Likewine99

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 took my SBB a hundred years ago (OK, maybe early on when it was first computerized).
I self-studied.  Did not go to SBB school, did not take an online class.  I had, and still have, the great fortune of working at a world class hospital. 
What worked for me:
Read Transfusion cover to cover for at least a year.  Regardless if I was interested in the article or understood it. Read the AABB Technical Manual, at least once, I think I read it twice, maybe three times. Memorize all of the common antigen frequencies, and some of the odd ones too. Read where the concentration of questions would be.  For example, there was anticipated to be 1 HLA question on my exam.  A person could get their PhD in HLA, I only read that chapter once. Memorize AABB Standards. Memorize the relevant FDA CFRs. Read a good hematology text book. That is a lot of reading and will have you well versed in most things related to blood banking.  You will easily pass your BB.
If you are taking your SBB, the only thing I was not anticipating was the management questions.  I did not study anything about that.  If I were to take it again (that will never happen), I'd read a book or two on employee relations / management.
I was one of the lucky few who passed (barely) the first time.  But you know what they call the person who finishes last in their class of medical school...

We keep ours a year. Do you use Bloid Hub?  If so all that info could be retrieved from there. 10 years seems way to long. We never kept them that long even when we weren’t computerized 

We keep them until the monthly invoice comes and then they are discarded.  All documentation of unit receipt and final disposition is in the computer system.

It would behoove you to keep it. Reason being, a unit in your care was issued before all required testing was performed. Even if the blood was returned, you need to keep the documentation as to why it was released from your electronic inventory record.
Now, say you issue a cooler full of an MTP pack and as the nurse is walking away, they cancel the MTP. The nurse returns the cooler, it doesn’t even make it to the floor, and you haven’t sent the slip for the physician’s signature yet. In that case, it could be a little redundant to make them sign a form for a nonexistent MTP, so I would just leave documentation of a variance from SOP document in the event of inspection with the documentation that an emergency release was initiated at the request of the physician and was canceled so you did not send a form.

I understand David's point and agree 100000%.  Having worked in 50 bed, 500 bed and 1200 bed hospitals and hospitals in small towns, suburbia, and big university medical centers, blood suppliers DO NOT understand the smaller places that can go days without transfusing.  
It is everyone's responsibility to be good stewards of this very precious resource.  Inventory management from the supplier level down to the techs in the blood banks is critical to making sure every patient everywhere can get what they need as quickly as possible.  
 
 
 
 

I understand David's point and agree 100000%.  Having worked in 50 bed, 500 bed and 1200 bed hospitals and hospitals in small towns, suburbia, and big university medical centers, blood suppliers DO NOT understand the smaller places that can go days without transfusing.  
It is everyone's responsibility to be good stewards of this very precious resource.  Inventory management from the supplier level down to the techs in the blood banks is critical to making sure every patient everywhere can get what they need as quickly as possible.  
 
 
 
 

NO QUESTION IS DUMB if you don't know the answer, and if you never ask it, you will never know the answer.  Having said that, you will, just occasionally, get some pretty dumb answers!
I agree entirely with David Salkin's answer, which, as always, is far from dumb.
When I was working at the Blood Group Reference Laboratory (way back, when it was still in London), it was discovered that I was Ch Negative.  Having not long left school, I got all excited over having a rare blood group, and, I think to bring me back down to Earth, they got me a tee shirt with "I'm Ch Negative" printed on the front.
In the MRC Blood Group Unit, in the same grounds, but quite autonomous (run by Drs Rob Race and Ruth Sanger) was a woman who had an exceptionally strong expression of the P1 antigen.  Having seen my tee shirt, some wit employed there bought her a tee shirt with "I've got strong P" printed on it.  As far as I can remember, she never wore it!!!!!!!!!
I've attached a short PowerPoint lecture about the P1Pk Blood Group System.
The P1PK Blood Group System.pptx

We also use the electronic alarm functions on our equipment, and at our last assessment the inspector brought up the chart pen moving.  She told me the purpose of the alarm checks is to make sure the pen moves.  I disagreed with her, said the purpose of the alarm checks is to ensure that the alarm is activated, and we check the movement of the pen each day when we do our temperature checks.  She thought about it for a while and ended up not citing us for this.  I know there are facilities who have abandoned their graphs for centralized electronic monitoring, so I don't see how they can require that a pen move when these sites do not even have pens or graphs.

With attention to blood utilization, the overall red blood cell usage has gone down.  Consequently blood suppliers have had to pair down the number of overall units they collect in order to avoid out dating products.  Since we are drawing a population, the proportion of desired units in that population (All Rh negs and all group Os) has not changed, but the absolute number of the desired we can acquire units has dropped.  Transfusion practices are still demanding nearly the same number of desired units as before blood utilization practices were implemented.  About half of the Rh neg units distributed go to a non-Rh negative recipient, often because hospitals do not want to "waste" them.  Perhaps if before making that decision to transfuse the blood bank contacted the blood center and asked if there was an immediate need to transfuse an Rh negative unit to an Rh negative recipient, we could better utilize the resources we have.
Also I believe the merging of blood centers has contributed to the problem.  Where the community blood center was usually able to manage the blood needs of the local hospitals, many are selling blood by contract to facilities miles away.  This has decreased the amount of ad hoc blood available for export.
The "low-titer group O" craze is also taking a toll because of the demand for repeat donors to fulfill the need to have Whole blood units with a 21-35 day out date, available for emergencies.
Most blood centers are trying to recruit blood donors by blood group now in order to avoid out-dating Apos and Bpos units. This means that Rh negative and group O donors are approached to give 2-3 times more often than donors of other blood groups.  The desired donors are complaining that they are being approached to give red blood cells too frequently and are starting to ignore our requests.
All of these issues (and perhaps others) are contributing to the nation wide blood shortage of the most desired units. Importing products is also difficult. If they are available at all, did you know that in order to import four group O negative units a blood center might have to also purchase 50- 100 group A Pos units?
Platelet utilization seems to be increasing.  Where do platelet donors come from? Usually whole blood donors. Sometimes the blood center needs to decide whether to take a group O product or obtain a platelet product based on the needs of the day. 
Thank you to those who are excellent stewards of the products you receive!  Blood centers are not shorting you because they are incompetent.  Frequently it is extremely difficult to obtain the most desired products any where at any price.  You can help your blood center serve you by being honest with your inventory.
 
