marvy1
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Posts posted by marvy1
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Consider asking Meditech, if it is possible to do a customization so that blood types from the historical conversion are treated as tested blood types.
Allow me to translate the above sentence: Consider asking Meditech if it is possible to do a customization so that their Electronic crossmatch actually works the way it is suppose to work.
We are going to start working on Electronic XM in Meditech and I'm so impressed that once again Meditech proves they really know nothing about Transfusion Medicine. I was also shocked to hear that someone else did a conversion of historical data in Meditech. It took us over a year (and many many software changes and fixes) to accomplish that conversion. In other computer systems, blood bank conversions can take 1-2 days.
- BankerGirl and bbbirder
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We don't reflex tests off the echo. The only patients we routinely do Weak D testing on are our neonates born to Rh Neg moms. We do not run neonate samples on the Echo. We do export both our Type and Screen results (we use Meditech 5.65)
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We use greenbox coolers by thermosafe.com. Validated them to hold 1-6 C for 6 days at room temp. They are a bit on the heavy side but they sure hold temp
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We never did the history upload you are planning, but thought I'd throw out to you some of my past experiences.
In an old hospital I worked, we did a Sunquest to Cerner Millenium history upload. My IT guy did it super fast and easy (took him like a few days). At my current hospital, we tried to do a Meditech older version (?) to Meditech newer version (5.65) history upload. It took my IT Dept a year to accomplish with multiple fixes required by Meditech along the way. I got the impression that Meditech had never ever done a history upload before. They make the task very daunting for the end user to discourage anyone from actually attempting to preserve their blood bank history. I believe their philosophy is patient history data is really quite unimportant esp. for blood bank.
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We routinely use Anti-AB to retype our Group O blood units coming in from our supplier. It is cheaper than using Anti-A and Anti-B for that purpose.
- carolyn swickard, Lbiggs and jayinsat
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I have used multiple systems for Transfusion and not so many on the donor side: Sunquest, Cerner, Soft, Meditech, Progesa. Soft is one of the better ones and Meditech is one of the worst. Haven't used Soft on the donor side so cannot comment on that.
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I have used both the Terumo and Genesis. The Terumo is a little easier to use, but with just a little practice, the Genesis performs admirably. One thing to consider is the availability of consumables. Recently we were running very low on neonatal syringes and sterile connection wafers that we use on our Genesis sterile connector. We had to get a "special" emergency release of these consumables from Genesis in order for us to receive these products. As I understand it, normally Genesis does not ship anything based on a PO but require a check in their hand before shipping. If we were a brand new client, I maybe could see the sense of this policy, but we have been spending money with this company for years. If I was buying again, I would seriously compare Terumo's policy on providing consumable items with Genesis to see if they are less onerous.
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We have a test code added to our crossmatch called "Avail until" which we result with T+3 when we set up a crossmatch on a "regular patient". We set our specimen outdate for all samples to 96 hours (would be 72hrs in the US). We use pre-op samples up to 30 days if patient was not pregnant or transfused within the last 3 months. When doing the crossmatch on these pre-op samples the day before surgery, we again result the "Avail until" as "T+3" so that they will be taken out of crossmatch 2 days after surgery. We had a custom report made that prints automatically just after midnight listing all the crossmatches that outdated at midnight. This report pulls the "Avail until" test result out of our crossmatch test. The night tech then takes the units that are listed on the report out of crossmatch. In EMR, floors can view the "Avail until" result listed in the BB tests. It works pretty well.
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Re: 1/2 life of Dabigitran is 14 hours. However, this drug is cleared by renal excretion. If creat clearance is impaired, the 1/2 life of Dabigitran can be much longer. I remember attending an AABB lecture on this where there were cases that took 4-5 days to return the Thrombin Time to normal values. Anecdotal studies at McMaster revealed some benefit to using FEIBA for large bleeds with patients on dabigitran. Therefore we will stock FEIBA for these instances. I have seen studies showing the PCCs do nothing to coag results on patients taking dabigitran. However, PCCs do apparently correct Fac10 inhibitors (PCCs also rapidly correct warfarin). We in blood bank carry all these products since in Canada, the Canadian Blood Service supplies them all.
