Likewine99

Sad to say that we weight every RBC unit when it comes in (400 bed Level II trauma center) and enter the stated volume when we bring the unit inot inventory. On plt and frozen products we enter the volum stated on the bag lablel. We were asked many years ago by nsg to provide this service. We used to weight it when we signed it out of the BB but that was getting missed. Just one of those battles we decided not to fight

Welcome to the site, you will love it here. In my MANY years in the field the decision as to how many staff members you have working in the Blood Bank. Lots of things play into this decision. Do you have automation, since you are a trauma center you are no doubt busy on all shifts. As a manager I was always looking at the famous "productivity standard", a number some bean counter pulled out of "thin air" Skill level, level of BB expertise, years of experience all play into staffing. So as you can see there really isn't one answer. Deny's suggestion is good but you should pull in your director before making any decisions and settling on an number that may not be adequate bench coverage and overstaffing is not good either. Good luck, check back often there is lots of good info on this site.

Wow, I'm with John on this one. This is probably something that you should look at as an "opportunity for improvement". IMHO it's a huge waste of time for your staff. Think about asking your medical director to intervene here. Docs will only listen to docs and basically don't give them the option to get a pool of plts. One pheresis fills their order, no muss, no fuss. Sandy L. is absolutely correct in her statement. And I agree with her, I don't recommend this practice either.

Agree with MAGNUM.

I have used "real life" examples, blinded so that no one can look up a patient in the computer system. I had several generalists on all shifts and some dedicated Blood Bankers too. I tried to pick examples that would help them enhance their knowledge base and give them some hints on how to handle unusual scenarios that they may encounter on their shift. Since you are using lots of theory questions I would suggest staying away from the all of the above/none of the above answers. Remember these are bench techs that need a good solid knowledge base to help them provide good, safe patient care. I have copied panels on patients and removed the names and said, here are the results what do you do next. In my management days I did exactly like Liz. I have also made them go back to the procedure manual and tell me where to find something. We always had problems with how to report DAT when poly is pos, what test to do next, why or why not? And don't forget to throw in a safety question just for variety

We used to use Hollister's banding system and the nurses hated the big cards because the felt the info was redundant and I saw more hand written mistakes that I could count. They were also expensive so we moved to a home grown version which worked just as well. In the many many many years I have worked in the BB I have seen many many many errors caused by both a nursing and BB staff. It doesn't matter if you re-band at 72 hours or keep the original number. The most important part is adherence to proper labeling AT THE BEDSIDE. A dedicated blood bank number is by all means a great way to help reduce transfusion errors.

Welcome to the site. It is the best! Glad you're here

Congratulations and welcome to the site! No question is too silly to ask and having been where you are, re: the HR part of the job, document, document, document (the good things and the not so good) it will save you some day I promise. Provides the necessary tools to recognize your stellar performers and notice trends for those that might need a little "remedial" help sometimes.

Just because the nursing staff doesn't want to do something is absolutely no excuse for compromising patient safety. You need physician involvement here, the pathologist, director of ED, someone with MD behind their name. You can quote Blood Bank regs all you want and they won't listen. Don't try and fight this battle yourself. Turn it over to your risk manager (hope that person is not an RN!)

For a 25 bed critical access hospital the gel with tube backup works very well. If you are looking at automation to save tech time the Provue works fine but it does use more reagent for priming. I work for an organization that has several small hospitals in 4 states in the Midwest and they all use manual gel due to the fact that they are all generalists.

Brenda brings up a great point, those confirmation stickers don't add anything of value to the retype process and in my experience fall off of the units if you live in a humid area (like St. Louis). And are an additional expense and sometimes confuse the person transfusing the product. (as in "why do they come on the blood and not the plasma or plts?). Set up your computer system to put the units in a not tested status upon receipt into the BB then once retyped status can change to available.

