do that after the initial set up. (The upside to that is that my mystery tech who feels urges to tinker with stuff can't figure them out, so they leave them alone.)
  21. We've been happily using an Echo for about 9 years. The instrument has been very dependable and is a workhorse. The turn around time for antibody screens is quick. Its footprint is not that large and it fits under our overhead cabinets easily. The test strips store at room temp, so that is an advantage for us. The mechanical part of the instrument is pretty basic with quite a few user replaceable parts. We've had good luck problem solving with a call to support and those times we actually need service, we haven't had to wait long to get an engineer on site even though we are in a rural area a long way from a larger airport. It's a quick train for new users with some nice features to prevent the kind of dumb mistakes that we humans can make. The method is sensitive - you will see more warm autos and anti-D from RhIG, but it is also going to do a great job picking up Jk and Fy antibodies. The cells on the ID panels (3 of them) are well selected. Immucor has tweaked the methodology over the years so that you aren't going to see many non-specific reactions. When we first started using the Echo nine years ago there were more of those types of reactions. When we automated I chose to switch to the Echo from manual gel. During validation I was pleased with the sensitivity compared to gel. We use DI for our middleware.
  22. For patients with no previous history we add a test called ABO/Rh confirm to the patient's order. There is no charge code associated with the test. The test is a tube front and back type. We require either 2 methods (Echo + tube confirm) or 2 techs if the Echo is down. We also use only one specimen. Patient ID is electronic and we issue blood products using a barrier method.
  23. Check the product insert for the RgIG that is issued at your facility. Rhophylac and RhoGAM both say to collect the Fetal Bleed Screen/Kleihauer Betke one hour after delivery. You don't want to make your policy too rigid to comply with however, so ours says that we draw specimens as close to 1 hour of delivery as possible. As Carolyn said, the most important thing is to make sure that the specimen gets drawn.
  24. Our document control system assigns SOPs to the appropriate staff members. They sign off in the system indicating that they've read it and that they understand it. That signoff is maintained as long as the SOP is held in the system, so pretty much forever. If there is a competency requirement along with a new or changed policy, then that is documented and stored as long as any other competency and would be included w/ the documentation for that year.
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