S.Hunt

Currently our central supply area logs in all lots of transfusion sets in an on line master log. They started doing this after there was a recall and they had no idea where the received sets were destributed. Basically the form lists the manufacturer - product -lot# -Expiration date (when applicable) - and number of units. When a unit/case/or multiple sets are distributed, the materials staff member performing the transfer, documents it. You should have a Master List of Critical supplies used in your Blood Bank/Transfusion Service/ or Blood Collection site and a tracking plan for these supplies just like for a blood product -> birth to final disposition. Good Luck - it took a long time to set up the CRITICAL SUPPLY TRACKING SYSTEM

We have established a 1 hour TAT from time BB testing ordred till testing reported. For blood products it is 1 hour unless patient has had or has positive antibody screen. Our contract with the medical staff states we will call whenever the STAT TAT will be exceeded.

We are a 150 bed hospital with limited space and have looked at the Echo and ProVue. The Echo is currently our first pick because of the faster turnaround time; ease of use; ability to put first panel on and run; it is a walk away bi-directional interphased machine that will interface with our MEDITECH IS; uses less reagent to run testing (and we all know that second to Gas prices blood bank reagent prices have been skyrocketing); and the ease of repair and service. The one concern we do have is that the ABO/Rh cards do both ABO and Rh and they do not have just an ABO card for doing RBC retyping of units from our supplier. The ProVue was considerred because we currently use Gel technology and we ferlt the transition would be easier for our crosstrained staff - especially the evening and night Techs. However, the space necessary for it, and the sensitivity of it's reader requiring many cards to be visually checked kept us in the Tube ABO/Rh and Gel Antibody screen - ABID technologies.

I was told there would be a 100% increase, however, after checking prices it is 110%. It appears the prices are increasing just because they can, as with oil. As with others our rep says this is to get everyone to use the Gel ABO cards. Why is it they want to push us to a slower technology (15 minutes)when our ER and OR want faster technologies and there is anationwide shortage of O Negatives thus fewer to have for emergency issue until a blood type is found? And we thought those with the power over our livelyhoods and budgets were in Washington. D.C.

We have also seen the respin phenomenon. But remembering chemistry training involving SDS Gel columns (ie Ortho Gel Cards) ,the packing problems with this molecular seive, and the package insert, we opt to repeat rather than respin. Could this be a DILUENT ADDITIVE PROBLEM? When LISS became a new attenuating medium for antibody identification, LISS antibodies drove us all crazy. Everyone has always said IF IT IS A LISS PROBLEM ALL REACTIONS SHOULD BE THE SAME. Our experience has not been all reactions the same, however, PEG Antibody Id's have shown it to be an additive phenomenon this phenomenon . This led us to use PEG ABID as a back-up to our Ortho Gel Card system for Antibody Identification when Gel results do not make sense.

We stopped stocking MICROGAM@ a long time ago for pretty much the same reasons as stated by others. - OB/GYN's not willing to commit on gestational age (especially when close to 12 weeks) - too much RHOGAM@ won't lead to problems in later pregnancies HOWEVER, not giving enough might. I pose another question - How many blood banks follow patients given Rho(D) IgG early on in the pregnancy and thus give Ante Partum Rho(D) IgG before 28 weeks?

We use 24 hours OR the expiration date whichever comes first. Our supplier will not accept platelet products back so once they are pooled we will accept them back from units provided they have not exceeded 15 minutes. The 15 minute policy is what we use as a time for red cells and platelets and has more to do with what nurses do with the products - put on top of air registers etc. - than acceptable practice.

Overseeing the "Tissue/Bone" program is the interpretation that our Medical Director has chosen. Not Responsible for the program. The reason for this is a practical one. We currently only store and issue Bone/Tissue, as we have the only freezer that gets cold enough to store it and comply with that need. Also the blood bank computer system module allows for the "Birth to Death" tracking needed, especially if there is a recall Storage and issuing was all we wanted to do, however, the new JCAHO guidelines came out and the OR, needless to say was no where neer compliant. Training? Competency checks? ANNUALLY - what do you mean by a monitored storage device? Acceptable supplier? The only part that hey were familiar with was the Acceptance protocol for the receipt of the ordered products before giving them to us to store. Our acceptance check list was modified for the receipt of Bone/Tissue and the BB wil not accept a piece of Bone/tissue for storage unless a copy accompanies the product. Thus at the request of our QA department, a Protocol delineating the responsibility of each party has been specifically stated and SOP's put in place to assure compliance. Utilization review - amount and type used/outdated, storage problems etc - is put into a report and presented at OR meeting and semiannual Transfusion committee Meetings. Any SOP changes have to be reviewed and signed by responsible QA departmental committees. Good Luck - This can of worms is bottomless and dealing with non-focused nursing staff is the biggest challenge. The not my job - your job, attitude wears thin and communication on all levels is needed.

I agree a great web site for Generalist Techs .

We do come accross patient's with rouleaux and it appears just like the pictures in th ORTHO Gel literature. However, more often than not we are aware of the Rouleaux before the Gel card antibody screen is completed in the reverse grouping which we do with tubes. More recently we have been encountering more Rouleaux than ususal and it appears to be due to a pharmacy formulary change for antibiotics. We repeat the testing using PEG (which has it's own set of problems) and in 98% of the cases the problem is resolved. Good Luck

Thanks for the E-Mail address of www.mers-tm.net -great resource We use the MEDITECH Blood Bank Module and are able to attatch markers to specific situations and retrieve events ased on a marker. We have put some of the forms into canned text and can retrieve them into COMMENT screen editors. Steve Hunt

Gloria, All of the literature reviewed by our blood bank shows , only CMV Negative units tested serologically should be considered CMV negative. We only transfuse Leukoreduced Red Cell products.

We have SOP's for the Gel prewarm technique and a tube prewarm technique and have only found the Gel system to work with weak cold agglutinins ( 1+) reactions. More often than not we need the tube method to resolve our cold auto problems. Like johna from North Carolina, we are aware of the "drawbacks" of prewarming , however have rarely encountered problems.

John, We dropped Weak D testing 3 years ago. Since we called the weak D patients "Rh negative - weak D positive" and treated them as Rh negative when transfusing them, we did not see an increas in the transfusion of Rh negative blood. We still carry D negative testing thr to coombs on all cord and neonatal heelsticks, especially on babies born to Rh negative mothers. Also our conservative OB/GYN group always gave Rho(D) IgG to D Negastive-weak D positive mothers so increased use of Rho(D) IgG did not occur. For us it has been a saving in reagent and tech time. I do have a question however - since there have been some cases of Anti-D being made by D Negative-weak D positive patients, will you give Rh Positive Red Cells to weak D poitive patients?

You can also try the ADVANCE.COM salary pole and the new MLO salary surveys also available on line. Both of these are regionalized and broken down into urba and rural. Good Luck - if you find some good staff make sure you keep them happy