AMcCord

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.

I believe California and Florida also have state licensure requirements as well.

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.

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 $$$.

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.

And don't forget to add critical tasks, as well as testing, such as issuing blood products.

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.

Me too! And chasing the snowflakes back and forth.

I tried it several times when we were still gel users, but never successfully.

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.

I haven't gotten any messages from either national or our customer service rep yet, so .......no clue.

I had the pleasure of attending an AABB session with Drs John Case and John Judd on the panel. Amazing session. Very knowledgeable gentlemen with wonderful wit and humor.

We still issue RhIG from Blood Bank but there was some discussion prior to a JC inspection a couple times back about pharmacy being ultimately in charge of all meds issued/administered. Nothing changed on my end and I never heard what pharmacy did to satisfy themselves that they were in compliance. Pharmacy does now order RhIG for us, though it is billed to lab and we collect the revenue, so I'm guessing that is part of what they did to make sunshine and happiness on their end. The current pharmacy director wants no part of RhIG outside of what they already do.

Working well for us as well. We use FinalCheck.

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.

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.

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.

Depends on the beer . My Belhaven Black better not be ice cold.

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.

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.

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?

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.

Is anyone aware of a vendor who has antisera for Cob (US)?

Of course its Friday afternoon! That's when all the run stuff comes in.

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.