AMcCord

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.

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.

I liked their competency assessment tool. Definitely labor intensive, but very good documentation. Will be working to replicate it in MediaLab.

Makes you wonder how often they clean up their fridges, doesn't it?

Sounds like a couple of the FDA inspectors I've experienced.

In the U.S. we are required to confirm donor types at the hospital.

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.

We are using the FinalCheck system.

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 #.

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.)

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.

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.

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.

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.

I just got a bid for setting up Haemobank and staff education is included in that pricing.

Background: My facility is an independent community non-profit hospital. We operate a free-standing cancer treatment center on our campus. When a patient requires transfusion there, we receive a specimen in our main lab for testing and issue blood products to the cancer center in coolers. That process is working very well. The complicated part: We are in the process of opening another cancer treatment center in a neighboring city about 12 miles away. The center will be located in a 'physician's building' that is physically attached to another independent hospital. This hospital is not part of us, totally independent, but we are working together for some things (we are their reference service for surgical path specimens). They will be performing some or all of the lab work for the patients seen at that cancer center. The tricky bit is going to be providing transfusions for those patients. Our employees will be transfusing the blood products according to the current plan, but who does the crossmatch/issues the blood product? We could consider stocking product there, but we can't issue it based on a crossmatch reported by the other hospital. They could crossmatch and issue the product, but for Medicare billing purposes the product charge and the infusion charge have to be together. It's not going to work to have the other hospital bill for performing the tests/issuing product and for our cancer center to bill for the infusion. (And to further complicate things, we use Epic/Harvest/SafeTrace Tx and they use Mediware.) Is there anyone in this group working with a scenario like this? If so, I would really appreciate any insight in how your facility makes it work.

Everybody was assigned every procedure and they signed off. We went live with MediaLab before all of our procedures were loaded so they weren't inundated with all the SOPs at the same time. They signed off as SOPs were added.

We haven't done Kleihauer Betke stains in our lab for years. When we did, I was the only tech who could consistently match the expected results on the CAP survey. Everyone else tended to over count fetal cells (which is better than under counting and under dosing RhIG I suppose). If we had a patient sample on my day off or during an off shift, the stain was reported out as a preliminary, then I recounted and sent out a final report the next shift/day. If I was on vacation, a preliminary report was issued and the sample was sent out. I tried and tried to improve performance - we sat at a double head scope and counted cells together, I watched them stain, etc. etc. Our patient volume was 1 or 2 a year with 6? or 9? survey samples. By the time we paid for the kit, paid for the survey and worked to maintain competencies for those 1 or 2 patient samples a year, it didn't seem to be a good decision to keep the test in house either from a $$$ or quality point of view. The reference lab we use now can give us less than 24 hour turn around. When we did do them in house, we used the kits from Sure-Tech (below). I see they have some nice controls now - when we used the kit we had to make our own controls. The controls could help with training/competency. They also have a reference manual that I would recommend that has nice photos of stained cells. I used it for training. Are you an ARC customer? I think that their reference services might do K-B stains.

We are scanning all completed patient antigrams, worksheets, and reference reports into our BB LIS. That information is accessible (and printable) from the comment section of the patient profile.

That was my first thought. I dislike what they've done with the Transfusion Medicine checklist. The All Common items that used to be 'customized' for Blood Bank were in the Blood Bank checklist where they belong. Now it's a guessing game from an All Common list that is really focused on Chemistry - does this apply to BB? how does it apply to BB? what is this even aiming to achieve??? What used to be covered in one is now spread into 3 or 4 places. Thanks CAP!

I'm looking at the All Common CAP checklist for Serology (Transfusion Medicine). Anyone have a good plan for COM.40700?

If your facility has Epic an order set can be built for product orders that has a list of indications. They have to pick one to complete the order. If they choose 'Other' there is a line that has to be filled in with the indication. That thins down the inappropriate orders quite a bit. I agree - many providers think 'cancer' is an indication for irradiation. We do make phone calls to clarify those orders. Often when we tell a hospitalist that the patient is seen by Dr So-And-So an oncologist and we don't routinely transfuse irradiated to that patient, they drop the order for irradiation.

We will soon be receiving pathogen reduced SDP platelets and LDVS SDP platelets from our supplier. I need to get billing squared away. P9073 looks like the correct code for pathogen reduced platelets. I do have 2 questions: 1) What code(s) are you using for HLA matched pathogen reduced platelets? 2) Are you using a code to recover the charge from your supplier for the LDVS testing surcharge on SDP and irradiated SDP? Thanks!

Our order sets in Epic are built with the required tests for each product type. Providers click all the boxes. If there is a current T&S or blood type on record (witin 72 hours), whichever applies, they get a message telling them that the test is a duplicate, consider deleting. If they don't delete the duplicates its a simple matter for us to delete as duplicate when we bring the order into the lab system. Our previous HIS didn't allow use of that kind of order set, so one win for Epic. On days when Epic is frustrating, I remind myself of that nice function.

And those are crazy expensive. I stopped stocking them, too.