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BBK710

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  1. Like
    BBK710 reacted to pbaker in Non cellular component transfusion and historical ABO/Rh   
    We always require an ABO/Rh for each admission, just in case someone else is using that patient's information.
  2. Like
    BBK710 reacted to mollyredone in Training new employees   
    Ditto what AmcCord and Tricore said.  The medical director's name is on every result.  If he/ she is unconcerned that is a very bad situation!
  3. Like
    BBK710 reacted to ANORRIS in Training new employees   
    Document everything...and get rid of him...
  4. Like
    BBK710 reacted to AMcCord in Training new employees   
    We've had some struggles with employee performance (though not for lying recently, thank goodness!). After we discussed the issue  among section supervisors, we came up with a form that documents what the area of improvement needed is exactly, what is expected of the employee to correct the problem and when we will reevaluate for improvement. The employee has the opportunity to specify what he/she needs from us, in terms of education or retraining, to be successful. He/she them is asked to sign off on the plan. After the specified period of time, the employees performance is reevaluated and that is documented on the form in as much detail as needed. We state whether or not performance is satisfactory. That way we have all the details for HR, if it comes to that. For some of our employees, just putting them on notice that they aren't working up to standards by using the form has worked wonders. It may not work for your guy, but at least you've got it in writing.  Management can't say they weren't told. Scary situation. I agree with tricore - you have to document in great detail and definitely involve your Medical Director, if you can.
    Opportunites for Improvement.docx
  5. Like
    BBK710 reacted to tricore in Training new employees   
    Document, document, document. I have had several employees who were hired by the evening shift and expected to work in blood bank (generalists) who were totally unsuitable to work in blood bank. Fortunately management listened. It helps to have a very involved Medical Director.
  6. Like
    BBK710 reacted to tbostock in Checking alarm activation temeperatures   
    I validated the electronic probe activation to ensure that it works properly. For the platelet incubator, we do check with warm and cool water as recommended by Helmer. The trick is to use water temp that is just outside that range so you get the gradual increase and decrease needed to be able to pinpoint when it alarms. There is also a setting for the threshold alarm that you may have to adjust to get the testing to work (for example if it is set not to alarm until the temp is above 24 for 5 minutes, you'll have to adjust that so that the alarm activates immediately). The manual shows you how to adjust that.
  7. Like
    BBK710 reacted to tbostock in QC on Panels   
    John makes a good point above, that if you are going to do QC, then you need to make sure each panel cell is testing with both a positive and a negative at least.  For example if you are using a diluted Anti-c as your QC material, you are only proving that the panel can detect Anti-c.  Any antigens that are only on the c negative cells on that panel are not being tested at all.
     
    In the true sense of QC, you're not just making sure some of it works, you should have to prove that it can identify each antibody.  Which is just crazy talk. 
  8. Like
    BBK710 reacted to Teristella in QC on Panels   
    We don't QC panels unless they are expired. If they are quoting the standard above, I'd point out that antibody detection methods are QC'd, since we do daily rack QC (or ECHO, or gel). That standard says nothing about antibody identification.
  9. Like
    BBK710 reacted to Dr. Pepper in Returning FFP not used   
    I agree with Terri. For years, AABB indirectly endorsed the 30 minute rule in the Tech Manual with a passage that read something like "Many facilities use a 30 minute limit....." but they dropped that a few editions ago and now want you to take the unit's temp. The 30 minute rule has to date back from the whole blood bloated bag days; if you try this yourself with a mock or outdated unit of packed cells you'll find it's more of a 15 minute rule at best. An inspection or two ago, I asked about the no-win situation with FFP, and they basically said you're screwed, it has to come back <10o, which is rather tough when you issue it straight from the waterbath.
  10. Like
    BBK710 reacted to tbostock in Returning FFP not used   
    There is no 30 minute rule. You have to accept returned products based on valid temperatures instead of time, unless you have validated a specific time. For example, some BBs have validated it themselves and found that after 10 minutes, it's out of range. It's way out of range by 30 minutes, so you may want to re-evaluate your process.
    As far as FFP, since it goes out warmer than red cells, you can almost never get them to be in range for return. Platelets, as long as they are 20-24 and you do a visual inspection, you could have it in your policy to return them according to certain criteria.
  11. Like
    BBK710 reacted to AMcCord in Daily QC for DAT and weak D test?   
    We QC the anti-C3b, -C3d on every day of use as required by standards (this is not a reagent we use every day). As David says, a positive and negative control are done for QC. We use a drop of Coombs Control cells for the negative control and a drop of Complement Control cells for the positive control. With the patient we run a saline control. For Weak D testing we run the Monoclonal Control as recommended by the manufacturer of the antisera.
  12. Like
    BBK710 reacted to AMcCord in Warm Auto's and the "New Insurances"   
    Speaking with our small neighbors in mind (and a few not so small), many of the small facilities probably don't have a technical supervisor with proficiency in these kinds of methods, much less maintaining staff with competency. Many have such a tight staffing situation that just doing a basic antibody ID is stressful (it can be a stressor here if it's a busy day). In fact most of our small neighbors don't do any kind of antibody workups - if the antibody screen is positive or the crossmatch doesn't work, out it goes to the reference lab. I know of quite a few facilities that don't even do moderately complex antibody IDs. They don't keep the antisera or multiple ID panels on hand to do them as a cost cutting measure. Reagents for advanced methods aren't even on the radar screen. I don't keep DTT, though I do have WARM and chloroquine. I'm the only one that uses these methods - keeping other techs proficient would be very difficult/expensive with the volume of special testing we do. The money crunchers may take that away from me before too long. The only reason they haven't up to now is that we are a long way from our reference lab, though our transport options have improved.
     
