LAS

This process may be too specific to our workflow and our volumes but: QC is scheduled to be run at midnight, 0800, 1600, and everyone knows that When techs run QC, we have a "canned" text comment they can drop in that says "No patient results were reported until acceptable QC testing was performed" or something like that. We're then covered if someone was late. I spot check for compliance and this seems to work OK for us. On the very rate occasions that I find missed QC or late QC with patients resulted, the tech has to review charts, meds, histories, etc. to determine if all of the results that were reported since the last acceptable QC was documented were consistent. They usually only have to do that once to get the message.

We are version 6.15 in Meditech and currently use TAR for almost all transfusion documentation. I find review fairly easy, but we have a real bull dog of an RN in our IS dept who did a great job building it, and assumes total ownership of it. Documentation outside of TAR (in nurses' notes, in "vitals" section, etc.) is not considered compliant for non-emergent transfusions. (Vitals entered in TAR do flow to the "Vitals" section of the EMR however). Nurses are prompted at the correct times and each timed entry includes a section asking if s/s of transfusion reaction are observed. She has included a 30 min post transfusion vitals check within the TAR record. I review a sampling throughout each month and forward minor exceptions to dept nursing leadership; I submit Report of Events for significant exceptions. Aside from checking for transfusion orders and labs, most everything else I need is included in the TAR documentation. How TAR is built in OM determines how much info is available in it. Don't get me wrong, I spend a considerable amount of time in the EMR sleuthing out why we transfused someone who didn't appear on the surface to meet criteria, but that is not the fault of the TAR documentation.

We are Meditech 6.15. The "Edit" tab on the Specimen desktop allows you to edit via a "BBK Specimen Expiration" selection in the pop up box. As with all the Meditech versions after Magic, there are usually several pathways to the same function, but this is what I have gotten used to. If the option is not available, there may be a setting in the Lab Access dictionary that has been set to make this option unavailable.

Nope; we correlate high/low platelet counts with smear. If clumping is present, we have a canned comment we drop in advising that platelet clumping was observed and the actual count is probably higher than reported.

Same here - transfusionists have list of symptoms; if any are noted, they stop the transfusion and notify the BB. Workup is performed and reported to the Medical Director (or on call pathologist) who makes the decision to continue transfusion or not. The patients' physicians cannot override that protocol. Unless patient's condition is such that immediate intervention is required, the BB is the first call, the physician is the second.

No that is not true, at least in my Hospital. Each unit is entered (can be scanned) into inventory upon receipt and everything that happens to that unit such as a retype, crossmatched to whom, issued to whom, returned to stock, re-issue, transfusion, etc. file to the unit record. There is an option for BBk unit inquiry, key in the DIN and all the info is there. Look backs couldn't be easier.

We have Meditech 6.0, but we own all things Rhogam related. Our pharmacy does not want it.

Our policy is DATs on infants of group O moms, Rh neg moms, or infants of moms with antibody history. We recently impleted a cord hold policy similiar to Liz H above.

We switched to the Typenex brand because it was less expensive. Of course we must go through a purchasing group and the Typenex brand was cheaper than the Hematype for our group. Most of our techs like them as well or better, and the others don't care which ones they use as long as they have them. Switching over was a non-issue here oddly enough - you know we laboratorians, any kind of change is a big problem for us

OMG! That reminds me of once long ago I was called to the E.D. for a draw. The patient had been hit by a train and was just a mess - deceased of course. I was advised to draw a blood alcohol from the heart. An EMT was there who had just had a class in drawing from the heart post-mortem and couldn't wait to jump in. With the physician's approval, she jumped in all right - with a giant syringe, a needle unlike anything I had ever seen before, and just jabbed in and out over and over until she finally "found" something. Gruesome!

