Eoin

We have joint commission visit again early next year so interested in your post mla. I don't know how they justify this stance. The only time we see it is when the nurses come in to discard the bag into our rigid infectious waste bins. Nothing to do with the lab or bloodbankiing activities as far as I am concerned, definitely clinical as they are never used, just discarded. Willlet you know if they raise it. I certainly won't be asking them. Cheers Eoin

We tell them - wherever possible, record start & finish time {same documentation as wards, but we have approved abbreviated flowsheet (from section for theatre transfusions in SOP) for theatre etc.}. Lke others, obs not required because of continuous monitoring. When the fit hits the shan, we ask them to retrospectively complete documentation (stressing that the life of the patient is paramount). Get some interesting documentation then - but they try. Cheers Wayne

We are a multi-disciplinary lab as far as on-call goes. Even though scientists are doing the odd crossmatch or three per month on-call, we have the "floaters" (I like that word - conjures up all sorts of images) go through a competency check each six months. Yearly for full timers in BB. Regulators are happy with that. Cheers Eoin

I guess it depends what is being used. Pradaxa (Dabigatran) for instance is a thrombin inhibitor and other inhibit different factors and yes for some of them there are no reversal agents. I have seen a number of articles on haemodynamic support of bleeding patients who are on these, but haven't seen any definitive one yet that has wide acceptance and support, but they do need support ( thankfully most have a short half-life). Cheers Eoin

I don't know of a standard. However the issuing Blood Establishment issues packed cells in plastic bag overwraps. They ask that these be maintained until the units are hung, so we comply with ther request. I think it is because of a decrease in surface contamination of the bag. However I don't know of any studies to support this. We have Joint Commission again next year, so could be interesting. On the privacy side, hand transportd blood or products are carried in a small red insulated box - so is not visible until at the patient bedside. Cheers Eoin

That is a great idea ChrisH. Old timers like me (maybe that should be lifers - 40 years must count for something) could learn / refresh as you go along. We could add comments or questions as you go. Good luck with it all. Cheers Eoin

There has been a historical standing that BB handles all this. The only benefit is that we know what patients are getting if problems with XM (or any other aspect) arises. We have tried shifting to pharmacy, but the resistance is strong. Intend to putting before Transfusion Committee at next meeting - but still expect strong resistance. Cheers Eoin

This is supposed to be discussed by clinician when getting consent. How often does it happen? Probably rarely. We are considering separate consent fr transfusion - one of the best I have seen is - http://www.urmc.rochester.edu/urmcmedia/hh/services-centers/blood-transfusion-center/Documents/Consent-for-Blood-Transfusions-419BT.pdf See what you think. I would also be interested in other replies. Cheers Eoin

We use Q-Pulse Ver 5.7. I agree with Malcolm. It is great from a manager's perspective. A bit painful to set up, but once up and running your work can be set to flag for the coming week / month or whatever tie you like. I am the administrator in the hospital for it and it can be tweaked to suit you (can set up templates). It takes the backbreak out of ver updating, approval and distribution and only one emergency copy of SOPs need to be kept - the rest is available electronically at all workstations wherever there is a PC. SOP review dates can also be set. It also has Audit, Customer, Training, CAPA, People (staff records), Suppliers, Assets and administration modules on it as well. I personally love it. It has stopped my life becoming hell and has saved a number of trees already. Cheers Eoin

We have a central monitoring system which monitors all critical temperatures in the laboratory (incl BB). This includes monitoring room air in the BB lab (where RT reagents are stored. This is required by our regulators (to fit ISO15189 and EU and Irish Bloodbank regulations). It is set to alarm if within 0.5 degrees of the critical limits and phones us as well. Can then get in on web access to see what is going on if out of hours. Works well. The probe is placed in ice and then hot water to test that function and is calibrated yearly (at time of preventative maintenance). Cheers Eoin

The four hours out of refrigeration is because of bacterial growth rates as unit warms up, so there is probably some scientific basis for the regs, but I agree - a new study with published data from it would be great. Cheers ]Eoin

I personnaly haven't come across any benchmarking in this area, but it should be driven by cost considerations. Like Dr Pepper, we are lucky we are near one of our suppliers and can ship back units with 10+ days life on them. They are a big hospital and can use shorter dated stock (we are smaller). We try to keep a small inventory and look at the list every day to manage closely. Our wastage was 0.2% for 2012. (Has been consistently coming down over the years with closer management). The savings are worth the effort. Good luck with it. It is a very importmant management requirement. Cheers Eoin

Welcome. I have over 40 years in transfusion and still learning from posts on the site (young at heart though). We look forward to your posts (or questions). Cheers Eoin