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John Moulds wrote a one-page QandA on this topic in the AABB news (Jan 2010). In sum: don't go looking for a cold ab...if it shows up in the ABORh testing for a cardiac case, there may be use in doing a 28 or 32C thermal range test (as well as the regular 37C). 4C testing is pretty much useless as most everyone reacts at that temp.
Malcolm Needs also replied in a similar topic thread back in Feb:
There has just been a reveiw paper published on the is very subject.
Jain MD, Cabreeizo-Sanchez R, Karkouti K, Yau T, Pendergrast JM, Cserti-Gazdewich CM. Seek and You Shall Find - But Then What Do You? Cold Agglutinins in Cardiopulmonary Bypass and a Single-Center Experience With Cold Aglutinin Screening Before Cardiac Surgery. Transfusion Medicine Reviews 2013 http://dx.doi.org/10...mrv.2012.12.001.
Basically, it says that doing such screens before surgery is a waste of money! -
I did hear the Johnson and Johnson is considering selling Ortho
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When working at an old hospital, we changed from Sunquest to Cerner and our IT guy wrote a script to transfer all historical data. This took him a week to figure out and 2 days to do.
In the current hospital I work at, when transferring from 1 older version of Meditech to a newer version, it took ~ 1 year + to make it happen. This included multiple software fixes along the way to accomplish the task. I assume we were one of the first Meditech hospitals to try this (since there were so many software fixes along the way). Meditech tries to make it so hard to transfer data and discourage hospitals from trying. I assume they must feel historical data is not worth transferring, otherwise they would figure out how to make it happen. I could understand if a software vendor had difficulty pulling data out of some old obscure databank, but we wanted to pull data out of their own software.
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John Moulds wrote a one-page QandA on this topic in the AABB news (Jan 2010). In sum: don't go looking for a cold ab...if it shows up in the ABORh testing for a cardiac case, there may be use in doing a 28 or 32C thermal range test (as well as the regular 37C). 4C testing is pretty much useless as most everyone reacts at that temp.
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There was a recent article in Transfusion on this subject:
Volume 52, Issue 4, April 2012, Pages: 695–701
How do I transfuse platelets (PLTs) to reverse anti-PLT drug effect?
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We routinely use PCCs for warfarin reversal. It really works fast to bring down the INR. The cost (here in Canada) is not a lot more than FP. It reduces risk of TACO and compliance is better (ie we used to see a lot of docs ordering 4 units of FP but often they would not all get transfused).
We follow the NAC (National Advisory Council on Blood and Blood Products) guidelines for dosing. Although, it is probably better to use the manufacturers recommendations for dosing as it also takes into account patient weight.
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We use the Meditech History Backup function to back up all our records onto a portable hard drive. This backs up any history modifications hourly, and the hard drive can be plugged into any PC or laptop during downtime, even during a power failure. I also check this at least every week because if the PC is powered down for any reason the backup cannot initiate and will stop after 300 tries (the highest setting possible).
My IT dept has the history backup running continuously (backing up continuously) to a web based file that is stored both on the local network and on a local PC (in case the network is down as well). It works great as you just need to type in the patient's name and up pops all the history
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We debated this issue back and forth. Decided to go the more conservative route and consider these "Weak-D" moms eligible for Rhig since a percentage of these "Weak-D" moms are actually partial D capable of forming Anti-D or are those uncommon "Weak-D" that also can form Anti-D
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We don't have any trouble detecting RhoGAM in the mother's sample using the Echo, unfortunately - much more so than gel. I can't say that we've seen it in infant samples, though we do antibody screens on very few, so I can't really make a statement one way or the other.
