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AMcCord

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Everything posted by AMcCord

  1. We are using a small hang tag (purchased from Amazon, cheap - intended to tag clothing) with a sticker I print on a fluorescent label. See below (actual size).
  2. Check your instrument manual carefully. Immucor has a statement in the manual for the Echo that addresses carry over. Maybe Ortho does as well???
  3. We've never been cited by CAP, the FDA or TJC. TJC does come into Blood Bank because we handle the frozen/refrigerated tissue grafts and never a word said. Our saline in use is quite visible to anyone who walks into the department. That request is overboard and made by people that have never worked in the lab. Agree with the comments about safely handling the plastic blob, utilizing the reagent w/o waste, proper labeling w/ lot, etc. and the fact that it would look just like formalin and some of the reagents hemo uses.
  4. Above is what we do with traditional reagents, including the fetal screen (lot to lot comparison as above). Automated reagents are QC'd when the lot is opened using the QC material we were using with the old lot. We inspect for appearance and shipping condition, check inserts, and document that for all reagents when received.
  5. I would recommend getting the LIS. It will provide a level of patient safety that you can't get with paper. It improves workflow, especially if you are using automation. Decreases documentation errors and omissions. It will simplify billing. It will vastly reduce the piles of paper documentation that you would otherwise be storing for years - patient, donor and potentially QC (depending on the software). It simplifies inventory management, especially when you get look-backs and recalls from your blood supplier years down the road. We are a smaller hospital that went to an LIS just a few years ago. I can't imagine ever going back to paper (gives me nightmares actually!). It has definitely reduced my workload in terms of all the record keeping, reporting, etc. that is required. I am filling out fewer error reports and deviations from SOP. With staffing issues a 'normal' thing now, I need all the time I can find to do all the other things I need to get done, including working on the bench. Are you going to do the reaction workups or refer those?
  6. And that transfuse order has to be from the same 'phase of care' where the patient will be transfused. If the transfuse order was entered in the ED or the OR, that order will not work for an IP on the floor - lets say ICU. BPAM won't work until a provider order is entered for that IP/ICU phase of care. Learned that one the hard way when we first went live with EPIC.
  7. We do accept product from other ARC facilities. The contract each facility signs with the ARC specifies how products are to be handled and I would think that this would apply to any blood supplier. The transferring facility completes the ARC transfer form that includes an attestation that states that the product was stored properly. We verify that the products were packed correctly for shipment and that the temp of the units when received is OK. That inspection is documented on the packing slip that ships with the products, including date/initial by the receiving tech. I think another point hat can be considered is the fact that the other facility has been inspected by someone - state, CLIA, CAP, AABB, TJC, possibly their blood supplier, etc. - that inspection would include their blood storage records and practices. Maybe I'm naive, but I figure I can trust that unless I have evidence to the contrary. (I am not FDA inspected or I might give you a different answer.) If product comes in that doesn't pass inspection, we reject it and I notify the facility and our ARC hospital representative. Transfers that come in with another patient are an entirely different thing.
  8. Check for work done by Mayo Clinic. I believe that they are sending out cold platelets w/ red cells on trauma flights. Maybe someone here can provide a reference for their trauma studies.
  9. We manually entered results after a 9 day down time. Manual entries were verified before they were pushed from the LIS to the HIS. There was a special work group that came in on a weekend and worked long hours to do it, then worked charges after that. Nine days worth of data was a mountain. I can't imagine doing 2 months worth considering staffing issues. I would vote for scanning. We can scan into the lab results section in Epic. It wouldn't be graphed, but it would be accurate.
  10. I had an OB patient with an antibody to anti-Goa that we picked up on prenatal screening. One cell was positive on the screen and nothing showed up on 2 panels, Because it was an OB case, I sent it to the ref lab and they identified the culprit.
  11. My facility has never been cited by JC for therapeutic phlebotomies. Interesting. I handed that service over (quite happily) to the outpatient infusion clinic years ago. I did train them initially and give them copies of my forms as a documentation suggestion. My CAP checklist gets N/A for those questions and I've never been approached by a JC inspector. I would hope that they have yearly competencies, but I don't know for a fact. Might have to inquire.