Here in Ireland we have regulations that it must be started within "30 minutes of removal and completed within 4 hrs" from controlled storage (i.e. suitably monitored and alarmed storage). This is traced through our blood tracking program. If it is returned outside 30 mins from removal, the fridge door won't open and they have to contact the lab staff. The unit is then removed by us from circulation. We have had times when Tx has been halted becausethe IV canulae has failed, but they know to speed up the rate when restarted or dump what is left at 4 hrs. We use packed cells exclusively, so no problem with the volume to go in, even in the low-weight patient, or the renally compromised patient (with suitable diuretic therapy). Times outside this generates a non-conformance within the hospital. Outside 6 hrs is a mandatory report to the National Haemovigilance Office. Cheers Eoin

Thank God for our Clinical Haematologist who supports us in continuing education and competency testing. We too don't have dedicated BBers, but they must rotate through BB at least once every two years for four months. Also they have enough sense to check if they meet a situation they are unsure of. I sympathise with you PAWHITTECAR and others who do not have the backing of management on this. Makes life very difficult. You are absolutely 100% right in sticking to your principles. They are a bit dumb if they don't realise that you are covering their backsides. Best of luck with it. Cheers Eoin

Well done. All inspections are a bit stressful, but if you do as good as this time, you will have no major worries. Cheers Eoin

Well done Malcolm. I see nothing wrong in a post from someone with a social conscience. Have signed. - Again an example of beauracracy not taking the effort to understand before acting. Cheers Eoin

Done - good luck. Eoin

We use Q-Pulse 5. (Gael). It is very good, and as a Quality Manager now it makes my life much more bearable. It is used widely throughout the world, and has high standing in the aviation woarld as well. Like all systems, it has some points that could be improved, but all in all is excellent - and you can set it up to match previous paper-based systems. Cheers Eoin

Oh Liz, I saw Happy Christmas & nearly freaked - but as you will be away it is appropriate and a good thing. So a very Happy & safe Christmas to you all. We get to share with our daughter's family (one five year old grandaughter) (our son lives in Seattle & has just been over to Ireland, so won't see him this year. It is a great time for family & friends. Enjoy Rome. We are not long back from Venice, where we also stayed in a monastery (fine accom & far cheaper than rip-off hotels in Venice) istituto san giuseppe venice. It was three minutes walk to St Mark's Square & five the other way to the Rialto bridge. Fantastic & would recommend to anyone. If you are a late night freak it won't suit though as they lock up at 11pm. Our hospital (private) slows up at Christmas as most consultants wind down to be with their families (suits me fine). Cheers to all Eoin

Don't use Quick Reply - instead go to "+ Reply to Thread" - then the "Go Advanced" at the bottom of the box and you will see a paperclip symbol (to the right of the Smily Face top row of the toolbar) that allows you to attache files Riaz. Cheers Eoin

Our policy specifically states that they must stay with the patient for the first 15mins. I push this hard at every lecture for the obvious reasons. Do they do it in practice when I am not on the wards? - I hope so, but demands are hard on them. I also suspect by the timings on those first obs (we use BloodTrack Tx PDAs in the clinical areas so can see them on Manager) that this is not so (can vary from 15 mins to 30 mins) - perhaps they are having trouble with obs equipment!!!!! Hard to monitor folks. Cheers Eoin

What products are used in your institution? There are lots of good information on administration of those on the web. That could be a good start. A practical problem solving exercise of something that has caused a problem previously in the hospital may also be useful. Another I have given focuses on the turnaround times for various situations (e.g. - routine no problems; emergency crossmatches; patients with antibodies; patients with the rarer blood groups, special needs patients (irradiated, washed cells etc) (telling them what may be used when necessary in an emergency). We find generally clinical staff have a poor understanding of the time required to get compatible blood in the cases above. They get an appreciation of the problems that you face with critical patients with these problems. Above all keep it in simple language. Technical terms will confuse them. Good luck with it all. Eoin

We get ours serviced and calibrated yearly. In between, provided your QC is good, there should be no need for additional work on them. Experienced bloodbankers will pick very quickly if a pipette is not delivering the correct amount form the density of cell suspensions and hight in the cells afyer each additon and the size of the spun button at the end as well. Cheers Eoin

We have a system which won't give access to the Issue Fridge without user ID and patient ID. It will then open if there is blood for that patient. Emergency O Negs are accessed through a different ICON. We have the tracking PDAs on the ward, so trhere is then a check between patient and unit and the good to go is given if it is blood for that patient. That unfortunately doesn't get around the WBIT (wrong patient bled initially). We shortly will be getting 2d barcoded patient armbands which will be put on at admission (waiting on the software). Then the PDAs can be used to scan that wristband and produce the labels at the time of blood draw. In the interim, we issue a transfusion armband (with 2D barcode) with the compatibility paperwork. British Committee for Standardisation in Haematology (BCSH) guidelines for this year now recommend second draw for confirmation, unless previous record agrees, so we may have to implement that as an interim measure. Unfortunately if you read SHOT reports, WBIT still occurs, so does need to be closed out. I would be interested in how many have a second nurse sign as having checked identity and labelled tubes, documentation at time of blood draw as a means of closing this loophole, and is it accepted? Cheers Eoin