swede

We are the main hospital in the system. We have a small, limited service hospital that is about 10 miles away. They send all the lab work to us that they are unable to perform at their place. They can type/screen and crossmatch, but they do not perform antibody ID. They keep a limited supply of blood because the hospital only has 4 inpatient beds, it is mostly ED and outpatient services. They use the same computer system (meditech client server), but it is set up by site for testing purposes. They had a patient that needed to be transfused before being transferred to our main hospital, then the patient was sent to our place for further transfusion. Should we retype type and screen the patient? We did repeat the type on a tube that was sent with the patient (proper ID, the identifying number is the same within the system). We used the screen results that were entered at the other hospital.....we can't add to the specimen because it is a different site, but we can look up the result and it is in the patient's EMR. We didn't want to delay further transfusion by redoing the antibody screen, but we are thinking we should have done so. Any suggestions? THis is all new to us since the small hospital just opened in March and this was their first transfusion and our first transfer in the middle of transfuson.

We use the Statspin III and have no problems with it.

I'll be humiliated right along with you....we use complement control cells!

The OR calls all the time to ask how many units we have available for Mr. XXXX. We do electronic crossmatching, so we usually ask them how many do they want. They of course keep saying well how many do you have. So we answer that currently we have 45 on the shelf! Then they say, "Well you don't have to be obnoxious!" Well, then how many do you want?????? We had a patient come in to ER with the diagnosis....."wants to be a witch" We also had a panicked ER doctor call out one night (yes, I was a witness) "Hurry get me uncrossmatched blood. Get me the universal donor.....get me B pos!"

We received a phone call one lovely morning from a nurse stating that she had just figured out that she hung a unit of blood on the wrong patient ( Apos to Opos, her nurse manager's father!) and she wondered if we needed to know that. Of course the response was WHAT...OH MY GOD! She said, "Well you don't need to make me feel bad.....besides, I gave him some Benadryl!" We were so thankful that he wouldn't be itching as he entered the pearly gates . Amazingly, the patient did not die.....

We've had the same response with a lady with 8 known antibodies...."Dr., it will be probably be a day or two before we can have compatible blood." "okay, can I have O negative Irradiated blood until you find some?" We decided that "deep frying" it must take the antigens off!

Yes! We stressed over how to report this one for several days. We also called and were told to use the "other" section. I haven't received my results yet from the pathologist, but hopefully we conveyed our answers correctly! We do electronic crossmatching, so of course we just performed immediate spin on the CAP, so we most definitely did not get the anti-Cw. I wonder if they included the anti-Cw to prove some point for electronic crossmatching??

We provide FFP or FFP cryo reduced for plasma exchanges. We have given the dialysis team anywhere from 2.5L to 5L at a time. We do not pool it. They have to use the individual bags. There have been no complaints. All three hospitals in our town provide for the exchanges in the same manner.

Has anyone seen the newest CAP Transfusion Checklist dated June 15. There is a long list of new questions regarding Therapeutic Apheresis. An outside agency provides our hospital with the service, and we provide the plasma for the exchange. How much involvement should our pathologist have in this? Currently he isn't consulted, the hematologist docs take care of it all. Are the questions NA since we don't provide the service? What do you do at your places?

We are planning on getting a Provue by year's end and will of course be switching from tube ABO/Rh to Gel. We have been using Gel for screens since 2001 and love it. When you have switched to Gel typing and are now getting Rh positive with a history Rh negative, what are you doing? Are you switching the patient to Rh positive or keeping them Rh negative? Also, for those few patients with no previous history that would have been typing as Rh negative in tube, but will be Rh positive in Gel, do you have a strength cut-off for Rh positive in Gel or is positive considered positive and the patient is Rh positive? I hope that makes sense!

Another wonderful episode of ER had a patient needing blood from the rare donor file and the ED doctor called directly to the "file", ordered the blood and it came within a couple of hours. Then, as usual, the blood bank at County screwed up and broke the unit while thawing it! Then I believe they miraculously found the father with this rare blood type and drew a unit and immediately gave it to the patient. I was "yelling' at the TV, but my husband was also griping because they were busily slamming brutal policemen that night too.....my husband is a policeman! Fun times!

We have gone round and round with our docs, but have finally come to an agreement. The staining is done on all shifts. Days is the only shift that will do a count. PM and Night shifts will stain and look at the slides. If they think the slide is positive, they report a preliminary report of "positive, count to follow". If it is negative, they report negative. For competency, we stain slides and have each tech interpret if they are positive or negative. Days will do the counts. For proficiency, Days stains one CAP challenge, PM/nghts stains the other. PM/Nights will look at the slides to determine pos or neg, Days will do the counts.

We don't use any extra blood bank ID bands. Nurses were always cutting them off and wanting a new one (?!) We use the patient's medical record number as identification because it never changes from admission to admission. When a patient is drawn Pre admission, the phlebotomist fills out a "pink card", they stick an aliquot label from the specimen on this card, the label contains the MR number, the patients name, and patient birthdate. The phlebotomist signs the card (and the specimen), the patient signs the card and takes the card home. When the patient returns for surgery, they bring the card with them. The admitting nurse compares the card to the wristband that is being placed on the patient, signs the card and returns it to the blood bank. If the patient returns without the card, or if information is missing, wrong, etc....the patient is redrawn. We have been using this method for about 4 years now and have had few problems. We draw patient's up to 3 weeks prior to surgery

We are also in the process of switching to Gamma from Ortho, however we may just suck it up at this point. Our Gamma rep led us to believe the prices would be good at least until the end of the year. Obviously that was not true. I think we should stay with the devil we know and not move the unknown!

Yes, prelabeled tubes are somewhat scary, but it was the lesser of the evils of letting them print out their own labels and get their own tube because that is when they start drawing two at once and saving them. There is not going to be the perfect solution to drawing and redrawing. Hopefully you will be able to find something that meets the spirit of the checklist and is still safe for the patient. We use the Mobilab barcode drawing system here, so patients are drawn with barcoded labels and armbands on the first draw. There are also ways to get around this, so nothing is 100%. Good luck!

We mark the actual tube with different colors of highlighters. We also write our initials within the highlight line. We place the label on the tube and they are so sticky that it is obvious if anyone tried to remove it to place on a different tube. So far (2 years) it has been working. The nurses or PCTs drawing the tube still need to sign with their ID when they draw the tube.

We do a second type on all patients without a history on file. We use specimens from a separate draw from other depts when possible. If the patient needs to be redrawn, the blood bank tech generates an order and sends a "marked" tube to the appropriate nursing unit via secure transaction in our pneumatic tube system. The tube is marked so enterprising nurses can't draw 2 specimens and hold one back. We have been doing this for 2 years now and have only had a few problems.

We are moving our entire laboratory in about 3 months. I need to know if there are any regulations on relocating/moving the storage refrigerators, freezer, platelet incubator. We are only moving down one floor of the hospital. Can we move one frig at a time, watch the temp for a few hours and then reload, or do we have to let them sit empty for 24 hours. The movers should be able to move them by keeping them upright....we are pretty sure the doors are all big enough. I have searched and searched and can't really find any guidelines . Thanks for any help you can offer.