We also find that Rhogam and allo-D antibodies both show up stronger in Echo than in Gel
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No consent needed here as it is not considered a blood product. To handle the pharmacy issue described by pbaker above, when the nurse/doc orders RhIg, it sends the order to us in the Blood Bank so that we can make sure all of the proper testing is done prior to issue. The computer also sends a "fake" RhIg order to the pharmacy so a pharmacist can review the order (there is a lot of concern about the FDA classifying this as a drug), and so that it goes on the MAR so that the nurse can scan it in when she gets it. It was a bit of work, but it works well.
In Canada, Rhogam and WinRho are considered blood products, because they are blood products. They are not blood components however. From Rhogam product insert:
RhoGAM and MICRhoGAM are made from human plasma and may carry a risk oftransmitting infectious agents, e.g., viruses, and theoretically the Creutzfeldt-Jakobdisease (CJD) agent. The risk that such products will transmit an infectious agent hasbeen reduced by screening plasma donors for prior exposure to certain viruses, bytesting plasma for the presence of certain current virus infections and by using pathogenremoval and inactivation techniques during the manufacturing process. All of the abovesteps are designed to increase product safety by reducing the risk of pathogentransmission. Despite these measures, such products can still potentially transmitdisease. There is also the possibility that unknown infectious agents may be present insuch products. All infections thought by a physician possibly to have been transmitted bythese products should be reported by the physician or other healthcare provider in theUnited States to Ortho-Clinical Diagnostics, Inc. at 1-800-421-3311. Outside the UnitedStates, the company distributing these products should be contacted. The physician
should discuss the risks and benefits of these products with the patient.
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I am a big fan of the PeG (polyethylene glycol) autoadsorption technique. It is fast, efficient, cheap, and doesn't require any special reagents other than a routine PeG additive (we get ours from Immucor). The procedure (from the AABB Tech Manual) is attached.
We started using PEG autoadsorption this year and it has pretty much replaced doing ZZAP-adsorptions.
It generally works great!
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I'm not aware of any software that currently has a viable link to hospital customer inventory. Some development work has been done in this area and I would look at transfusionmedicinerfid.org to see some of the best work in this area.
Companies are still a few years away from having fully developed connections between blood centers and their hospitals. Ultimately any solution will have to work across platforms since a blood center cannot dictate to their entire customer base what software will be used.
Mak is used by a number of large, national blood center operations. One can speculate what that means in terms of usability. I know that the ARC has been many years in implementing their system. It may be more of a demonstration of what companies are willing to take on such an enormous task such as the ARC.
I've used Progesa both on the hospital and donor side in Canada a couple years back. There can be full integration of the 2. Not my favorite software but it works ok. I did see a demo of their newer version which appeared to be improved.
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A little off topic...but with the given scenario of a coumadin overdose, we would have not issued FFP but gave Octaplex or Beriplex or some other Prothrombin Complex Concentrate. Extremely effective at bringing the INR down for coumadin od patients.
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We bought the larger ones and holds 6 units and was validated for our use at 8 hours. They work great and are very popular.
Kym
We use the smaller "Golden Hour boxes" from Minnesota Thermal Science. Find the shell to not hold up well and since it is canvas, it does soil. Now brought in green boxes from thermosafe.com They validated wonderfully (when kept at room temp they stayed below 10 C for 6 1/2 days!!) and have a easily cleanable outside hard plastic shell
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We commonly see positive DATs in Group A patients post-IVIG. Eluates yield Anti-A. Some IVIG manufacturers now have disclaimers that their products can cause acute hemolytic reactions due to Anti-A in Group A populations. I have also seen it interfering with the backtype (on Echo analyzers). When we see the Anti-A in the plasma, we err on the side of caution and give group O blood, but usually only the patient's cells have the Anti-A from the IVIG.
Blood Bank Computer Software (this one? that one? no one?)
in Transfusion Services
Posted
I have used: Progesa, Softbank, Sunquest, Cerner, Meditech and a couple more I can't remember. For Transfusion: Softbank is the best I used and Meditech is by far the worst.