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Everything posted by jcoburn
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PM's are included in contract. We use Rely-ON and our saline is regular(non-buffered) blood bank saline from Fisher Scientific. We have had to replace the probe and our service rep did replace a probe sensor once and the drive belt for the probe once. I haven't had any other problems. Sure saves me a ton of time. (can time be measured in tons???)
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We've had the Echo for over two years and have had none of the issues you mention. This has been one of the most reliable instruments in the lab. Other than PM's hardly ever see service.
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Too much machine for our needs. We have our little Echo and are quite satisfied.
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As many have stated, mistakes happen. I still contend that the dishonesty purported in the original question cannot be tolerated. No manager worth his salt would sit still for staff falsifying results. That is not a mistake, but a deliberate action. The person should be brought up before whatever review board has certified this person's competency so that his/her license can be revoked.
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Any scientist who falsifies results, even once, will not work for me. That instance should be documented and if substantiated is grounds for immediate dismissal. No amount of training or retraining can correct character flaws. Dishonesty cannot be tolerated on any level in the laboratory (hey, we're not lawyers or politicians) the blood bank should be especially scrupulous in this matter, but you don't have to know blood bank to manage this type of personnel problem.
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All these new techniques: Super glue, WD40... and I thought the Antifreeze (PEG) technique was the epitome of tube testing in the BB. Boy do I have a lot to learn after only 25 years in the laboratory. Never too old to learn new tricks...not this ol' dog!
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Malcolm, Could you fill me in on the Super Glue Technique, I couldn't find it in the Technical Manual. Do you use it INSTEAD of AHG, or is it a potentiator? (sorry, couldn't resist...):sarcastic
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First off: It is impossible to make ANYTHING foolproof, because fools are so ingenius! That said, all you can do is document on annual competencies that the staff member attests to the fact that they have read and understand the SOP's. I find that including an index of the manuals, with a space to initial as each one is reviewed will work, but you still have to keep up the documentation. If you do stumble upon a "foolproof" way, please let me know.
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We are an outpatient laboratory so no transfusion service, mostly OB panels. Our Echo has been operational for ~ 18 months and has saved me a full CLS FTE. This was one of the best decisions I made for our laboratory. Lab assistants do the routine maintenance and load the machine. Scientist spends minimal time (10-30 minutes/day, depending on experience) verifying QC and patient data. Voila! 30 OB screens completed! Clinicians are happy, my CEO is happy, I'm happy, and most of all, my board of directors is happy!
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Guess everyone can't have our Immucor rep, she is GREAT!
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We also use the Echo. bbbirder is correct, no single system will detect all antibodies. I evaluated gel many years ago (before provue) and found examples that were detected in PEG but not by gel. In this go-round, the decision to use the Echo rather than Provue was economic. We are happy with the Echo. Our volume has increased to the point that I would have to add an extra FTE were it not for the Echo. My experience with the Immucor customer service is that they are responsive and available. I have no regrets with my choice of the Echo for our operation.
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We have the Echo and run the WB control once per day of use for group and screen. We only do the weak-D control if the assay is used on the machine that day.
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Great information, Thank you.
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We export results to our Orchard LIS. I wouldn't have it any other way. The potential for manual transcription errors is just too critical not to take every available oportunity to reduce that potential. 100 years ago*, when I was a fledgling blood banker, my mentor told me that 90% of the errors in blood bank are clerical in nature. I think that remains true to this day. Why tempt fate? * may be a bit of an exaggeration.
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Sorry, I guess I misled you. L106 is correct, Immucor supplies a very well thought out validation guide. This makes it extremly easy to write your plan: basically the plan is to follow the guide for each function that the facility utilizes. If the performance is as expected, that function is validated. L106's response is correct, our rep was very helpful in getting us examples to model our "plan" after. It ended up being just a couple of pages. Hope that your rep is helpful, too.
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Immucor's validation plan is very complete as it comes from the manufacturer. You may have to tweak it a little depending on your circumstance. (We are very simple, primarily obstetric patients so we didn't have to add anything, just delete the many options that we are not using). Good luck!
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While I agree that the attending clinician is the ultimate interpreter of the data that laboratories provide, I think that we, as scientists, have an obligation to make sense of the data before we report it. We cannot just blindly take results from machines and report them (lab assistants can do that, no need for a CLS). On the other hand, while obtaining specimens during transfusion is not optimal, John is correct: other than H/H, little else would be significantly affected. The need for data may well outweigh the risk. Give the clinician a clear picture by attaching the "collected during transfusion" caveat to the results.
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There is a lot to be said with staying within your comfort level, but there are trade-offs, too. Like John, we have the Echo and it fits our needs very well, but we were manual tube before so we had no vested interest in any particular platform. There is a bit of a cost/test difference but probably not enough to be the primary impetus for selection (although I've heard that recent price increases by "some manufacturers" might negate the validity of that last statement). Watch out for maintenance contract charges: Ortho wanted twice what Immucor quoted, but maybe their instrument requires more service?
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I have had a couple of instances of inconsistant antibody ID's with the Echo. One, an apparent Jka, could not be confirmed by our reference lab, but could not be ruled out, either. Another that I just encountered yesterday had a 2+ pos on one screen cell, but the ReadyID had no reaction at all. Extended panels had several cells positive, but no panel. I've asked for more sample (outpatient) but I suspect our reference lab will not find anything! I've also had 2 other samples which "screened" positive, but ID'd negative. Reference lab screens were negative in both cases.
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Immucor provides a very thorough validation template for the instrument/methodology. It would not be difficult to expand on that validation to include serum vs plasma studies. You could even use the same comparative method templates that Immucor provides. I created my own spreadsheet in excel, patterned after the Immucor template, that automatically calculates true pos/true neg/false pos/false neg and correlation percentage. I plug my reactions into that, attach the print-outs from the Echo and copies of the manual (reference method) results. If I finish my procedures this weekend I'll be tubeless (well, almost) next week! Hooray!!!
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Mark, we have an Echo here at Central Coast Pathology in San Luis Obispo. What do you want to know?
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TRM.41350 (label or tag must remain attatched during txn)
jcoburn replied to tracylab's topic in Accrediting Agencies
I wrote a Meditech label application which produces a gummed label that includes all of the required data. Patient Name, blood type, medical record #, Donor number, blood type, expiration date, compatibility statement, date of crossmatch, etc. I would be happy to help you with this, contact me @ jcoburn@ccpathology.com -
I am interested in your report of false positives. Were these antibody screens that had no identifiable antibody with a panel? or screens that were not positive by some other method? We have all encountered method-dependent antibodies as no one method will detect all antibodies in all circumstances. Most times I would rather have a false positive than a false negative, even if it results in extra work missing an antibody could have far more significant sequelae. jc
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I'm happy to see this thread evolve. We will be installing an Echo in February. I looked at the ProVue and manual gel as alternatives to our current tube testing, but manual gel still requires a great deal of hands-on time and the Provue is more expensive and slower than the Echo. Also Ortho wants twice as much for a service contract! According to my last e-mail from Immucor, the instrument will be installed on Monday, Training on Tuesday through Friday and then we're ready to start our validation. Hopefully, it won't take too much time since we are a commercial lab and do not do any transfusion medicine, only T/S, DAT, ABID. The reason I even looked at automation? there is such a paucity of scientists that our only alternative is to automate! I look forward to watching the progress of the other new ECHOites here and I will try to keep you apprised of our progress as well. John, have you finished your validation? How'd it go?