Marilyn Plett

We no longer have L/D but when we did, Heme performed all KB and would enter the patient results in the computer system. We would base our number of RhIG injections based on the result and the package insert.
As far as PT, the BB would get it first and perform the Fetal Screen. We would enter our results on the forms and then give the PT to heme to perform the KB. That way we both performed the portion of the PT we actually did in our departments. Since heme did the majority of the work, the department lead would enter the results into the CAP website. 
I agree with John. Some inspectors think if you don't do it the way they have been doing it,  you are doing it wrong. There are lots of roads to the same destination, but some are better paved.

Somebody was sure digging through the archives to find this one!  Glad to see.  This was probably one of my first posts.
To be honest, I don't remember if we ever went with the second type but I imagine we did knowing the corporate QA team at the time.  I do believe that anything short of a second draw is little more than smoke and mirrors to show compliance with some mandate.

I would just be a bit suspicious if say there was a + reaction with A1 cells and 4+ with B cells in an apparent group O - or vice versa; or very weak reactions in a young healthy adult.....a bit of common sense required, that's all

We are going to put a hang tag with a fluorescent green label on our pathogen reduced platelets using the language suggested by Cerus - FDA approved as a substitute for irradiated product, meets AABB requirements for CMV neg, etc. etc. I'm not optimistic about many people actually reading the education materials.

Just a thought.  With an issue like this you have to come to a point of realizing that you can only do so much especially when much of the process is out of your control.  You can drive yourself crazy playing the "what if " game!  Once you've done the best you can for your situation then accept that there will probably be a fallible human somewhere in the process who will come up with a creative work around.  A nurse will put a unit in the medication refrigerator until she's ready for it or they will put it back in the cooler in OR after it's been setting next to the patient during the procedure, just in case!  Accept that you don't have complete control and never will, you'll live longer!  

Back in the 70's, two patients with identical names and identical hospital ID numbers except for one number were in rooms across the hall from each other. The O patient received the red cells intended for the B patient. I discovered the error when I accidentally entered the wrong room to collect a transfusion reaction specimen and did my due diligence on patient identification. Subsequent new admission rules forbade having two patients on the same wing with the same name.
 

Back in the 70's, two patients with identical names and identical hospital ID numbers except for one number were in rooms across the hall from each other. The O patient received the red cells intended for the B patient. I discovered the error when I accidentally entered the wrong room to collect a transfusion reaction specimen and did my due diligence on patient identification. Subsequent new admission rules forbade having two patients on the same wing with the same name.
 

Back in the 70's, two patients with identical names and identical hospital ID numbers except for one number were in rooms across the hall from each other. The O patient received the red cells intended for the B patient. I discovered the error when I accidentally entered the wrong room to collect a transfusion reaction specimen and did my due diligence on patient identification. Subsequent new admission rules forbade having two patients on the same wing with the same name.
 

to be fair techniques in the early 80s were not what they are today, neither for blood grouping nor for antibody screening/identification.  Methods were not standardised.  The number of drops of serum (almost always serum) to the amount of red cells could vary from 2:1 to 8:1.  The concentration of the red cells could be anything from about 2% to almost 10% - and often pooled. And pooling was one of the main reason for checking under the microscope.  Incubation time varied too - often depending on the length of your coffee break or lunch break.  LISS was in its infancy.  Washing was done by hand or with a 'Coombs washer' - 3 or 4 washes, with or without albumin.  So perhaps not surprising that people were not too confident in their visual results.  Much less knowledge then too about what was and what was not clinically significant.  (I can remember when we treated cold anti-A1 as clinically significant)
Thankfully since those dark ages things have improved massively - but sometimes some of the old habits stick - like using a microscope to read apparently negative results.  The practice lives on  (in some places) but the reasons for that practice died out long ago

I have never understood this obsession with looking at reactions down a microscope in blood bank, except looking at things like a Kleihauer or when teaching, to show mixed-field reactions.
The great Peter Issitt, not a bad roll model to have, wrote, many years ago now, a passage that I attach from page 69 of his "Applied Blood Group Serology" book, 3rd edition, 1985, Montgomery Scientific Press.
That having been said, all reactions seen MUST be recorded, it is just that macroscopic reading is almost all that is ever required.

I had always found it difficult to convince nurses that we were working with a person/patient and not a room/bed!  This became even more difficult after all the privacy rules and regulations came about.  It was almost as if they were terrified to say a patient's name aloud!

Beyond any shadow of a doubt - personnel will always be the greatest challenge.  Not enough, not well enough trained, will they follow the SOPs (in spite of the continuous Competency - truly a pain!), will they show up, will they get along with each other...........
Be prepared for that challenge and take advice from a good manager, if you are blessed with one.  Always consider that mistakes may stem from a misunderstanding of what is written in the procedure or the procedure might need a tweak to eliminate a "process" problem.. Approach mistakes from the point of view - "Is it a process problem?  Can someone else make the same mistake?" before you go after the person who made the mistake.
As someone said earlier - get familiar with the standards of whatever inspection organizations you will be responsible for.  Read all of your procedures with those standards in mind and line them up.  That will make inspections so much easier and always gives you a "reason" if you have to change something.
Keep your sense of humor and be adaptable.  Nothing will stay the same forever - change comes along frequently and you have to roll with it.  Make friends (with distance - not "buddies") with your techs - stay friendly with other techs in the Lab and make friends with other administrative personnel - you will be on the front lines with other personnel in the hospital more than other Lab supervisors - think ER and OR.
Best of luck.
 
 

A new tee shirt I gave myself for my birthday.  I should have had a shave and lost about 70lbs first, but hey!

Congratulations, Malcolm!  "For he's a jolly good fellow ... that nobody can deny!' ... so the song goes!

