Franklyn

We use a three ply form, so its an oki data dot matrix type printer.

In such cases you are required to notify the recipient directly. We do inform them of the issue in the letter and offer testing and other information. Luckily, such lookbacks are rare these days...

We have remotely placed refrigerators in four different OR areas and one in the ED Trauma room. We have experienced similar issues with three of them and decided to add a door monitor to the refrigerator. When someone opens the door, an alarm goes off in the Blood Bank. Policy dictates that the Nurse call the Blood Bank and tell them who they are removing blood for and, if they do not, we call and inquire. Perhaps not the best solution, but we no longer loose blood without at least having been warned that someone went into the refrigerator and the only item in the refrigerator is blood, so... We can increase our chances of tracking down the units and maintaining traceability.

CLIA has no such reg. As a rule, the regulating agencies do not get that granular but usually have language along the lines of "...evey 24 hours or as per manufacturers instructions..." As the compliance guy at my facility, whenever someone trots one of these zingers out I always ask for the citation so that I can verify it myself. You would be surprised how often they suddenly cannot find the citation or how quickly they change their minds about it.

If you have access to a copy of the AABB BB/TS standards, they go into a bit more detail. Perhaps that will help.

About the only scenario I have seen so far where I feel accepting someone else's ABO results (presumably in emergencies only) would be in a network of hospitals all sharing common corporate level SOPs with documentation of training and competency. You have the best "bet" of getting consistently followed SOPs. Other than that, I would still prefer to do it myself for all the previously stated reasons. We, too, have had patients share insurance cards and end with more than two completely different ABO/Rhs on file for a single patient. It can be a real nightmare.

The reason for a new specimen on the day of surgery for patients that flunk the Preadmission testing screening or that have unusual antibodies is so that we thoroughly screen the patients and provide correct components on the day of procedure. If you have been pregnant, received a transfusion or have a history of antibodies, your antibody screen results 21 days apart may be different. So we re-test and crossmatch on the new sample to ensure that the correct products are setup and to confirm that, even though they were pregnant or received a transfusion, no new antibodies have appeared. We only crossmatch and issue products based on the results of the new sample for these patients. If they were pregnant or transfused but upon screen negative initially AND on the day of procedure specimen, we will electronic crossmatch and issue. If they EVER had antibodies, we coombs crossmatch antigen negative units, only.

If you are just calibrating them it is a tachometer check and time check against standard references. Your procedure will depend on your equipment. Are you certain you do not have a Biomedical engineering department that can do that for you? Serological calibration is bit different. Which do you need?

The standards do not specify what the "pre surgical testing" window is. We keep our samples for 23 days (up to 21 days prior to surgery). The most important part of that process is the interview because only patients that are not pregnant, have not been transfused within a defined time period and have no history of unusual antibodies qualify for the program. Everyone else gets drawn/redrawn on the morning of the surgery.

We do not accept ABO/Rh results from outside our institution. The goal of the second type in either regulatory and electronic crossmatching is to have a high level of confidence that you have drawn the correct patient and have an accurate ABO/Rh etc. As institutions will vary on their policies surrounding weak D test (for example) or their methodology (Tube, Gel, Solid phase) we insist on two types in house.

I apologize for not responding to this earlier as I assume the question was aimed at me. The gel and solid phase methods have very similar specificity and sensitivity. They each have their weak spots but, overall, we went with the solid phase and switched to PEG as our backup methodology. We submitted an abstract on our validation back in 2005, rather than try to paraphrase, I have attached a PDF of the submission. 2005 Validation Abstract.pdf

Well, I contacted three vendors (Gem, Jewette and Norlake) and sent them all identical packets of information which included the general size, rough sketch of layout, features desired (e.g. redundant air-cooled compressors) and requested quotes. I received quotes from Gem and Jewette in short order and after several telephone conversations with the sales rep from Norlake to answer his additional questions the ball got dropped. While I do agree with you in principle, such was not the case here. I did obtain multiple quotes as each vendor clarified the feature sets they were offering and then decided to go with the unit from Gem. My opinion stands.