We always determine what blood type is issued, never the physician. In my hospital, we do not post any type of compatible blood product guidelines in our E.D. since they do not order transfusion by blood type. If someone is interested, we can chat with them or refer them to various users' guides, but typically it is handled on a case by case basis on the rare occassion that someone has a question about differing blood types. Fortunately they either order a crossmatch or ask for an emergency release unit, and then let us do our jobs. They want no part of this decision and are more than happy to leave that part up to us

We do type/screen and issue Rhogam when complete. If the patient cannot wait, she can return up to 3 days later and still receive the injection. We do not armband these patients. Frequently the docs send the patients over for a gestational diabetes screen at the same time, so they are here for a while anyway.

I used to work with an old phlebotomist who, when disgusted with men, doctors, nurses, teenagers, etc. would announce: "put 'em in a tow sack and dump em back out; they all come out the same." Not sure exactly what she meant, but it always seemed appropriate at the time

Our reaction form is created in a flowchart manner; if certain tests are positive, then other tests are done. Our procedure lists those tests and under what circumstances they are to be performed. Other comments in the procedure itself allow for futher testing as deemed necessary by our pathologist. The pathologist of course, "signs off" on the procedure.

We issue products at a window in our blood bank with a clearly visible doorbell in case no one happens to be in the room. Everyone in the hospital found a way to simply ring the bell if they needed us, except for one nurse. She would come to the window and whistle... dog whistle. Yes, she would come and whistle for one of us to come and take care of her. We would ask her to just ring the bell and the next time... whistle. The last time she did it was when I happened to be in the next room, heard it, saw two techs prepare to go fetch, and told them that when they started drinking their water out of a bowl, they could go when she whistled. Well what do you know, she walked into the next room and I calmly looked up, feigned surprise, and asked her if we could help her. That was the last time I heard her whistle. P.S. Rumor has it that she got fired for flashing a patient. Not sure if it is true or not, but honestly I would not be surprised.

We use the PFA and use canned comments as well.

Yes, someone in our pathology group is advised 24/7 of transfusion reaction workup results, even if negative.

That's very interesting. Thanks for the information, Linda. (Do you have any idea exactly who would be responsible for obtaining and keeping a file of these CLIA certificates? Perhaps the hospital's Compliance Officer??)

We are a smaller facility and have only 3 physicians who order irradiated products. We do tag the patients in our system, but still require that the orders specify irradiated products. If they do not, we have the luxury of being able to contact one of those three doctors and clarify the orders. Were we to decide to take ownership of that process, it would be necessary for us to have some sort of formal written agreement approved by our medical director and our medical executive team. It is not something we would take on ourselves, but now that I have read the posts I can see how helpful that would be in some situations. As always, thanks to all the posters out there. You guys are great!

We do not yet have electonic recording of transfusion reaction workups for nurses. They are required to notify the laboratory immediately upon suspicion of a reaction, and the paper form that they complete indicates what time the transfusion was stopped and what time the laboratory was notified. After we received notification, if appropriate paperwork is not received in a relatively short period of time, we request it. We audit every chart that has a suspected reaction and fortunately have not detected any problems with excessive delays in notifications. We consider this a STAT procedure, so in my opinion it would be absolutely appropriate to set some type of standard.

Agree with Donna.

Lara - please do keep us posted on the 6.0 conversion. We are looking at it as well.

One word of caution - be sure that it is barcodes on the patients that are being scanned. We have problems at my institution because barcodes are used for other applications also (billing, misc record keeping, etc.) and are available in many forms/locations. POC nurses simply take their glucose meter, scan a barcode on a chart at the nurses station, go into a room and perform a test.

We have found that when people outside the lab ask about TAT, they typically mean order to result time. We have fought the battle of receipt time as well, but it was a losing fight. We are able to break it down into segments: order to collection, collection to receipt, etc., but to the person that is asking, a request for TAT data generally means order to result time. ( I so agree with the comment above stating that TAT for the physician is from the moment he thinks about ordering it)

If the patient is an in-patient and we know that he has not been transfused since the antibody was ID'd, we do not ID it again. We crossmatch antigen negative blood (AHG) and transfuse. If the patient has been transfused since the antibody ID was done, then we would perform antibody ID again. If the patient is an out-patient, we ID every time. We have generalists, pool, and cross-trained staff members and for us, this is the most straightfoward way to handle this.