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Posts posted by Likewine99
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Helmer is the way to go, we too perform plasma exchanges and the unit we have will do 8 at a time in about 20 min.
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We have been using ABD/Reverse and ABD/ABD Ortho gel cards for well over 10 years. We find that the anti-D in either card is more sensitive than Ortho's anti-D tube reagent. We often have pts that typed Rh neg over 10 yrs ago with tube that are 2-3+ pos with the ABD gel cards.
We have had one instance when a donor unit that was labeled A neg from the blood supplier (using another reagent manufacturer) was 2+ Rh pos in a gel card and 2+ weak D pos in a tube test.
Like anything else new it was a little cumbersome at first but if we were to revert back to tubes our 20 techs that work in the BB would have a fit.
The only time we use tubes for ABO/Rh typing is the true emergent, actively bleeding patient and to do donor confirmations on the units associated with an active bleeder.
The generalists are comfortable with it and on eves and nights it gives the flexibility to walk away and do something else. Start your ABSC first and get it cooking, load the ABD/Reverse card, put it in the centrifuge. When the time is up spin them both together, you'll be amazed at how much time you have.
We have NOT noticed anymore ABO discrepancies that we did with tube, remember gel and tube testing are "tools on our BB toolbelt".
Gel reagents are cheaper for our organization due to the Materials Mgt people and contract pricing.
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When the unit is issued from the BB.
Our SOP is written to reflect this and since we are responsible for monitoring compliance for transfusions, nursing
(for once!) follows our guidelines.
30+ years expereince and five different places of employment.
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I'm in agreement with L106 and in my organization the "stellar performers" are given the same merit increases as those who "barely meet the standards". 2%!
I know it's not all about the money and that the exceptional techs do extra because of their internal motivators and their work ethic.
We are all asked to do more with less (I am BB sup and Lab Manager simultaneously) and for us right now it is all about the bottom line $$$$$.
We have tried to have protected time each month for techs to do their continuing ed but we've implemented a new BB system, will be implementing a new EHR and it's the middle of vacation season in our lab.
Rashmi, you may be being unrealistic but I understand completely what you are saying. There are too many techs in all age groups that subscribe to the "eight and skate theory". Put in my 8 hours and skate out the door.
Since we just experienced a "reduction in force" in my lab in April can you blame them?????
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Our units have a tag on then denoting which ags are negative. Our blood center reference lab is CLIA and CAP accredited. In the process of becoming AABB accredited
If there was a question about the unit it could be traced back to the blood center records via our BB computer system and theirs.
When we enter ag neg units in our system we add the ag neg comment, i.e. K-, Fya- etc and append the message "performed at XXXXX reference lab".
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Because of the price we discontinued both of these survey about 2 years ago.
We also discontinued testing eluates in house because of the price of the reagent and lack of expertise in the dept.
Is there a theme here???$$$$$
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dferia is correct, if you can examne the overall process there might be a spot to build in some type of extra check, especially at the point where humans enter the process.
If possible have someone in the lab who doesn't work BB, or someone from outside to walk through the process, it is amazing what non-Blood Bankers see, sometimes we are too close to the process.
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Ziplock bag labeled biohazardous because nursing wanted it that way.
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You are going to love this site, glad you're here.
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Ours is the same as L106 and we offer the KB stain 24/7.
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I have borrowed our BioMed's calibrated, digital temperature thing, the one they use to calibrate temps throughout the hospital.
It gets away from the liquid in glass, has been certified by an outside source and has a better temp range than the NIST thermometer we have in Chem.
I use the neat glycerol solution too.
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We are gel users so our goal is "platelet poor plasma". Our old centrifuge died about 6 months ago, we have 2 StatSpins that spin 3000rpm for 3 min, they are wonderful. WIth the old one we did 3000 rpm for only 5 min.
We uses these samples at the manual bench and on the ProVue, not a problem.
You could spin some specs at different times and see at what point you get to plt poor, i.e. <10,000 plts when run on the Hematology analyzers.
You could track turn around times for T&S from receipt in lab to final answer, tie it to a delay in getting blood out the door.
You could pray that that centrifuge dies and you have to replace it. Good luck, 10 minutes seems like an eternity to me now.
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Cap piercing, like a Hematology analyzer.
When using a printed result to enter into the BB computer system have all patient demographics from the LIS print.
Make it "fixable", when our current analyzer has a bent probe the FSR must come out, we'd like to change it ourselves.
Very flexible, end user customizibel software.
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We were just instructed by our billing consultants and our Revenue Mgt dept that it is allowable to enter this charge on an inpatient account. Our OP tx center has done this themselves forever, our IP nursing staff is "too busy" to enter this charge so the BB does it.
