Vaatha

What was the DAT result? If it was weakly or 1+ positive, you cannot accept the Rh result. At our facility, if the mom is Rh Neg and the baby initially types Rh Neg, with the DAT positive, we cannot perform the weak D; we have to send it out to the Reference Lab for testing. If the antigen sites for D are coated already by anti-D, then the baby might type as Rh Neg. The cells need to be eluted, EGA can be used to knock off any antibody and do the blood typing. If the doc doesn't want the baby stuck, we turn out Rh Indeterminate, and recommend the baby be typed later.

We perform a Type and Screen on all maternal specimens for transport babies sent to our NICU. If we do not receive a maternal specimen, we do the antibody screen on the infant specimen. Billing is telling us that since these maternal specimens are registered as outpatients, we need an ICD-9 code for billing when we order using CPOE (Clinical Physician Order Entry) in Cerner. Does any other lab do this, and which code do you use? thanks, Darcy

We are using a digital thermometer with a Traceable Certificate of calibration with an accuracy of 0.1C when tested at 22C. We originally bought a NIST mercury thermometer which ran between $1200-2000 but after breaking it twice in a row, and our facility moving to a non-mercury policy, we had to switch. we send it off to the Control Company yearly for calibration. This thermometer works pretty good, but does NOT work for taking temps on units, since the metal probe is too long and we cannot get an accurate temp due to ambient temps interfering. That's why we decided to try an IR so that we would have quick readings of the units. Can IRs take accurate reading on water? If I can put the NIST in water and compare the IR to it, and that's acceptable for validation, I can try that. Otherwise, my only other option to see if we got a new thermometer in the Gen Lab that's small enough I can test the unit temp with it, since most new thermometers come with a certificate of cal good for 2 years.

We ordered a Fluke 561 Infrared Thermometer to use for reading temps on returned units. I was told the thermometer was calibrated, but when it arrived, the documentation stated that a Certificate of Calibration to NIST was not available, and if we wanted one, we would have to send it in to be calibrated for $112 on top of the cost already spent for the thermometer. I called AABB and asked if the thermometer HAD to be calibrated to NIST standards, and their reply was that as long as the thermometer was calibrated by a national standardizing company, that should be sufficient. The statement on the IR says: "Fluke Corporation further certifies that the measurement standards used during the calibration of this product are calibrated, at planned intervals, traceable to SI units through an internationally recognized National Metrology Institute (NMI)" AABB says that NMI should be an acceptable agency for the calibration. However, the document states that it is not a certificate of calibration or traceability. Do we actually have to have a certificate, or would it be good enough for the inspectors to keep this document and the shipping receipt (for the date purchased), since this is not our NIST thermometer? I also have questions about testing out the IR against our other thermometers and checking for variability, emissivity settings, etc-what post would I go to for that, or should I open another?

We are not happy with the reagent inventory and quality control program that comes with our Blood bank software-it is limited, and not user-friendly, and we are considering creating an Excell program to handle our QC, or seeing if we can find a separate QC/Rgt inventory program that can be loaded on a PC-otherwise it's back to paper. I would prefer to have a commercial program rather than creating one myself. Does anyone know or use such a software program, or have any advice for us?

We're currently trying to build the QC and Lot Maintenance in Cerner Millenium. We're still debating whether to leave it turned off but use the program anyways, or scrapping it, and going with a separate software for the QC and reagents. It's workable, but very limited and not user friendly by comparison with Mediware's HCLL QC and Inventory. If you're in the process of building, I'd be happy to let you know what I've found out so far. Most places I talked to that were using it, opted to run the QC but keep it "turned off". And believe me, if you are multiple site, you can't have the QC "on" unless it is built at all the sites, otherwise it will interfere with testing-especially if you have shared orderables.

To complicate matters, there is also the slight problem of false positives occurring with the Immucor Fetal Bleed Screen Kit. We had quite a problem with that for several months, and were driving our hematology dept crazy with all the Kleihauer-Betke orders due to the false positives. After a recommendation from one of the Immucor technical staff, we switched to using buffered saline in our FBS procedure, and that seemed to solve our problems. We did a small correlation to make sure the buffered saline was getting accurate results, which it was. We haven't switched back to regular normal saline and we don't plan to-not while it seems to be working okay that way.

The majority of our patients are OB's. We have seen enough cases where the fetal screen is overwhelmingly positive due to the patient actually being Weak D positive that we actually have as our policy that the tech must do a weak D workup if the fetal screen is positive, before turning out any positive fetal screens. If the weak D is positive, then we turn the fetal screen out as indeterminate. Either way, we would still order a Kleihauer-Betke to determine hemorrhage and dosage. Despite the weak D, we would still consider these patients as Rh negative in regards to receiving any blood products or rhogam injections.

Our trainer and installer with Immucor was very clear about not having all reagents on the Echo more than 12 hours at a time. If they are on for >12 hours, then the reagents expire in 72 hours-except for the Indicator cells, which have to be changed every 24 hours anyways. We are still validating, but due to her recommendation, have come up with the plan to have 2 separate sets of reagents (all the same lots, of course) that we change out at 9am and 9pm. That way we wouldn't have degradation of the reagents to worry about, or having to discard a bunch of reagents because they were left out too long and thus shortened their expirations.

Has anyone built the QC and Lot Maintenance for Cerner Millenium Blood Bank/Transfusion Service? Our consultants have not dealt with it before and cannot answer my questions. We are a multfaciity site that will be sharing the Cerner QC module. The guides say that the Lot Maintenance is not multifacility and security is maintained by naming conventions and service resource. I'm not sure exactly how that works. If I select Anti-A to our service resource, does that mean that the other site then can't use it-that I have to choose "ALL" service resource so that both sites can use it? How would we be able to distinguish between the 2 inventories? Can anyone who is multifacility and built this help me?

Any suggestions on what to do with analyzers that have "sunsetted" or are no longer supported by the manufacturer? Do schools want them, or are there places that might want the parts? What do other blood banks do with this equipment? Anyone?

This is the second week we've had the ECHO-we just received our training for our "superusers" last week. We've had one software error that has shown up twice in the past two days. It's called Spool Subsystem App error, and Immucor says that it is a Microsoft error. They say it usually has to do with the printer, but we haven't been having any printer problems. If it keeps occurring, we may need service. I have not seen any software errors specific to the ECHO software.

We use HCLL software from Mediware and enter our results directly into the computer. We do bench tube testing and automated testing-the automated comes directly across to the computer in a "performed" status-all we have to do is verify them. Batch entry, except for automated results, or unit type confirmation, is discouraged-we usually open one patient at a time into a worklist and then minimize, so that only one patient's results are up on the screen at a time. We use paper records for downtime, and since we went live only 2 years ago, and paper records have to be held 3 yrs onsite per our policy, we still have files from before go-live that we are slowly getting checked and stored. If a patient comes in, or it has been >3 yrs, we check the info on the card against HCLL, and then store it away.