Likewine99

Get your legal dept, risk management, pathologist and billing people involved. This is too large of a task for just the Blood Bank to handle and is a multi-faceted project. Lots of moving parts in this thing, don't forget to check your state regs too. I did a similar project several years ago for a patient who was to be "transfused at his home". We managed to get it accomplished but wow, was it a lot of work. Lots of patient safety, liability, documentation pieces to this. Good luck, remember, don't operate in a vacuum and document every conversation you have with everybody. This site will be extremely helpful too. Good Luck:)

Helmer 8 unit. Have had one in every BB I have ever worked. It rocks!

Same as SMILLER

SMILLER you are on the right track. If a critical department isn't able to function the ED's go on diversion. Our county has a whole "triage" kind of procedure if one of the hospitals is on diversion. Our hospital did the diversion thing a couple of years ago. Water main break, no water coming into the hospital so they stopped admitting patients and the whole hospital was on a Code D. Evacuation plan like R1R2 is a good idea and practice it and document it to keep the regulatory folks happy and your employees safe.

We enter the samples in the LIS as "patients" with a standardized naming convention. Order the tests and they pass over to the BB IS. Enter the donor unit in inventory like it was a PRBC. When survey results come back discharge pts in BBIS and discard the donor unit. Have passed several CAP inspections throughout the lab using this method.

labgirl153, step back a minute and re-read this sentence: now you don't really expect me to adhere to a single paper from immunohematology's ancient priesthood to hold water do you? You have asked the folks on this board to comment. If you choose not to "agree" with someone that's fine but you are coming across a little snipp-ey for lack of a better description. rravikin is not suggesting more work for you, I read his suggestion as just that, a suggestion. We have lots of tools on our antibody ID toolbelt and saline enhancement is just one of them. Think about it, there is no enhancement medium "in vivo" so what's wrong with using this technique? If your not comfortable with it don't use it. Just because it's in the AABB technical manual doesn't mean you have to use it either. Do what you feel is best for the patients you care for and relax. This is a fun place to exchange information, not snipe at your fellow Blood Bankers.

I agree with David, CAP is not always up on what we currently do in practice in our labs. I currently do lab IS and build our Blood Bank system for multiple sites. This weak D thing wears me out!!!

I know it seems like overkill but we have a sign off sheet on the first page of every policy and procedure. We did this to satisfy a CAP reg. I agree with DPruden, one sign off sheet listing all procedures is easier. Re: CAP survery samples, we do like Mabel, pass them around if there is enough sample. For those folks that haven't done a CAP survery, in my prior position I have used a "live example". That is, if they have done an antibody workup on a real patient, I make a copy of it and place it with my competency documents. In my book this qualifies as a "true unknown". You could also do an unknown, dry case study for antibody competency. Have done that for people who only work occasionally and work off shifts.

I agree, tube testing read by a human is the weakest testing method. Anyone testing 1+, 2+ positive with tube are called Rh positive. Using Ortho's gel system, we have found that the anti-D in the gel cards is more sensitive than Ortho's tube anti-D. Don't forget, if a prenatal specimen was tested at one of the large, high volume labs that do a lot of OP work (won't mention any names here but you get the idea) you may see a patient typed as D negative since they don't usually consider weak D typing as a "reflex" test then when they present to your L&D you may see them be Rh pos. With no disrespect to those labs, Bld Bk is not one of their specialities and is probably a low percentage of what they do in those types of labs. Mabel has it PEGged (no pun intended), if everything related to D typing and antibodies correlated our jobs would be a little easier.

We are the same as Terri and our BioMed guys rock

Great comments on this topic! At my prior job (2 yrs ago) we moved as much testing to the Provue and gel cards that we could, the gel card pricing was cheaper than traditional tube reagents and this was based on our tiered pricing across the entire organization. I think it's really hard to try to save a certain amount of money based on what the bean counters ask but I also don't think that you should waste time, reagents, etc. In today's lab environment I always felt it was hard to control pricing since most of that was negotiated way higher up the food chain than where I resided. Another thought, look at where you have the most blood wastage. A certain nsg division, physician, outdated products on your shelf that kind of thing. It's another great place to see where you might have an opportunity to shave some $$ from your budget. Don't forget unnecessary OT, those 15 minute increments can wreak havoc with costs and budgets. I'm not advocating affecting patient care but if someone works over a bit shave it off the next day. Good luck, I'm sure you'll get there!

Our process to to not be wearing gloves when we sign out a unit of blood but we are still wearing our lab coats since we are working in the lab. I just worked last evening, flying solo in our 400 bed Level II trauma center blood bank, and when someone came to the door to pick up a unit of blood I removed my gloves, washed my hands and went to the sign out bench to sign out the blood. The donor unit is placed in a bag that is marked biohazard. This procedure is done in case anything "leaks" on it's way to the floor and it was suggested by nsg that we do this. Come to think about it, do RN's on the floor wear gloves when they spike a unit? This topic could go on and on and on and on. Since the majority of units issued from any blood bank are not visibily contaminated with blood I would think "no gloves" would be OK. But then what do I know????

We've found that if you get a "funny looking, sort of hazy" screen in gel to check for rouleaux using the old saline replacement technique before you head off into panel land. I agree with the other posters, if you do the absc in gel to do the panel in gel too. In this instance with a pos scr and neg panel you could revert to a tube screen just to confirm that it's not gel junk. We also use "all common clinically significant antibodies ruled out" when we've ruled out everything. These pts get a gel xm with an immediate spin added to satisfy the CAP reg for ABO compatibility.