 
 

When the reason for a deviation is determined we can decide how it needs to be addressed. In some cases, the deviation was an acceptable response to a given situation. No follow up required. If education or training is required, that is provided and documented on the same form. If the deviation is the result of continued 'bad behavior', training/education issues, or egregious disregard for policy, then our next step is an 'Opportunity for Improvement'. This is something we use throughout our lab. The tech and a lead sit down together to discuss the deviations and the problems identified to determine what the tech needs to do to remedy the problem. The tech is also asked what he/she feels is needed to help him/her resolve the problem. Once the lead and the tech have come to an agreement, the resolution to the problem is spelled out, including any education/training the lead will provide and the expectations for the tech's future performance. An end date for the required improvement is also determined. When that date is reached, the lead evaluates the tech's progress. If all is well, that is documented. The End. If there are still issues, the lead can re-evalute the situation. Additional training or education can be provided, with another periord of evaluation. If need be, the problem can be referred to the lab manager for possible disciplinary action.

We had stopped doing cord blood panels on O Pos moms for several years. Then a Family Practice physician took over as chair of OB/Peds and insisted that we resume cord blood testing on all O Pos moms. Why? ... because his children were born with elevated bili levels and his spouse is O Pos. Was there a difference in the treatment of these infants because their DAT was positive? ... probably not. We need to revisit this issue because we do a lot of cord blood panels on O Pos moms and it adds to their bill w/o adding much, if any, benefit to the infants care.

I would think that a 4th option in the poll should be: Routinely perform only D typing on babies from D negative mothers.  
Why do ABO and DAT routinely on these babies?  

For a technical assistant: answer the phone, sign out blood, thaw products, take temps, discard samples, maintain blood and reagent inventory (with assistance if needed), any kind of housekeeping, stock supplies, any filing if you are still use any paper.
Don't discount the MLT's, they are as technically capable as a CLS. Remember it's not the letters behind the name that make a good tech it's what's in their head and their heart.

Nurses performing ABO/Rh testing, scary.  AMcCord and R1R2. 

Nurses performing ABO/Rh testing, scary.  AMcCord and R1R2. 

Nurses performing ABO/Rh testing, scary.  AMcCord and R1R2. 

Agree with AMcCord.   Can't and don't want to imagine nursing personnel performing this test.  

My advise for safe patient care is confirmation of the patient blood type by a laboratory professional. 

we purchase pooled cryo from the blood center.  no more pooling
 

We use the STAT Spin Express 4 here which allows us to centrifuge our specimens for 3 minutes.

It is my understanding that if you use a computer system that is validated and has been set up with logic to recognize valid typing reactions (and reject others) that you meet this requirement.

One of the advantages of double red cells is giving them both to the same patient to reduce donor exposure.

As everyone else said, document, document, document.  This person is a huge risk to patient safety which should send up red flags to everyone and it's also a risk to your hospital to have someone of this caliber in your lab.
Do you have an HR counseling policy, I've used it to document unsatisfactory technical performance or a violation of organizational values and mission.  Start with a verbal warning/discussion.  "No you may not do a DAT test without having your competency signed off".  After the verbal (document this) then take it to a level I (or whatever your HR calls it), refusing to follow policy and procedure, unsafe patient care, tie this to something in the counseling framework.  Get input from HR with this.
At the time of the Level I, reiterate that if this behavior is observed  again this will take the counseling to a Level II.  At this point the tech may need to go on a "highly structured performance improvement plan" which I've seen done in conjunction with the employee.  Goals are set, timeframe for touch base meetings set, feed back sessions on progress.  You are giving them the benefit of the doubt and this is fair to the employee in question.
Usually if the performance improvement goals aren't met, bye bye, adios, das veydanya.  You can't do this alone, you need upper management and HR involvement because this could become quite unpleasant for everyone involved.  Especially a patient.  

I want to preface the following remarks by saying that I am, or at least spent over 35 years, a blood banker in various capacities.  I am one of you. 
Blood bankers, with good reason, can generally be described as untrusting to the point of paranoia.  No one can do the job as well as we can and that includes other blood bankers.  I have never known one of us who would willingly trust a sample drawn at another facility.  It's hard enough to trust our own phlebotomy staff!  I don't even want to get into nurse draws!  We are this way because we understand the potential dangers and in all honesty most of this comes from a true concern for patients we never personally see.  I had one staff member quit a blood bank day shift to work as a generalist on the night shift because she was convinced that the use of the new automated analyzer would result in the death of all of her patients because she would not personally be doing the testing.  Granted that's a little extreme but it is an example.  
So to answer the original question of this thread, I am fairly confident you will find little or no support for "using a blood bank sample drawn and tested from another facility".