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Everything posted by AMcCord
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Very efficient!
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I've validated doing cord blood testing with the Echo and plan to implement it (some day, in my abundant spare time!). I got assistance/advice from a hospital in Utah that has been doing them that way for a long time. They rarely have problems with specimens. All my specimens played nicely during validation. I'm sure there will be an odd specimen that will cause problems, but there's always one now and again that misbehaves in tube.
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Is the transfusion hang tag disposable after tx?
AMcCord replied to STEPHANIEF's topic in Transfusion Services
Our tags go bye-bye with the bags. All documentation for the transfusion is on a worksheet in the EMR and prior to the EMR, it was on a paper transfusion flow sheet on the patient chart. -
Looks like you are are definitely on to something...keep us posted!
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I've seen patients with funky reactions shortly after they've had imaging procedures with contrast. Once the contrast media clears their system, everything is better again. It can be helpful to ask about what's been going on with the patient prior to specimen draw, including meds given.
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I would recommend it for a smaller lab with no computer as well. When staffing is tight, it can save your sanity. If you're used to doing all your paperwork on actual paper, adjusting your routine to work with Echo is a minor issue. I also see an advantage in the increased sensitivity for antibody detection/identification and the ability to use some of the same reagents for tube and automation. There is no way I would part with ours.
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Best of luck to you...think positive!
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We had an anesthesiologist send fully crossmatched blood back from the ER because it was type specific and he wanted O neg because "that would be safer for his patient". Our medical director put a quick kabosh on that one.
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...and they are happy to tell the family that WE are the reason that Grandma's surgery was cancelled and she has to be rescheduled. Orthopedist's favorite saying "Who ME?!? plan ahead?!!!". The lab is like a little kid's imaginery friend - anything goes wrong, it's the imaginery friend's fault. At our hospital, we used to swear that everyone thought that it was the lab's fault if the cafeteria burned lunch!
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Enter Nursing Data into EMR by Blood Bank staff
AMcCord replied to Llehman@ecmc.edu's topic in Transfusion Services
All transfusion records go into patient EMRs from the nursing end of things. They built a transfusion flow sheet into the patient care area which simulates the paper flow sheet we used successfully for years. They are supposed to document vitals, units numbers, times, signatures, etc etc real time. It's obvious from some flow sheets that real time is a REAL flexible concept to some of them, but most of them do a good job. No way would I agree to document something which I did not do. -
I was thinking perhaps a drug induced warm auto that is non-reactive with cells not coated with that drug, but his med list isn't really great for that theory.
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Though I've asked, I've never gotten an excuse or a reason that makes any sense. (My tiny mind actually wonders if they know why they want it - something their mentor always did, perhaps.) My conversations with them lead me to think that they don't really understand what it is we are doing when we do an autocontrol - perhaps they are unable to communicate what it is that they really need.
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Emergency release of uncrossmatched products
AMcCord replied to BBKT's topic in Transfusion Services
No ID, no blood is our rule. Our ID is the trauma # with Male or Female. Any docs who get sniffy about it, get a quick education from the ER Trauma coordinator. Once they understand the reason for it, they usually behave themselves when it comes to ID. Most of our anesthesia staff is very good about ID, so that's a help when things are stressful. -
We do an autocontrol with antibody screens only if specifically ordered by our Oncologists - they request that we do it that way. (We do not, however, do the auto with crossmatches for our Onc patients.) Otherwise, we do not do autos with routine antibody screens.
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What's your patient's blood type? Diagnosis? Meds?
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We are also a long way from service. Being self-sufficient is the name of the game.
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Love that silicon spray - that along with WD-40, bent paper clips and duct tape can fix most things.
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We require an auto with ID panels, but only do the DAT if indicated. Panagglutination, positive auto, funky looking panel results, specifically requested by physician, and history suspicious for hemolysis covers a lot of the 'indicated terrirory'.
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The surgical patients who live miles and miles away always make it in, too, even the minor cases that could easily be rescheduled. The surgical cases who don't make it are the ones who live a few blocks away.
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Did the patient get a big bolus of heparin by chance? though the timing seems pretty short for the platelets to disappear if that's the cause of the thrombocytopenia.
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I usually mix 8-12 drops of outdated antisera with 2 mL appropriate type serum or plasma for anti-Fy(a) or (, anti-Jk(a) or (, anti-S and anti-s. It will depend on how strong a particular lot of antisera is - lately my anti-Jks are a bit weaker (12-14 drops seems about right), so you just have to tweak the batch a little sometimes to get the result to want. I start my students out with antibodies that react 2-3+, then as they improve or if I'm feeling evil that day, I cut back on the antisera and give them +/- or 1+ samples.
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When we have to give non-type platelets (which is often), we try not to give type O platelets to non-type O patients. Actually, it's difficult for me to even get type O platelets at times.
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Same for us.
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Fun idea actually!
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We were sited by a CLIA inspection for not doing direct observation competency assessment. The inspector told us that we had to assess the 'major' procedures/processes annually. In Blood Bank, at least, you can incorporate a lot of 'major' procedures/processes into one observation exercise - one crossmatch w/ antibody can include blood type, antibody dectection, antibody ID, antigen typing, crossmatching immediate spin and AHG, correct donor selection process, tagging, and checkout, equipment (centrifuge, cell washer, ProVue or Echo or whatever, etc) -takes a long time but covers a lot of ground.