    It's not just the cost of reagents, either. You have to have surveys, if they are available. Those can be very pricey - I'm thinking that the elution survey alone is $800ish per year. If you don't do surveys you have to have some other way to prove you know what you're doing - like sending a split sample to a reference lab a few times a year. That could be even more expensive than a survey. 
     
    If your patient is a Medicare or Medicaid patient, you aren't getting reimbursed now. Their diagnosis (DRG) is worth a pre-specified amount of $$$. If they have extra expensive tests done, too bad for your hospital...no more money. Most insurance companies are following the same game plan.
     
    So, after rambling on, in answer to your question, if you don't have much volume for these kinds of tests, it is not cost effective for your lab to try to do them. If you do have the volume, it may still not be cost effective. If you don't have much volume, its probably better (safer) for the patients if your lab doesn't try to do them.
  13. Like
    BBK710 reacted to Malcolm Needs in Ruling out Kell with Heterozygous cells?   
    I am going to be REALLY unpopular here, but I'm going to say it anyway (because I am a pedant)!!!!!!!!!!!
     
    Antigens CANNOT be either heterozygous or homozygous; only genes can be heterozygous or homozygous.
     
    An antigen can be described as either showing homozygous expression, or heterozygous expression.
     
    That having been said, is a red cell sample that types as K+k- phenotypically, genotypically K/K or K/Ko, or even K/k, with a mutation within the Kell gene that prevents the k antigen being expressed and detected with all anti-k grouping reagents (just in case anyone doesn't believe me - we had one!).
     
    That's got that off my chest.
     
    Now then, there is NO doubt that there are some anti-K's around that only react with K+k- red cells (dosage), but they are fairly rare, however, how many people use antibody screening red cells that are K+k-?  I doubt if there are any.  Therefore, we are all ruling out anti-K using red cells with apparent K antigen heterozygous expression on every single sample that (apparently) has no atypical alloantibodies present.  Am I wrong about this?
     
    It follows, therefore, that, over the years, there MUST have been occasions when a patient with a very weak anti-K (one that is only detected using red cells that are apparently showing homozygous expression) and who has been transfused with K+ blood (do the maths).  As far as I know, there are no papers within the literature that report a case of either a delayed or an acute transfusion reaction as a result of this.  Yes, this may cause the anti-K to become stronger (and, hence, be detectable using an apparent heterozygous red cell sample showing K+k+ expression), but then, if this happens, you give K- blood.
     
    So, my considered answer is that you can exclude using K+k+ red cells.
     
    I shall now go and lie down!!!!!!!!!!!!!
  14. Like
    BBK710 reacted to jayinsat in Second specimen when there is no historical Group & Type   
    We do the same as DOGLOVER. However, i've always disagreed with the exclusion group O patients. I believe they should be retyped as well in case FFP is required. I realize the probability of HTR is low from incompatible plasma transfusion, yet I would still hate to give O FFP to a non O patient that was mistyped as O due to an identification error.
  15. Like
    BBK710 reacted to AMcCord in Second specimen when there is no historical Group & Type   
    We do not charge for a 2nd type - it's part of the cost of doing business.
    CAP TRM.40300 Historical Record Check says "If no record of the patient's blood type is available from previous determination(s), the transfusion service should be aware that there is an increased probability of an incorrect blood type assignment and, consequently, of a hemolytic transfusion reaction. If a laboratory collects an additional sample for the purpose of verification of patient identity, a repeat antibody screen need not be performed on this specimen."
    CAP TRM.40670 ABO Verification (Computer Crossmatches) "The recipient's ABO blood group has been verified by repeat testing of the same sample, a different sample, or by performing a historical search of laboratory 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."
    So, since you are not doing a computer crossmatch, CAP does not 'require' a second sample. If you are doing a computer crossmatch, you have options other than a second sample, but those options are going to be pricey.
    Since your concern seems to be safety, look at how your facility IDs patients, how many admitting errors or fraud cases (patient admitted under someone else's name), who draws samples, do you have control over the collection process, how well can you enforce the rules of patient ID at the time of collection, how many 'wrong blood in tube' incidents do you see, etc, then decide what gives you the most secure, safe process. Lots of variables. The answer may or may not be a second specimen.
    I think the day will probably come when the 2nd specimen will be required if you don't use a digital bedside ID system. I don't think that's an absolute solution to the problem, because that requires that there is never an admitting error/fraud that puts the wrong ID band on a patient's arm. And it also requires that people faithfully and carefully ID their patient the old fashioned way every time a sample is drawn and blood is given, not blindly zipping that barcoded armband and calling it good. But what do I know.......I'm just a blood banker. Actually I do have the answer. We all should all get a computer chip inserted in the scruff of our necks, like we do for our pets!
  16. Like
    BBK710 reacted to David Saikin in KB stain   
    I am insanely jealous - I keep trying to get one of those but it is futile.  That is the way fetal bleed calculations should be done.
  17. Like
    BBK710 reacted to Dr. Pepper in Blood Bank Heat Block   
    I was taught a bit ago (well, in 1972) to touch the top of the heat block as you put your tubes in. Not quite a thermometer, but at least you know it's plugged in.
  18. Like
    BBK710 reacted to tbostock in Refrigerators in Surgery   
    I'm opposed to it. A few Joint Commission inspectors have mentioned to me over the years that they have removed many from ORs and they were glad to hear we didn't have one.
    I agree that if this is a done deal, to try to have continuous monitoring on the equipment with temp indicators on the units. Having an electronic method to monitor the temp of that equipment would be preferable to taking manual temps every day.
  19. Like
    BBK710 reacted to Dr. Pepper in Bit of a rant....   
    Auntie and others, we share your pain. If I may add to the list of pet peeves:
     
