sgoertzen

When blood bank is called to release uncrossmatched blood, we specifically ask who the ordering physician is. The blood banker then places an order in EPIC called "Release of Uncrossmatched Blood" which is the statement (taken from AABB Standards) about the situation being critical enough to warrant the release of blood before compatibility testing is completed. This order must be electronically co-signed in EPIC by the physician that we name as the ordering physician. We have EPIC and WellSky (Mediware HCLL), but it shouldn't matter what blood bank computer system you have since this is all done (ordered/cosigned) in EPIC. I'm attaching our uncrossmatched worksheet that includes the instructions that we follow to place this order in EPIC and assign it to the ordering physician for co-sign. I check each day to make sure it gets co-signed. Once signed, I print the order with the co-sign tracking information, attach it to our worksheet, and file the paperwork for easy retrieval during future inspections/assessments. TO-381F01 Release of Uncrossmatched Blood.docx

We have a busy Fetal/Maternal Center for high risk pregnancies at our hospital. Our primary method of testing is solid phase (Capture) for antibody detection and identification, and our secondary method is PEG tube testing. The perinatologists are requesting antibody titers on all pregnant women with clinically significant alloantibodies. We have repeatedly seen clinically significant antibodies that react 3+ to 4+ with solid phase methodology that end up being "too weak to titer" when we move them to the tube for saline/37C/AHG titering. Even the non-diluted plasma reacts negatively in the tube at 37C and AHG without any enhancement. This is confusing to the perinatologists and I understand why. It doesn't make sense to them that a 4+ strong antibody can be too weak to titer. Does anyone else frequently experience this? I'm just curious whether anyone is routinely using any kind of enhancement when performing antibody titers on known clinically significant antibodies (such as CcDEe, K, Fy, Jk, etc). I know that the CAP ABT Survey choices for titer "diluent" are saline, 0.5% albumin, 6% albumin, 22% albumin and their "technique" choices include various versions of IS, RT, 37C, AHG, DTT (we're using saline w/ 37C incubation and poly AHG). With the exclusion of a gel titer, if you have a procedure (with criteria) for performing an "enhanced" titer, would you be willing to share it? For those of you using albumin for diluent, do you find this helps enhance the reaction of the antibody and what strength of albumin do you use?

Hi Sonya - yes, it's a custom label we had them make for us at Shamrock. If you like it, they may just let you order ours rather than create your own! Hope you are all well and happy in San Diego!

We apply this custom label to all PR platelets and PR platelet aliquots (see attached picture). We're a children's hospital and we've been giving PR platelets to neonates since March 2017 with no problems. PR Platelets.docx

We use Safe-T-Vue 10 indicators on RBCs/FFP issued in a cooler, and the Fluke 561 infrared thermometer to take the temp on products that come back that weren't issued in a cooler.

Our hospital went LIVE with Epic and WellSky in April 2020. The rest of the lab is Epic Beaker. We previously had MediTech house-wide. We have not experienced an interface delay between the 2 systems as David mentions above. We're a children's hospital with a level 2 trauma center.

For routine transfusions, each transfusion should include the volume of the product given. In massive transfusions, however, it is often common for them to track/document just the total cumulative volume of each type of product given during the massive bleed event.

In order for the vitals to “attach” to the product for various blood bank reports, the nursing staff must use the vital assessment within the TAR system (the Document button in TAR). If they choose to use a different vitals assessment outside of TAR, it will not attach to the product and you can only view those vitals by clicking on the “Vitals” button in the EMR of the patient and scrolling to the date/time of when the Transfusion was being administered. It’s a bit of a pain when you are doing Transfusion audits that appear to have “missing vitals”. They were often taken, but just entered outside of the TAR system in a different spot in the EMR.

I notified my Immucor rep but he wants to know what lot # CorQC is everyone having problems with? bldbnkr, Texas Lynn, David?

To be an assessor for AABB, you have to currently work at an AABB accredited facility and be an individual AABB member as well. If you meet these requirements and you meet the experience requirements, you can apply to be an assessor. It is a big commitment, but well worth it! They expect you to make a real effort to attend the assessor day training each year at the AABB annual meeting and to accept and complete a minimum of 2 assessment assignments each year. If you have to miss the annual meeting for whatever reason, they do allow you to make it up with on-line training, but it's required that you get your initial 2 day "new assessor" training and preferred that you get your subsequent annual assessor training at the face-to-face annual meeting each year.

AABB does not require or recommend that you give group O washed blood to neonates < 4 months of age. I work at an AABB accredited children's hospital (so lots of neonate transfusions) and we have never used washed blood for them during the 28 years I've worked here. 31st Edition of AABB Standards for Blood Banks and Transfusion Services: 5.17.2 If a non-group-O neonate is to receive non-group-O Red Blood Cells that are not compatible with the maternal ABO group, the neonate's serum or plasma shall be tested for Anti-A or Anti-B. 5.17.2.1 Test methods shall include an antiglobulin phase using either donor or reagent A1 or B red cells. Std. 5.14.3.4 applies. 5.17.2.2 If anti-A or anti-B is detected, Red Blood Cells lacking the corresponding ABO antigen shall be transfused. Our policy is that we routinely give neonates fresh group O Leuko-reduced, Irradiated, CPDA RBCs, but if they must be given something other than group O (example: a directed donor unit), then we require a full AHG crossmatch be done on the unit using baby plasma.

