AMcCord

We came up on SafeTrace Tx in May. Haemonetics offered validation with a 'partner' company, but we chose to have our system validated by BC Solutions. Using a totally independent company seemed like a better idea.

Our Helmer CW cell washer does not make a beautiful tight button, but it does make a button that is consistent. As Scott says, I think that defining your acceptable button appearance is good enough.

We also got push back on redrawing patients for a second specimen - reason...patient satisfaction. We do type one specimen twice, but use electronic patient identification and issue blood with a barrier (FinalCheck armband/lock system). I was questioned about the expense of the FinalCheck system by the hospital administrator when I proposed it, but when I told him that a second draw would be required w/o it and that the lock would be a good deterrent to hanging the wrong unit on the wrong patient IF we strongly policed the use of the system, he agreed to the expense. Is it possible to cheat the system and still have WBIT and mistransfusion? Yes, human nature being what it is, someone will always find a way around all rules, but I think it drastically reduces the possibility. I should note that we are all lab draw or lab observed draw w/ rare exceptions in the OR. That does make the armband use more effective. I think that the 2nd person verification for patient ID at time of draw is pretty open for potential abuse.

I had a similar experience when a Family Practice Dr, who was chair of the OB committee at that time, brought back the Immune Anti-A, -B test. The only 'reference' he offered was his experience with his children. We wanted to ask if those tests affected how the infants were treated, but refrained....tongue biting was involved. The pediatricians say they don't need the test.

This, plus Pre-admit patients are 14 days.

I haven't done an eluate on a cord blood in many years. If mom has a clinically significant alloantibody, we antigen type. If we can explain the positive DAT with mom's antibody, her blood type (O), or her current dose of RhIG, we won't consider a routine elution. If the baby's bili is unexpectedly high or if we have some other reason to suspect that an alloantibody is causing a problem, we would perform an elution. Our cord blood panels are ABO/Rh and a DAT. If mom is type O and baby is type A or B, we perform an immune anti-A, or immune anti-B. This includes an auto control, an antibody screen and an AGT test with a reagent A1 or B cell against cord serum/plasma. I've tried to get rid of the immune anti-A, -B, but we have a couple of family practice docs who insist that it be included in cord blood workups. Heavy Sigh!

CAP says you have to be able to detect complement when you perform a DAT (exception - cord blood). So you would need to do the automated IgG and tube for C3 to satisfy CAP.

It happens both ways here.

Before you set a specific number across the board, I would suggest that you check you package inserts. Some of the human source rare antisera have positive agglutination defined as 2+ or greater and don't usually give much stronger reactions. The monoclonal rare antisera usually seems to react 3-4+. I would also expect stronger reactivity for anti-A or anti-B, depending on what you are testing them against. I would see 2+ reactivity for them as an indication that the reagent is not OK. We look for reactivity consistent w/ previous lots - +/- one grade of agglutination.

Congratulations! and thank you for your contributions to modern blood banking practice.

With many reagents I see the limitations section of the package insert as 'no news is good news'. If something has the potential to cause a problem it will be there, especially something that might be commonly encountered.

I suspect that nursing management or quality is aware of it in many places, but in smaller to mid-size facilities they are going to be looking hard at the cost to benefit ratio. At what point are there enough units transfused so that the institution feels that it can 'justify' the expense of full- or part- time employees to supervise transfusions. Transfusions happen 24/7, so it wouldn't be just one person. Until it becomes a recommendation or requirement from somebody like TJC or an excellent case can be made for cost savings, it's probably not going to happen. I think my facility would benefit from a specialized 'transfusion team' who could take on some aspects of the TSO.

No, administration of RhIG should not affect the FMH Rapid Screen test. The 'Limitations' section of your package insert will contain information on what can/will cause problems.

We recently went live with SafeTrace TX and we are going use the analytics module with that for monitoring. Haven't got it up yet. It is fairly basic but hopefully will give us real time information.

We are in the early stages. We monitor Hgb at time of transfusion and have a policy with suggested transfusion triggers. Our blood administration order sets reflect those triggers and require a reason for transfusion. The medical staff transfusing the majority of our patients are hospitalists, which does make a difference. We have also initiated minimum blood draws for all inpatient lab work and police that pretty aggressively. We are a small hospital, but this has made a sizeable impact on our transfusion volumes. I want to start looking at transfusion rates, readmission rates and diagnosis...if we can figure out how to pry that info out of Epic.

