Likewine99

We did an open house last year and it sort of "demystified" what goes on "down in the lab". Serve snacks and you will have people beating your door down. It was a lot of work but very well received.

It's great to see a post by a physician here, thank you Dr. Hannon. Having been on a Bld Conservation Team as a Blood Bank Supervisor, the best way to get a bld conservation program off the ground is physician buy in; starting with the Med Dir of the the BB, CMO of the organization, CEO of the hospitals. Once the clinicians are in agreement the next logical step is to start collecting data on patient outcomes, lenght of stay, start quantifying thing in terms of what a bld transfusion really costs your organization. Once you start tying some $$$ to this I bet it will get everyone's attention. Good luck, this is a tough (but fun) project and it's not insurmountable. IMHO it's also a great service to the patients we care for.

I've done eluates in gel and I agree with Generic, the junk sometimes makes true reactions hard to read. And I think gel is sort of "super-sensitive" for lack of a better term. I'm not surprised that tube testing was negative. I've always thought that an eluate was lots of science, a moderate amount of art and toss in some luck just to cover all the bases.

1. Who collects your blood bank samples? All are collected by nsg, no phlebotomists in lab except OP lab. 2. Do you use an armbanding system? Yes, network wide, homegrown armband modeled after Hollister/Typenex 3. If nursing draws your samples, how do you handle patients who have no history? Two specs from two separate draws. Steal specs from Hematology about 90% of the time. 4. Have you had instances of wrong patient drawn? Yes, I hate to say.

Check out "The Safety Lady" at safetylady.com. She's an expert in lab safety stuff and might have a reference on her website.

Rant on Malcom, I understand completely. And btw, I agree w/you on the Jka typing. And bbanker2 just remember, better safe than sorry, esp with Jka. Twice in my career I've seen Mr. Jka cause "adverse outcomes" for the recipients. Folks in smaller hospitals encounter "odd" stuff so infrequently they were erring on the side of caution. Been there done that, it's scary.

I worked in a pediatric BB for a while and did the same as jill. Our adult hospitals modeled their ped transfusions after us but they rarely did a ped tx. I agree w/you on the L&D labeling thing. I've heard it explained off to "well you have no idea how hectic it gets in the delivery room". I'd say stick with a spec from the baby, esp if you have inhouse phleb. Your chances for correct labeling go up immensley when the lab does the draws.

Hey, think about this, it's sort of like a Pyxis (not a plug for the company) drug dispensing unit they used on the nsg divisions. I've never seen a BB dispenser but I've supported EHR go lives on the nsg divisions and they must badge into the Pyxis system to remove drugs for their pts. There's an interface between the EHR, what order the doc writes and the drug dispensed into the machine by the pharmacy. Since the FDA considers blood as a drug why not? Just MHO.

I agree with Joanbalone, that it is not our job to babysit the surgery dept (or the surgeon!) but we do receive a schedule in the BB and it's reviewed mostly for BB staff piece of mind and to make sure we have enough plts on hand. Deny has a good point, keeping the surgery schedule for more than one calendar day probably isn't necessary since once the surgery date has passed it becomes a moot point, even if the BB ends up bailing out the OR for something that was missed. Our organization doesn't want the surgery schedule floating around any more than it needs to to comply with HIPAA laws. After one day ours goes into the confidential recycle bin. A Risk Mgt professional told me one time, after we had something that was missed by the nsg staff at handoff, that the "surgeon has ultimate responsibility" for making sure everything is ready prior to starting a case. We just need to keep in mind what is best for the patient.

I agree wtih Mabel, time prohibits lots of people from blogging. I usually read PathLab Talk at my desk at work during lunch or at home on the w/e or evenings. I am still a practicing BB tech, PRN at the place where I used to work FT. I now build and validate the lab module for my organizations EHR and for our BB software. Sometimes, when I've been on the PC all day at work, the last thing I want to do is stare at a screen all evening. Keep up the great work, I admire your committment and know that it takes a lot of time to maintain a blog site.

We do the same as you but we don't extend the XM, we send the workup out every 72 hours.

This is an age old Blood Bank question (not that I'm old or anything:p) but my thoughts are that you can monitor TAT's anyway that keeps the number counters happy but the most important thing is the right result, on the right patient as fast as humanly possible. The true test for BB TAT is how quickly can you get the products ready and out the door as in the case of a trauma pt or the open heart pt that has gone bad, or the baby that needs the exchange transfusion. And you know no one ever monitors those kinds of cases.

The unit may have been irradiated in a "batch" which may explain why there wasn't a purple sticker on it. For your peace of mind ask to see the irradiation batch log for the unit in question. Several years ago I brought up an blood irradiator and you did not have to put one of those purple stickers (the ones that the middle turns black on when exposed to the radiation) on every unit. The NRC regs at the time outlined that the batch needed a sticker, not each individual unit. We did however put a plain, regular purple "irradiated" sticker (much cheaper!) on the bags that were in the same batch. Those indicator stickers were $1.50 apiece!! Maybe they just forgot to put the plain sticker on the units in the batch?? I think you did the right thing, a Jka neg unit is a valuable thing and you don't want to delay patient care if possible. I do think your blood center's response was a little "unusual" but remember, you may have been talking to a bench tech who later cleared the final answer with the manager.