  12. We issue units for warm auto cases as 'incompatible, approved by pathologist'. We enter a comment in the patient Blood Bank record with the date/time we got the approval, from whom, and documentation of any instructions they give and any instructions we are asked to pass on to nursing. In some cases, the pathologist may consult with the ordering provider and request that he/she sign a 'Request for Release' form with one of two options selected: - incompatible units due to clinically insignificant interference (cold agglutinin, rouleaux, etc.) OR - incompatible units due to interference from a clinically significant warm reacting autoantibody. Although some units may appear compatible in vivo, it is impossible to rule out any underlying clinically significant alloantibodies that may cause a hemolytic transfusion reaction. The pathologist may also sign the release form in some cases, if requested by the provider.
  13. We use the FinalCheck armband and lock system with Epic BPAM. We also use electronic patient identification for specimen collection. The armband code is not documented in Epic or anywhere else on the floor, only in Blood Bank. The blood product is locked in a bag at issue and the combination to the lock is the code the nurse takes from the armband at the bedside. No armband, no blood product (except emergency or MTP). Once the unit is removed from the opened bag at bedside, the identification process continues w/ 2 person verification and BPAM. It is not cheap, but it closes a loop for specimen collection. The process works smoothly. We lose very few armbands. There are more problems with BPAM, most of which are related to somebody forgetting to check a box in Epic to begin the transfusion, forgetting to enter a volume, or scanning the wrong barcode.
  14. We are seeing the same issue in our rural hospital lab (170 bed hospital). Using a traveler on evenings and one on nights right now, 3 open positions with 2 more resignations expected before the end of the year. We offered to 4 students who trained here - no takers. All of them are off to the bright lights, big city and sign on bonuses.
  15. I believe California and Florida also have state licensure requirements as well.
  16. If you use the specimen for testing, retain it for the same time period as other tested specimens. I am not aware of any requirements for specimens collected 'in case we might need them or get orders later'. However, the antisera reagent inserts specify how long a specimen is OK for testing, dependent upon the tube/anticoagulant used for specimen collection. That should be addressed in setting your policy.
  17. We used to use the CAP competency assessment, which worked fine. Yes, it's a big build, but once it's in it's easy to modify as needed and it printed out a beautiful report for employee competency files that clearly documented the 6 required elements. We recently made the switch to MediaLab because we also use it for document control and inspection documentation. MediaLab competency looks very similar to CAP. Makes me wonder if MediaLab built CAPs program. There are some extras, however. There are some assessments shared in MediaLab that you can pull in and modify to meet your needs which would reduce the build time. You can still build quizzes, link SOPs, add photos and graphs, etc. You will get good assistance from MediaLab. They respond to messaging quickly, you can make a phone call and they will talk you through what you are doling, and they will do on line demos. And I believe they are a little less $$$.
  18. We don't tend to do much Blood Bank testing for Covid patients now, however when we were doing types to give convalescent plasma we did see a few funky reactions in backtypes. Nothing strong. Whether they were Covid related or just that patient...who knows.
  19. And don't forget to add critical tasks, as well as testing, such as issuing blood products.
  20. We automated (Echo) for types; screens; cord blood DATs, weak D, types; and antibody IDs about 13 years ago from manual gel. Before gel we used manual REACT, but have always used tube for backup and problem solving. The bulk of our work runs on the Echo. We send out very few specimens to a reference lab and don't resort to tube testing very often for problem solving. We do see more warm autos with solid phase, but use tube with PeG, LISS, or saline phase if we have to, to determine presence/absence of underlying alloantibodies. Staff adapted quickly to the Echo and solid phase. Our MLT and CLS students learn quickly as well. We are a busy rural referral facility with approx. 150 beds and 12 generalists who rotate through Blood Bank (some more than others). I am the only full timer. We deliver almost 1000 babies and transfuse about 800 units of blood a year. Blood Bank is staffed with one person on days and on evenings and nights a generalist handles Blood Bank along with other responsibilities. Works very well for us. Saves our sanity on high workload days. On those rare days when the instrument is down the tech in Blood Bank is very sad. I would never go back to all manual testing.
  21. Me too! And chasing the snowflakes back and forth.
  22. I tried it several times when we were still gel users, but never successfully.
  23. Just got a call from our rep - ARC nationally is going to start allocating O pos and O neg red cells. It will be based on your facility usage pattern and may be updated weekly. Donations are tanking and they are having staffing issues, as we all are.
  24. I haven't gotten any messages from either national or our customer service rep yet, so .......no clue.
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