Agree with David. I did see a physician once administer lasix (I think that was what it was) through the same tubing that blood was being administered through, but for a change I kept my opinion to myself

I agree, I think you did the right thing re: you patient's antibody workup. I don't agree with your Lab Director stepping in and "siding" with the "other tech" who just happens to be the previous supervisor. Your patient received high quality service from your blood bank, your lab manager however did you and the rest of the blood bank a terrible disservice by intervening in a discussion between 2 staff members. He/she has basically allowed the former BB sup to continue to make decisions that are no longer in their scope of responsibility. YOU are the supervisor now. You get 10 Blood Bankers in a room for a discussion and what do you get, 10 different answers Mabel is correct, turf wars with ex-supervisors stepping back into bench positions are difficult so be careful. I do have to ask though, does your lab director make it a practice to help the other depts make pt care decisions?

I agree with Malcom. From a compliance standpoint and patient safety perspective, this tech needs to complete competencies for any testing procedure or non-technical process they would be doing. I once had a CLIA inspector ask to see employee competency records for every tech that was working in the Blood Bank the day he was onsite. I currently work PRN in the Blood Bank, about 1 or 2 shifts a month, and I do all of the same competencies as anyone who works there full time.

We moved away from autos about 5 years ago. I would not say we "don't accept" autos but our blood supplier doesn't routinely draw them, it requires Medical Director input before a unit is drawn. We are a 350 bed hospital that does quite a few ortho cases, at least one hip a week if not more. Our ortho and urology docs moved away from this practice with lots of input from the blood conservation team of which had doctors on it as members.

You are looking at all the right things and I agree with Mabel, if someone leaves/retires think about do you really need a whole FTE to replace them, if at all. With a Provue can you cross train "non-bloodbankers"? Watch those early and late clock in and outs. One 2 week pay period our lab had over 8 hours logged just from this. Without a trans committee it will be difficult to lower your blood product costs. My organization had an excellent blood conservation committee and the right players were on the team. It was led by a physician champion and we had support from our blood supplier. John is right about administrators "mandating" a certain percentage of cutbacks. Blood Bank always gets hit b/c our blood product line item is so large. We totally eliminated autologous units in our inventory, wasted 60% of them anyway. It took the Orthos a while to get used to it but once they bought in that helped a lot. Best of luck to you and like the others said, keep us posted.

I agree with David too, validation helps you learn the system inside and out. I've never worked anywhere that farmed it out, too expensive. Of course I like to do this kind of stuff, I know I'm crazy, can't help it.

You know how it is John, you mention the word blood transfusion and it automatically becomes our responsibility.

I was a Blood Banker working on the Orders Team at one of my prior jobs and I drafted an electronic version of the Blood Bank's manual emerg release form. When it was placed it printed in the BB so they would know to start the emergency issue process. Like the other have said, this can be entered by a unit secretary or RN and goes into the physicians Order Review queue for final sign off. The BB could then access the EMR and if necessary print off a "signed" copy of the Emerg Rel order. Worked great and gave the BB a better tracking mechanism since the paper forms were often "misplaced".

When I was a BB sup I was the on call person but in over 12 years at 2 different hospitals I was called in the night maybe 2 times! The only time I was called in was after I went to a PRN status and the hospital was on a code Disaster for a tornado. We have detailed procedure and policy manuals and the techs use and they rely on each other on the off shifts. If we had antibody problems they went to the ref lab mostly b/c we had usually worked them up as far as we could take it and those middle of the night abid's to ref lab were very few and far between. For those who rely on non-exempt, hourly wage bench techs be careful that you are not violating any institutional or state labor laws. If a non-exempt employee is on call, in our state they were to be compensated for being on standby and if called they were considered to be "working" and should be paid. I know most techs do it b/c of dedication to the job and the pts but our compliance people keep an eye on such things. Of course any of us on this forum would want to be called regardless of time of day, after all, we do what we do to make transfusions as safe as possible for our patients.

We are the same as Steven Jeff

Welcome, we are glad you are here. Lots of great information exchange here. Hope you like it!

Don't remember, probably a Google search for something BB related. Love this site, lots of good Q&A and some great humor too. Thank you!!!

Great feeling isn't it? Sit back and enjoy!

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