Same as David, quit using them about 20 yrs ago. They do not add any value to the retype process and they usually ended up falling off and sticking on the refrig, us, the floor, etc. This of the money you will save not buying labels and with the time saved you might have time to get to lunch/dinner on your shift

TVC15, back when I worked in a Level I trauma center we had a B neg male that we had to switch to B pos b/c we ran out of B negs. We also had another instance of an A neg female of child bearing age that we had to switch to A pos. At the time I was as concerned about this practice as you are now. The supervisor, a well seasoned SBB reminded me that "80% of all Rh negative patients are non-responders, regardless of how much of the D antigen you expose them to". She also reminded me that we needed to get product out the door or the patient wasn't going to make it. I understand that you are not comfortable with the practice but the physician has the ultimate responsitilbity for the patient and if trauma literature supports this practice and your institution has approved it then there you have it. Like Cliff I am respectfully disagreeing with you on the basis that in the 30+ years that I've practiced in the Blood Bank I've never seen O negs "not a problem to come by" regardless of the size of hospital where I was working. Thanks for bringing this up and asking for input from the forum, I find this thread very enlightening. One of the reasons why I love this site!

I agree with Generic and our practice is the same. We do a 2 cell screen on the Provue so one gel card could be incubated 3 times if used on the PV. Doesn't the package insert for the gel card say they can be incubated up to 45 min or something like that?

Our Blood Bank policy is to give O pos to male trauma patients and females beyond 60 years of age (Level II trauma center). We made this process change in conjunction with input from our Bld Bk Med director and our director of trauma services. The trauma literature that the MD's refer to cite this as an acceptable practice. The trauma director told me that from their side of the equation, when a patient experiences major trauma there are a multitude of things that occur physiologically and that their immune system becomes suppressed in the process since their body is basically trying to stay alive. Making an anti-D is the least of the problems to consider in a trauma situation. If you think about it, the blood is passing through their system so fast that there probably isn't time for the Rh pos cells to hang around long enough to cause any antigen exposure. Inventory utilization factors into this decision also. You really want to save the Rh neg units for those patients who truly need them and not "waste them" on a trauma patient. I like Malcom am comfortable with this process too. 80% of the trauma patients at our hospital are males under the age of 30 and even if they do develop an anti-D during this transfusion episode, hopefully if they are ever in need of a transfusion in the future it won't be in the emergent situation. If they do they now they become one of those patients who really need the Rh neg units, like your stated example. Just remember, no Blood Banker or MD wants to give Rh pos blood to an Rh neg patient but you do what you have to do to help the patient. BTW, I live in the metropolitan St. Louis, MO area and there are 3 major trauma centers here and all 3 of them follow the O pos to male trauma policy.

With no disrespect to your consultant, I've not seen any reg that says you need to empty the bag before you dispose of it. Maybe you should ask him/her to cite the reg for you. And in the interest of staff safety and unnecessary exposure, do you really want them emptying a bag of blood in a dirty sink just to save a few bucks on the cost of biohazard waste?

Mabel, I've had to do this in the past to keep my organization's bean counters happy. They wanted a cost "per test" for an antigen screed based on CPT codes, so I calculated our cost for one unit screened for: Our most commonly used antisera (All of the Rh's, Kell, Fya), and I included: reagent price (to the drop), number of controls run, cost of test tubes or gel cards (down to the price per well), tech time to do the test (in 0.25 increments of an hour), saline, pipettes, pipette tips, all things associated with testing. Since the different antisera had different costs I gave them everything broken out by anti-sera and let them pick the one they "thought" was the most representative of what we had billed in the previous year. I didn't waste my time trying to explain the nuances of Blood Banking theory, they were only interested in numbers anyway. This fun exercise did give me a fairly decent idea of what it costs to do this type of testing but it is nearly impossible to get it down to number of units you usually have to screen, etc. Good luck and have fun:D

We use HCLL in a shared database structure, 5 hospitals on one server. Each site did their own TT build and validation as their ABO/Rh and absc testing was a little bit different at each site. Making them all the same is a great idea for those of us who maintain the system but in reality you need to look at what each individual site is doing and make your build assessment based on the testing that is performed at each site. Good luck and happy validating!!

We've done DAT testing in gel for years and love it. We use IgG and poly cards, C3 testing in tube. Techs who are not dedicated to BB like it. I would say look into it, what do you have to lose? We do our cord DAT's in IgG gel, works just great.

You will need to have a certified NIST thermometer to use as your reference thermometer. I've always tested all thermometers in the dept across all temperatures, that is; freezer, refrig, RT and 37 degrees. That way when one breaks or quits working you have one ready to move into it's spot. We did this twice a year, or whatever your accrediting agencies require. Then make up a log sheet, you can use an Excel spreadsheet if you like. Give each thermometer a number, label it, test it across all ranges, record the temps along with the reference thermometer reading and don't forget to list on your log sheet the tolerance limits. I don't have access to our SOP's but this is the "easy button" as far as tasks in the BB.

We also do 24 hours. Once you know you've reached a steady state temp for 24 hours you will sleep better at night!

I agree with the rest of the group. And depending on your location and size of your hospital you probably wouldn't get "every" mass casuality patient. I believe your county EMS staff have their own sort of triage system so that not all massive bleeders go to one place.

I agree w/Malcom 100%. In this instance I have seen this reported as "unable to determine Rh type due to positive DAT". Bet the DAT will resolve itself eventually.