You can outline in your QC/QA policy and procedure what your lab consideres a "designee". If you have a computerized BB system your truth tables and error flags provide a level of electronic review which can be utilized to assist your techs/designees in releasing results from the lab. Then throw in a blurb outlining that anything "unusual" or "suspect" is reviewed by the lab director prior to release from the lab, with the ultimate goal of providing timely, accurate results to the physicians. I think you can fufill this reg with the proper wording and you are on the right track with you and your counterpart doing daily review. Make sure at inspection time you are doing what your p&p say you are doing. Good Luck:)

I agree with David. I had a conversation with our Trauma Surgeon once upon a time and he'd read in his journals that in the massive tx scenario, the pts immune system "shuts down" due to the fact that there is so much other stuff going on physiologically. The last thing this patients body has to worry about is developing antibodies and the blood is zipping through them so fast they probably wouldn't have time to make an antibody anyway.

Thanks Malcom. I've passed this on to several of my BB buddies here in the US. You are lucky to have met such a great man.

I've been dinged for arrows and " " marks on manual log sheets. You could write in your policy/procedure that lot numbers appearing on successive lines are the same as the ones prior. Then if a new lot is used enter it, then it becomes the current lot. Or re-do your QC sheet, yes this takes some work. Put your lot numbers at the top of the page, days of the week and rxns to follow then lot numbers don't need to be re-written every day. And you are absolutely correct, fix this now, it will make design of your new system so much easier. Good luck, keep posting!!

We do 14 days. There is a blurb in the AABB Standards somewhere that applies to your question. You'll probably have to define it for your facility and put it in your SOP.

A wise tech from our reference lab once told me that gel, LISS, PEG are "tools on our antibody ID toolbelt" and that different tools are better for different things. I agree with Malcom, gel is great at detecting cold abs. I've seen cold abs that are so sensitive that if you were working on the bench directly under the airconditioner vent it appeared and if you moved to the other side of the bench where it is "warmer" it went away. I'd be comfortable with reporting just a cold and be glad it's not a warm!

I'm not aware of a reg that states that you have to list what methodology you used. I would outline in your SOP's which test is your primary method with your secondary method used as backup. You could also add a statement somewhere in the procedure that says something similar to: "Gel (or tube) is the primary test methodology. Secondary/backup methods may be employed as an alternate method of testing." One you switch from paper I bet your system will tie the testing to a QC rack.

cassinc has nailed it! Start with a high level perusal of the CAP checklist, make notes the first time around. The next time around reference all of your procedures, if you want to get really fancy put it all on a spreasheet. If there is something missing either add it to an existing policy or procedure or create a new one and educate your staff. When you get word of when they are coming get organized. Have everything at your fingertips, manuals, QC records, etc. If your hospital is part of a group, reach out to the other BB sups. Figure out who your "stellar performers" are and get them engaged in the CAP process. This will make them less nervous the day of the inspection. When CAP comes and they are asking you questions, answer the question, be brief, don't ramble on, you might hang yourself. If you give them an answer they "don't like", ask them how they do it in their lab. Chances are good that you are doing what the reg says, it's just not in a format that is familiar to the inspector. If you get someone who is just "out to get you" be as nice as you can, take the deficiency and remember you can always contest it after the inspection if you truly feel you have fufilled the reg. It sounds like you have a lot going on. Remember, you can't/shouldn't do everything. Get your staff to help and when you leave work, don't answer e-mails, do work at home, or whatever. It's a straight path to burn out and with your abilities and skills you want to be an asset to the lab and not become a liabitliy. GOOD LUCK, keep posting!

I think David is absolutely correct. Any software that is used in the delivery of blood or blood products must be FDA 510K (the number of the FDA reg) cleared. If you find a HIS/LIS system that meets this reg then you would have to validate it just like any other piece of BB software. In my current position I function as an Application Coordinator for general lab and have BB software experience. At this time I'm not aware of any HIS/LIS system that can do it all. BB systems are usually "bolted on" to the lab software. Mostly due to the complexity of the FDA reg and the validation process. If you know of a system that "does it all" pleas post and me know.

Microbiology does the set up, they don't trust us Blood Bankers!

Welcome to the site, you will find lots of useful information here. Good luck with your new position. Keep your eyes, ears and most importantly your mind open. Any problems/questions you come across post here and we'll be glad to help you out.

We are a 435 bed Level II trauma center and moved away from autologous blood about 3 years ago. The decision was based on data that showed that we wasted about 60% of the units which cost the organization quite a bit of money and that our transfusion triggers were lowered to hgb of 7.0 or less. Most of the autos ordered were from the Orthopedic docs and our Medical Director along with our blood supplier were able to provide them with data that backed up the theory that drawing auto units did not benefit the patient.