    1. Starting weekly temperature discs on fridge/freezers on the wrong day and/or time. Then 5 days in a row 5 different techs document that the scribe is OK.
     
    2. Not recording medical record numbers and dates on panel scoresheets. Record keeping in general.
     
    3. Not printing copies of panel scoresheets on both sides so you get the extended antigen typings on the the back. Not changing the scoresheets when you open a new panel lot.
     
    4. Filing QC records etc. with bloodstains (hopefully reagent but you never know) all over them.
     
    5. First cousin to the above: finding blood all over the counter, centrifuges, agglutination viewer, outside of the biohazard bin, drawers or cabinets, making you wonder if a worker had been shot or merely had sneezed violently during a torrential nosebleed.
     
    6. Discarding packing lists from the blood center so I have to get copies to check the bimonthly bill. Happens pretty much each cycle.
     
    7. Finding obviously broken thermometers, pipettors etc. in place. Whoever broke them knew they had done so but decided to keep it secret..
     
    8. Not telling you when the last kit, vial, package, bulb or box was opened so you might have a ghost of a chance to order more before you run out.
     
    9. I put out a half dozen pens and markers a week. Where do they go? Even if we supply the whole lab we should have reached the saturation point decades ago.
     
    10. A tech asked me if it was OK in a pinch to just use one drop of plasma/serum per tube for an antibody screen; another tech had told him that was fine if you didn't have much sample. This was right before last year's competency eval, so I included that as a question. 5 people said it was OK. So we had a little inservice on the value of following the manufacturer's directions, our own P&P, and the need to validate any variations in protocols etc before you do so. I heard a great line a few years ago that went something like "Ignorance ain't what you don't know; it's knowing too many things that ain't so!"
     
    Thank you, I feel better.
  20. Like
    BBK710 reacted to tricore in Why we do not have Micro in the Blood Bank   
    I don't mind a microbiologist who doesn't know much about blood bank. I certainly don't know much about micro. I worry when the people who are working in blood bank don't have basic BB knowledge.
  21. Like
    BBK710 reacted to tbostock in Why we do not have Micro in the Blood Bank   
    Yes, I'm surprised at how many in the Lab don't understand Blood Bank.  But then again, I've been in the BB for 28 years...so please don't ask me a Micro question.  
  22. Like
    BBK710 got a reaction from AMcCord in Nursing orders to transfuse   
    Currently we require that nursing documents on the blood request card that they have verified the physician order to transfuse. We only crossmatch units if there is an order to transfuse. We do not "hold" blood for anyone except the OR and those units are not issued to anyone but the OR. If they are to be transfused post-op we require the physician to place a new order to transfuse. We are in the process of creating a nursing order to transfuse that will print in the blood bank so that we know there is an order to transfuse.
  23. Like
    BBK710 got a reaction from tbostock in Nursing orders to transfuse   
    Currently we require that nursing documents on the blood request card that they have verified the physician order to transfuse. We only crossmatch units if there is an order to transfuse. We do not "hold" blood for anyone except the OR and those units are not issued to anyone but the OR. If they are to be transfused post-op we require the physician to place a new order to transfuse. We are in the process of creating a nursing order to transfuse that will print in the blood bank so that we know there is an order to transfuse.
  24. Like
    BBK710 reacted to tbostock in CAP TRM.31450 Comparability of Instrument/Method   
    I joke that I do this correlation to prove that the methods don't always correlate.
    I don't hand pick strong ones, I just randomly pick some positives and run them on Tango (solid phase), gel, PEG, and LISS. If they don't all agree, I explain why...the apples and oranges thing. In BB, if there was a perfect method that detects everything, we would all be using it, wouldn't we?
  25. Like
    BBK710 reacted to R1R2 in CAP TRM.31450 Comparability of Instrument/Method   
    I agree with dlb, this is a complete waste of time, don't overthink this.
    R1R2
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