I contacted Norlake recently regarding a walk-in refrigerator. After several telephone discussions and a few emails wherein we exchanged information and specifications, the salesman dropped off the face of the earth (so to speak). Thus my one and only experience with that company was rather poor.

Welcome aboard!

I have remote refrigerators all over campus, but they are monitored by the blood bank remotely. When we place products in those refrigerators they are "issued" to the units in our computer system, so if we discover an error on a unit placed remotely it is FDA reportable. I am surprised the state inspector had anything to say about it. I don't live in Idaho, but two person confirmation is typically a bedside task and is required by regulatory agencies like the JC and CAP or the AABB. Granted, their may be such regulation in Idaho (I wouldn't know) but my first reaction would be to request the exact citation. I have had way too many inspectors try to force compliance with their "opinion" rather than what the actual requirements are.

I requested a variance for a similar reason for my facility. The request was denied by the AABB, so good luck.

The short answer is "Yes" - you need documentation that the storage temperatures "wherever" you store those products are within acceptable range. Oddly, it seems to be a once per day requirement unlike our blood bank q4 hours requirement.

If you are evaluating the HemoTemps or other indicators when the products come back to you, just use the previously mentioned data loggers. If the temp went above 10 or below 1, it is plain as day on the graph. Course, if the end users are doing the evaluation this isn't of much use...

I am using the Veriteq loggers, but not the centralized system they can communicate with. The loggers themselves are nifty little gadgets, if a bit fragile for the use I am putting them too. Veriteq has recently made some design changes to address most of those issues, though. I looked at the system a while back, and chose not to pursue it. However, since I cannot remember why I made that choice, check me out. They have been very responsive to my requests for assistance, so from a customer service standpoint I have had no complaints.

We are using CIMScan by CIMTechniques. Previously we used the Rees Centron system. The system has been great (the end users not so :-) and the next version of CIMScan (v6) pretty much meets my wish list. I am just waiting for approval to upgrade.

We used the Rees System (Including Centron) for 15 years and a little over a year ago switched to CIMScan by CIMTechniques in S.C. Both systems do, basically, the same thing but with different architecture models. We found that even though Rees Scientific was a bigger company with a larger install base, service and support were actually pretty poor. CIMTechniques is a much smaller (up and coming) company but as such they were "hungrier" and much more responsive to out needs. It is a trade off, to be sure, but thus far we are very happy with our choice. We looked at the newest Centron system, Isensix, MACK, Veriteq and CIMTechniques prior to sending out our RFPs. Oddly enough, I never looked at the Temp Trak but the system looks very similar to the others.

Tissue Track Core, QSight and Graft Tracker are all "Hosted" systems. You connect to them via a web browser from any computer in the hospital. So, you installation cost is limited to the bar code scanners and computers "in house" that you need to purchase AND the annual contract with the vendor. Since the cost varies based on a bunch of little things, it's best to contact the vendor and ask for a quote. They will be happy for the chance to sell you something...

We do not receive a copy of the transfusion report form (bag tag) back either. The record of the transfusion is in the computer system and easily accessible and as our nurses do not document the transfusions in a standard manner (surgery is on a flow sheet, Heme-Onc is on a special sticker they apply, Nursery is in the computer, etc). Return form serves no purpose. However, we use a multi-ply form. The floor gets the top and second copy, we keep the third. The top copy goes into the charts. The second ply goes to the nursing manager for their audit. The bottom copy stays in the blood bank as a temporary record in case we get the unit back (as in from surgery). Transfusion audits are a tricky thing. The nurses have their audit (which is really just a documentation audit). Random spot audits are done periodically to check practice. We do not, have not and have no plans to audit every transfusion as you do. We transfuse about 5,000 blood products a month so such a detailed audit would be impractical.

I think "average" will depend on your facilities size. We have a MSBOS (minimum surgical blood ordering schedule) but that is also facility dependent. I think you will need to build the dataset for your institution and then look at it rather than try to find "published averages." Good luck with this one...

We have a nightly extract of every patient we have worked on that is downloaded from the LIS and uploaded to an Access database. The extract is some 70 MEG at present. The LIS extract and download/import are scheduled and happen automatically. Putting it in access allows for a fast search and lets us link to the special data if a patient has antibodies of special needs.