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sgoertzen

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Everything posted by sgoertzen

  1. We created this label (Shamrock): It's actually a brilliant orange color. Perhaps Shamrock would let you purchase this one that we already created for ourselves (Valley Children's Hospital)?
  2. Re: We still have concerns about pre-op patients who aren't wearing any Epic band to scan when their pre-admit specimen is drawn. (I'm taking advice on how others manage these.) Likewise for outpatient transfusions. Epic told us that their system is not designed to use the process of banding outpatients and pre-op patients. WE INSISTED since 1) we've always banded any patient getting their blood drawn... especially for blood bank testing, 2) we were determined to meet AABB Std. 5.14.5.3) requiring an electronic (scanned) identification system, and 3) we decided that we were NOT going to go backwards after all these years and create a new system in Epic that was less safe just because they said that's their design. I insisted that PPID scanning be used for the specimen collection/labeling and that the same armband be presented on the day of their admission or outpatient transfusion. The patient is given strict instructions (an instruction sheet that they must sign and is scanned into the EMR) that they are to keep the band on or at least have it in their possession on the day of admission/transfusion. The original band used for specimen collection is replaced with their new encounter band only after the 2 bands are compared side-by-side and match exactly for Name, MRN, DOB. It was a bit of a struggle to get everyone on board to veer from the Epic "Foundation" methods, but we were finally able to convince people that this was a significant patient safety issue and was necessary.
  3. I highly recommend you use this opportunity to discontinue using a separate BB ID band. Using the patient’s regular ID band works great. If you’re using scanned PPID from the wristband for specimen collection & labeling, adding another ID band into the process no longer adds any safety benefits. You’ve already created your closed loop system using the regular hospital ID band and scanning it for both specimen collection and blood administration in BPAM.
  4. Here is our procedure. TO-480 Mixing Blood for Exchange Transfusions and CRRT.docx
  5. 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
  6. 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?
  7. 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!
  8. 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
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. I notified my Immucor rep but he wants to know what lot # CorQC is everyone having problems with? bldbnkr, Texas Lynn, David?
  14. 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.
  15. 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.
  16. 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.
  17. 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!
  18. 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!
  19. 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).
  20. We designed and ordered special labels that we attach to our psoralen platelets. The ISBT codes for our products are E8331, E8332, E8333, E8334, E8335. Psoralen-Treated Platelets Place this label on all Psoralen-treated (Pathogen Reduced) INTERCEPT Platelets to remind the care provider that they are equivalent to IRRADIATED and to store at room temp.
  21. We've been using leukoreduced RBCs and PLTs in lieu of CMV seronegative for over 20 years for all pediatric (including neonate and micropremie) transfusions. I work at a 350 bed children's hospital with a large NICU, 3 satellite NICUs, an active ECMO and heart surgery program, and we care for many children who receive bone marrow or organ transplants. We converted to this back when studies showed that leukoreduced products were found to be basically equivalent to CMV seronegative products for rate of CMV transmission. We use leukoreduced for all transfusions (including exchange transfusions) regardless of patient age or size. We have never had a case of CMV transmission through transfusion. Over 80% of our blood donors are CMV positive in our area.
  22. I received this email below from jeskarmazinmd@gmail.com on 1/18/2019. You may want to contact Dr. Karmazin if you have any healthy plasma collected from young donors (16-25 yr old) that you would like to sell. Hi, I am interested in setting up an account to order young plasma (FFP), from donors ages 16-25. My company, Ambrosia, is focused on using young plasma as a restorative treatment for chronic illnesses. We have had success over the last several years, including a clinical trial completed in 2018. Please let me know if you have any questions. Thank you, Dr. Jesse Karmazin
  23. This is the way Meditech documents the splitting of products. Now with ISBT, the product code does not change when you split, so this is how the computer differentiates one split from another made from the same product. The split number (A, B, Ba, whatever) needs to print on the tag so you can tag the product properly and the blood bank and bedside staff know which split is being issued and transfused. I've had Meditech 27 years, we're a pediatric hospital so we make tons of aliquots, and no inspector (CAP, AABB, FDA, JC) has ever had a problem with this. Your CAP inspector should not cite you for something they don't understand. The previous post is correct - adding an A or B to the DIN when splitting has nothing to do with a closed or open system. I would challenge that citation.
  24. For many years we have been using borosilicate glass tubes (12 x 75mm and 10 x 75mm) with a patch for writing on them to perform our blood bank testing that needs to be done in tubes. We currently purchase ours from Kimble-Chase - item numbers are 60A10BZW and 60B12BZW. As companies have merged over the years I guess things have changed because one of our blood bankers recently noticed some very small print above the barcode on the box of tubes that says: "For Research use only. Not for use in diagnostic procedures." I would consider blood bank testing performed in tubes to be a "diagnostic procedure", so we've gone in search of an alternate vendor for glass tubes with a patch specifically made and approved for blood bank tube testing. We can't find anything out there on the market. We've checked with other local hospitals and they had never noticed this message until we brought it to their attention and are choosing to ignore the manufacturer's message and continue to use the tubes. What vendor is everyone else using?
  25. We've used TAR for years and it works well. We use the regular hospital ID band (where the barcode is the patient account number) - we do not use a special band. The nurses must scan the patient ID band and all 4 quadrants of the product label. We still require that 2 nurses Esign in TAR after completing their bedside checklist. We have built all their necessary non-scanable checks into this checklist (AAB Std 5.28.3). We use TAR everywhere except SURGERY, since they have their own system (called O.R. Manager) and they do not use Meditech in the surgery suites. We do not print a paper form for any location but SURGERY. For blood issue, we use a pick-up slip (we have them preprinted as pads that they keep at the nursing stations throughout the hospital) where they must fill out the patient name, MR#, Acct#, and what product they want to pick up.
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