There is absolutely no scientific or clinical reason that a vaccine could not be stored with frozen blood components.  That doesn't mean you won't get some overly officious inspector who will decide it's a bad idea.  But currently there are no regulatory or accreditation issues that I am aware of.

Congratulations!

Ok, here we go.  First is from a personnel stand point.  When promoted from with in you are no longer "one of the guys".  This means that some of the staff will try to leverage your close friendship which in turn will cause problems with others.  Both you and the rest of the staff need to recognize that things have changed on a personal level, at least in the work place.  This does not have to be dramatic and should not be, but it is real.  Some can do this and some find it very difficult.  Now, when coming from outside your are exactly that, an outsider.  Now the level of this can vary immensely depending on the situation.  One time when I changed facilities it was just across town and I new many of the staff at the new facility so a lot of the unknowns were minimized.  On the other hand, I also moved to another facility out of state and pretty much walked into an unknown from a staffing standpoint except for what little I could glean from the interview.   As I noted in my previous post, be very judicious when using the phrase, "this is how we did it."  I've had new employees who would say this at every opportunity and then go into detail about how we were either doing it wrong and that their way was just much better.  This became very trying to everyone else on the staff and we finally just tuned them out.  Because of that we probably did miss out on some good ideas.  One last point, in either case be aware of any others staff who may have either applied  for the position or simply been over looked.  Depending on their personality they can either be a great help or a significant hinderance.  Do everything you can to get them involved and engaged.  They can be your greatest asset but it may take a little extra work on your part.  For me, the personnel issues were always the most difficult. 
I'm assuming that you are new to the lead position and not knowing your previous experience here a couple of generalizations.  Unless something is an obvious hazard to either patients, staff or the ability to pass an impending inspection/assessment don't be in a big hurry to make changes.  As they say in the military, you need to understand the lay of the land.  Become familiar with the blood bank/transfusion service medical director and let them have the chance to become familiar with and confident in you.  They can and should be your greatest allies.  Ultimately most of what you want to change will have to be approved by them.  You need to understand the current processes before trying to change them.   At one of the facilities I moved to I noticed that many of the staff were not following their procedures "to the letter".  The way I dealt with this was at the monthly staff meeting we would go through a procedure as a group, line by line and I would ask the questions, "Is this how you are really doing it?  If not, why not and how are you actually doing it?"  This is when I would make suggestions for changes and generally a lively discussion would ensue.  It took quite awhile to go through the procedure manual but by picking, what I considered the most important  one first it was time well spent.  
This is getting a little long so I'll end with how I described my position as Transfusion Service Supervisor at a 350 bed level ll trauma center.  My job was to provide the staff with the tools (equipment, knowledge, material and support) for them to do their jobs at the highest level possible.  All this while keeping the dragons (administration) away from the door.  Good luck and if I can think and anything else that others may miss I share a few more golden nuggets of wisdom with you.  Above all else have faith in your self.  
     Wow I think that's the longest post I've ever made. 

Maintaining enough staff.  Too many people use a large facility as a stepping stone to another job for more money.
Having Senior Management understand the difference between a Blood Bank and Clinical Lab - we're not the same.
Maintaining inventory.  There is always a shortage of something.
Competency Assessment - huge pet peeve of mine.  You go to a talk by _____________ and hear them pontificate on how we all make competency assessment so hard on ourselves.  Then say something silly like, all you need to do is watch them do a _______ proficiency testing sample, they will be processing regular samples at the same time.  They'll do equipment maintenance, QC, and result entry.  See, it wasn't that hard...  Drives me nuts.  In reality that never happens, we have 40 other staff we need competency for and obviously we can't share the PT sample.  And then the Joint Commission wants competency every 365 days +/- 30 days.  For a lab our size, it takes a tremendous amount of time.  Sorry, this really does drive me nuts with the inspectors.

To this I will add, pick your battles carefully.  Make sure they are worth fighting.  If you came from outside the facility be very judicious when using the phrase, "The way we did it"!  Changing something to the way you did it else where is not necessarily a change for the better just because it makes you comfortable.  Make sure you understand your new facility's processes before trying to incorporate sweeping changes.  As I noted above, much of my advise would depend on if you came from outside or promoted from within.  This is just one golden nugget for you to consider.  

I do enjoy simple and practical.  We have a tendency to over complicate just about everything!

I don't believe that an optical aid necessarily refers to a microscope. In my pre-retirement years we used the agglutination viewer when an optical aid was required. Example: https://www.fishersci.com/shop/products/fisherbrand-tube-agglutination-viewer-5-watt-bulb-w-magnifying-mirror/22363560

Very proud to have received this through the post earlier this week, to go with being elected to Fellowship of the British Blood Transfusion Society earlier this year.

Inspectors are like a box of chocolates, you never know what you are going to get.
I tend to agree with those who put forth do what you are comfortable doing for validation and/or QC.   If you, your staff and pathologists are ok with your process then an Inspector (AABB or CAP) can have an opinion but they cannot tell you to stop or defend a deficiency.   If your documentation has merit then you have a strong case of how you use your expired red cells or antisera for the care of your patients.   We all do the best we can with what we have to work with.
 

Couldn't agree more, particularly, certainly in my own experience, many inspectors have a minimal amount of experience in the field (particularly Reference Laboratories), but feel they have to comment to justify their employment, even though they don't actually understand or know what they are talking about; not all, but far too many.

One thing I discovered in my many years as a Transfusion Service Supervisor is that inertia is the most powerful force in the Universe!  Trying to initiate change, especially in blood banking can be extremely difficult, often impossible.  Pick your battles carefully and make sure they are worth fighting.  Good luck.