We're in the midst of moving to Epic. We'll have Beaker for the Lab and WellSky (formerly Mediware HCLL) for the Blood Bank. Still too early to tell if we'll be happy with HCLL since we're still building it and will Go-Live in April 2020.

We're a children's hospital in the process of building Epic/Beaker/WellSky (Mediware HCLL) with Go-Live set for April 2020. We've bumped into a huge problem with Epic stating that our outpatient drawing area must use their Epic/Beaker outpatient product which does not allow for electronic (scanned) patient/sample ID and there will also be no patient ID bands. We've been using electronic ID of patients and samples with our current system (MediTech), so losing this functionality would be taking a major step backwards for us - especially with our Pre-Op patients and their blood bank specimens. We don't want to have to go back to requiring 2 specimens collected at different times on all first time blood bank patients, and using no ID bands just sends up giant red flags to me as far as patient safety is concerned. Is anyone else experiencing "no ID bands and no scanning verification of ID band vs. specimen label" in their outpatient areas? How are you dealing with this? I'm hoping that I can get some advice from all of you Epic/Beaker users. Thank you so much!

We're a children's hospital in the process of building Epic/Beaker/WellSky (Mediware HCLL) with Go-Live set for April 2020. We've bumped into a huge problem with Epic stating that our outpatient drawing area must use their Epic/Beaker outpatient product which does not allow for electronic (scanned) patient ID and there will also be no patient ID bands. We've been using electronic ID of patients and samples with our current system (MediTech), so losing this functionality would be taking a major step backwards for us - especially with our Pre-Op patients and their blood bank specimens. We don't want to have to go back to requiring 2 specimens collected at different times on all first time blood bank patients, and using no ID bands just sends up giant red flags to me as far as patient safety is concerned. Is anyone else experiencing "no ID bands and no barcode scanning of ID band vs. specimen label" in their outpatient areas? How are you dealing with this? This problem isn't related to SoftBank vs. WellSky so I'm hoping that I can get some advice from all of you Epic/Beaker users. Thank you so much!

Someone above commented that a 2nd sample is only required in the U.S. for computer crossmatch (which used to be true). But with the 31st Edition of AABB Standards (effective April 1, 2018), this requirement was moved so that it now applies for all pretransfusion testing for allogeneic transfusions including all types of crossmatching (IS, AHG, and Computer crossmatching). This is more in line with CAP requirements and makes more sense in order to detect possible Wrong Blood In Tube (WBIT) events. AABB Standards for Blood Banks and Transfusion Services, 31st Edition 5.14.5 Pretransfusion Testing for Allogeneic Transfusion There shall be two determinations of the recipient’s ABO group as specified in Standard 5.14.1. The first determination shall be performed on a current sample, and the second determination by one of the following methods: Testing a second current sample. Comparison with previous records. Retesting the same sample if patient identification was verified using an electronic identification system or another process validated to reduce the risk of misidentification. Standards 5.11 and 5.27.1 apply. Personal Note: If you intend to retest the same sample (by a different person or the same person), be prepared to show the AABB assessor your validation proving that your "another process" is actually validated to reduce the risk of misidentification (i.e. WBITs). CAP Checklist Requirements: TRM.30575 Misidentification Risk The facility has a system to reduce the risk of mistransfusion for non-emergent red cell transfusions. NOTE: Mistransfusion occurs from misidentification of the intended recipient at the time of collection of the pretransfusion testing sample, during laboratory testing and preparation of units to be issued, and at the time of transfusion. Misidentification at sample collection occurs approximately once in every 1,000 samples, and in one in every 12,000 transfusions the recipient receives a unit not intended for or not properly selected for him/her. The laboratory is expected to have implemented a plan to reduce these risks through implementation of a risk-reduction system. Among options that might be considered are: (1) Verifying the ABO group of the intended recipient on a second sample collected at a separate phlebotomy (including the recording of the result in the institution's historical record); (2) Utilizing a mechanical barrier system or an electronic identification verification system that ensures that the patient from whom the pretransfusion specimen was collected is the same patient who is about to be transfused. Other approaches capable of reducing the risk of mistransfusion may be used. The laboratory should participate in monitoring the effectiveness of the system that it implements. The laboratory should also consider improvements in procedures and/or educational efforts as part of its program to reduce the risk of mistransfusion. TRM.40670 ABO Group and Rh(D) Type Verification The recipient's ABO group and Rh(D) type has been verified by repeat testing of the same sample, a different sample, or agreement with a historical type in the laboratory's records. NOTE: Repeat testing of the same sample may be inadequate unless the sample has been drawn using a mechanical barrier system or digital bedside patient identification system. For laboratories that employ computer crossmatching, serologic crossmatch techniques must be employed when ABO typing discrepancies are present (e.g. mixed field reactivity, missing serum reactivity, apparent change in blood type post hematopoietic stem cell transplant).