We print a tx listing from our BB system and do the IP charge manually and we get the "revenue" in the BB. Prior to entering the charge we view the pt account to make sure we don't double charge this fee. It takes us less than 10 min to do it daily, 400 bed Level II trauma center.
Next time the wind changes direction we will probably d/c entering this charge.:surrender
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Ditto what LShirley said. I've worked in a pediatric BB and we used gel for ABO/Rh and loved it. If you have an out of group BMT or cord blood transplant patient you can actually start to see the mixed field as engraftment occurs.
I am now at an adult hospital with a ProVue and JOANBALONE is correct, usually one unit of O cells to a non-group O person will show up as a nice mixed field on the ProVue.
We had a B neg pt the other day that got O neg cells at one of our sister hospitals and we picked up the O cells right away.
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Jatin, having just gone live with a BB software system last fall here's my wish list:
Easy to navigate, especially for techs who are not dedicated Blood Bankers.
Hard stops at any patient safety/critical step, i.e. you absolutely CANNOT issue a unit of A blood to a group O person.
Have your programmers work hand in hand with the Blood Bankers. There are several things in our new system that as a blood banker, I know a programmer wrote. We don't think the same.
Interface to automated analyzers must be bidirectional and not a nightmare to troubleshoot.
Screens and worksheets need to be very customizible so each site can build their screens to parallel their workflow.
Provide exceptional support during build and validation, get back to your customers within 24 hours when they are building, this is a very stressful, busy time.
Data conversion is a big thing, we as blood bankers want to see what went on with a patient in the old system and not have to hunt all over the place to find it.
Thanks for listening, good luck and I hope you make it big!!
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We are the same as tbostock. Love the StatSpin Express.
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Our hospital is going live with EPIC for our HIS in August. THe EPIC version we are using does not have a lab module yet, therefore we are interfacing our 15 year old McKesson HBOC and our 6 month old HCLL to EPIC.
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Pos DAT on a cord blood and incompatible XM's (usually the people with warm autos, we like to give nsg a heads up that they are incomp)
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As a BB supervisor I have first hand experience with the FDA related to a clerical error that occurred in our BB. We had a very good Root Cause Analysis team and we made sure to include techs who work in the lab but not in BB, sort of a fresh pair of eyes to really examine the old, defective process.
Your supervisor is probably right, youi will need some way to capture who applied the label to the tube, who resulted the test and you will need lots of documentation on the process changes and staff re-education.
We instituted a post analytical clerical check using printouts from the analyzer and screen prints from the computer. When done at the manual bench, with gel cards, the gel cards are saved for the clerical review. We do the clerical check on the shift and immediately if the pt is to receive blood. The non-blood bankers were trained in the clerical process for those nights and w/e when you may be the only blood banker in the house.
I'm sorry this had to happen to your pt, your lab and your techs. We found the RCA process to be extremely helpful and almost 4 months after our incident we really do feel more comfortable knowing someone is checking our results and it really has made it safer for our pts.
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I took the BB exam about 8 or 9 years ago and and used the ASCP BOR question book, the BB part. I also read the technical manual and the standards, I was weak on anything related to donors since I had always worked in a hospital BB.
David is right, the questions can be tricky and it seemed like on every question I was able to narrow it down to 2 choices. Good luck and on the slight chance that you don't pass the first time take it again right away so things still stay fresh in your mind.
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conwaysbb, our MTP is very similar to yours and we went to 5 day plasma about 2 years ago and have virtually zero waste. The trauma surgeon was perfectly happy with this as were the other physicians on staff at our place.
I have some articles on file at work, e-mail me @ Mary_Mendel@ssmhc.com
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KB's are done on all shifts, STAT eligible, performed in Hematology. Techs are generalists and competency is monitored by having the techs all count the same slide and the CV between the results is HUGE.
Our stated TAT is 2 hours from time of receipt in the dept, hard to do on nights esp. We do the tes regardless of the patient's ABO/Rh and as stated by the other posts, our pts are OB and usually have been in an MVA or fallen.
Yes we hate this test too but have been "requested" to keep performing it 24/7.
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We have ProVue and HCLL (not interfaced but in the process) and have been live for 3 years. Please contact me at Mary_Mendel@ssmhc.com and we can discuss this in more detail.
I don't think I can explain our workflow here w/o putting everyone to sleep:sleepy:
Updated CAP checklist June 15, 2009
in Accrediting Agencies
Posted
We have an outside company perform them for us but you could write an SOP to say that the Medical Dir of the BB has "oversight" of the program in conjunction with the Hem docs and the provider.
I agree with David, N/A except for the blood products.