I remember doing RhoGAM 'crossmatches'. Guess that makes me old 😏. The statement regarding 'looking for reasons to withhold' is exactly the issue. If the screen is negative, we give RhIG. If the screen is positive and we ID anti-D, unless we have evidence to the contrary we assume it's from previous RhIG administered and we give more RhIG. Either way, we don't withhold the RhIG. Why then require a test that doesn't affect outcome...what value is added? If there is another pregnancy, the patient will have another screen done at her first Prenatal visit. That test then drives her treatment, not a test performed at her last delivery. I have hopes of streamlining the process to save the patient $$$ if possible, shorten the TAT time for issuing RhIG, and save us working up all those RhIGs that the Echo helpfully detects.

We get a specimen for all L&D patients. All get a blood type. Some have orders for a Type and Screen. If we've done the antibody screen with a T&S, we don't repeat it w/ the RhIG workup. To refine my question, how many of you issue RhIG with NO antibody screen done during the admission?

We just recently initiated scanning for blood products in the OR (Epic). Because blood products are not often transfused in the OR here, I foresee that the problem will be that anesthesia will get 'rusty' and find it difficult to utilize scanning. Too easy to forget details for something you rarely use. The first place everyone calls for assistance with BPAM is the lab and we generally can't help them - not something we've been trained to do, though we've learned some basics in self-defense. BPAM looks different in the OR version, so the tricks we know are probably not going to be very helpful. If blood is given frequently in the OR, I think it would work fairly well, The OR version of BPAM is clunky, but workable. In a mass transfusion situation, it may not be useable because it could slow things down to much. No refrigerators or coolers in use here. We issue units as requested, with positive patient ID provided by the runner. For routine situations, we have a specific document that prints for Epic for each unit. In urgent/emergent situations, they bring us a chart sticker. No patient ID, no blood. We will hand deliver units to the OR for emergent situations, if we have enough staffing to do it. Sign out would be performed by two blood bankers in that situation.

We are discussing changes to our RhIG workup protocol, I'm curious about what the consensus is regarding including an antibody screen in routine testing. Please see the poll above. Thanks.

I wonder how many facilities have a TSO. Mine doesn't. I suspect many smaller, maybe even medium size facilities don't have them.

Once the patient reaches the OR, his/her armbands are cut off and laid on the patient's forehead, chest. An armband sticker can be attached to the Informed Consent, which is in the OR with the patient. All armbands must be replaced before the patient is moved to PACU. We provide a reattachment band for the Typenex band. The others get taped together. If the band is not on the patient when he/she reaches PACU, redraw and retest. PACU does a great job policing that part. Based upon my observations of anesthesia in the ED checking patient ID prior to transfusion for traumas, it's obvious they take it very seriously and I would expect the same in the OR. We have discussed expectations for patient ID and they've always been very receptive.

We also prevented a mistransfusion event and potential ABO HTR because we use Typenex bands. Ours was an ER admit with identification issues that hadn't been detected. We insisted on transfusing with the matching band, not who ED thought they had and prevented the transfusion. We use the Typenex BloodLock system. All blood bank specimens w/ rare exceptions in the OR are drawn by lab. We have total buy-in from nursing management and education. We lose an armband on rare occasion and when that happens I usually get a call from a nurse reporting it immediately and stating that 'he/she has educated the nurse who cut it off so it will not happen again!'. I have not yet had a bag cut to remove a unit and we've been using the system for several years. We are one facility w/ about 300 nurses trained.

We are working on a derivative tag for RhIG from our new blood bank information system (SafeTrace Tx). So my question for everyone...Does your label for RhIG include the patient specimen expiration date/time?

Transfusion reaction workup is a whole 'nother animal. If I get a post-transfusion specimen that is hemolyzed, the first thing I do is ask the phleb if the draw was difficult. If it was, I send up someone else to obtain a new specimen. If we can't get a clean specimen, then that information is part of the documentation and taken into consideration with the interpretation of results.

We also use Epic BPAM for administration, so if provider orders are not in the system correctly and nursing doesn't release those orders, BPAM won't work. They've been learning that the hard way. Some nurses still like to point the finger at Blood Bank, but their IT folks can see when the problem is user error rather than a lab issue. They educate nursing staff accordingly. There are still problems, but at least nursing management knows where the problems originate and some of the front line nursing staff is getting pretty tuned in to BPAM. When blood products are in a 'completed' status in Epic at my facility, a little red blood drop shows up at the top of the nurse's screen in Epic, something like the 'new test results available' notification works. They still call sometimes, but that little drop has helped tremendously. We do communicate by phone if the patient has antibodies or there is some other reason for delay. We might also notify surgery or the ED that blood products are available in some situations, but not routinely. When the provider signs the Transfuse order in Epic, a copy of that order prints in Blood Bank. When the transfusionist releases the Transfuse order, a copy prints on the floor and in Blood Bank, so we know that they are ready to start the transfusion. The nurse who comes to check out a blood product brings the Transfuse order that printed on the floor when the order was 'released', which serves as positive patient ID for us. Works well for us even if it does kill trees.