Likewine99

We would do the same as David. The comment our Med director gave the floor was "it doesn't turn green at midnight".

Prior to automation we allowed 3 samples at a time. IMHO 4-6 is too many, one is not enough to get the work done in a timely manner.

We use hand labeled tubes with a "blood bank number" written on the tube. The BB number is found on the second, additional armband that is applied to the pt at the time the initial BB specimen is collected. The tube label contains: pt full name, dob, collector's ID (their computer log-in), date collected, BB number. We opted not to use MRN as a second pt identifier as it could be copied from a pt label that just might be accidentally hanging next to the pts bed. The only pre-printed labels we accept are cord bloods or perinatal OB workup samples.

Absolutely not.

L106 is right on the money. Ours is done through the BB computer system, based on the phase resulted. Yes, we do love the LIS folks!

Make the 0.8% suspension of cells, add 25 uL of anti-D tube reagent to the tube, incubate 10 min and centrifuge. We put the word out to our sister hospital BB's for specimens and checked with the blood supplier and reference lab. We only had 8 samples and it took forever but it was 100% correlation and worth it.

We have written our SOP to reflect that the truth tables in the computer system check for donor/recipient ABO compatibility at time of product selection and that if an inappropriate donor ABO unit is selected you will receive a warning. In the event the system is down and you perform a gel XM you are required to also perform an IS XM as part of computer downtime SOP.

We are the same as Losmeister

We use pink just to differentiate that the specimen needs to come to the BB and not Hem. Other samples in our lab are labeled with bar coded labels, our pink top BB tubes are 7 mL and they are hand labeled. The EDTA is the same in pink and purple and I agree with John, the liquid in the EDTA tubes will not make a difference in BB testing.

Welcome to BBT. Crazy but fun is a great description of life in the BB.

Like David we have a Massive Transfusion protocol that the BB follows to help guide the docs in the ED since they are so busy. With only slightly elevated results, at our place, this pt wouldn't have qualified for FFP. We do Coag tests after 6 units of PC. In the future you could always "ask" if there are any labs they might need. As a courtesy to the ED and as a service to the pt.

If the unit is hanging when the pt left we consider it "transfused". If just sent in a box it is handled like a "transfer out of BB". Lots of communication with the ED's and the receiving BB's is essential to getting product final dispositon correct. We do not require the tag to be returned but sometimes we do get it back. We don't have an official policy actually written, good idea though.

Once per admission.

We call them antigram. I think Liz is correct.

We do not see and have never seen the physician's hand written order.We are now on an electronic Med Record so this is probably a moot point. I could go along with "input from the Blood Bank" but I think it is unreasonable to expect Blood Bank staff to interpret every order written. What do your Quality/Risk people have to say about this?

Since the hinges on the lid are not directly involved in the cell washing procedure I agree with your staff. I'd probably just run daily QC, maybe check the fill volume and call it quits. Think about it this way, is fixing the hinges directly involved in the cell washing process and would tightening them affect your test results?

We type both units. We have had the instance that Deny mentioned above, mislabeled unit. We received 2 units from a dual red cell collection, same ISBT numbers but different product codes. One typed A neg (the correct type) and one typed O pos (the mislabeled one). I know it's rare but in the antigen typing world I would be conservative and say type them both.

The self caught, immediate one I think is acceptable as we are all human and make mistkes. You are not being too picky, is that possible in the BB? John is right, look at the processes but "flying fingers" and heavy workload are not acceptable reasons. From and HR perspective everyone at my place gets one verbal warning, supervisor documents in the file. Next occurrence becomes a Level I counseling for not following policy and procedure and it progresses on. This is a pt safety concern.

We do 72 hours but have been known on SEVERAL occasions to take the blood down at 48 hrs. Especially if pt went to surgery and has a stable hgb. Day zero is the spec date, XM's expire at midnight on day 3 and it is controlled by the comptuer system. We choose the midnight cut off to make it simple for daily inventory reconciliation.

Lcsmrz and Eoin make very good points in their posts. As a BB supervisor I've seen marginal techs makes mistakes as well as the stellar performers. Since this person is employed by your hospital and working in your lab you might want to think about giving the person the best training you can with close observation to make sure they are capable of handing your workload in the BB. My guess would be that HR didn't even ask about any "errors" the person made. At our place, HR just does a cursory interview, over the phone most of the time and if the potential employee is "eligible for employment" at the last place they worked HR usually passes them on to us for interview. We are all human, we all make mistkes, myself included. Everyone deserves a chance but if you are concerned about performance and you have to option to not train the person in BB you could keep them in Chem/Hem. Again, watch the privacy issues. If this person is going to make it they will, if not you'll know right away. Good luck!!

Hang in there, you will get used to it. Everyone posting is correct, if you keep the electronic pipette maintained it can last you up to 10 years.

We have found the anti-D reagent in the ABD/Reverse cards is more sensitive than the tube anti-D. We do routine ABO/Rh's in gel cards, in the emergent situation we use tube reagents. Our cost has gone up considerably on traditional tube reagents and fortunately we have a ProVue. It has freed up some hands on tech time so we are able to concentrate on other tasks (such as answering the phone 1,000 times/day). Our techs are mostly generalists with only a handful of seasoned (read middle-aged) bloodbankers that have a lot of BB experience. Generalists love ABD's in gel, esp on the night shift when they are doing 10,000 things at a time and covering multiple benches.

I agree with Lcsmrz. I have also seen this done with massively bleeding, female open heart patients.

We do the same as David and after checking on the RhoGam status, report it as: "Anti-D, passive due to RhIg administration"

We instituted certain spots in the BB where we call it "no chat, unless stat". We used red tape on the floor and made boxes to stand in so that when in the red box you absolutely shouldn't be interrupted. They were at the sign out bench, in front of the analyzer, at each bench were you were doing manual testing. Those places where you needed to be able to concentrate and not be interrupted. It is the understanding of all lab employees, whether BBers or not, that if someone is in a red box you shouldn't interrupt them. It's unreasonable to expect the BB to work in a vacuum and the nature of our work lends itself to communicating between co-workers. L106 has the right idea, just ask your co-workers to be respectful of you trying to concentrate. If they get offended then they probably don't have enough to do and should take their conversations elsewhere.