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Everything posted by clmergen
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We do require blood types to be on record but not from current admission. As for choosing platelets, I always look at my first expiring and then the blood types. However, if I had a larger volume platelet, I give those type specifically whenever possible. But sometimes in an emergency, it may go to an out of type patient.
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For equipment not used daily, we circle the date and initial that we are acknowldging that QC was not done and the equipment was not used for that day. It is clearly defined on our form as an acceptable answer. Just leaving something blank is unacceptable.
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Blood Transfusion with EMR
clmergen replied to bmarotto's topic in Computer Systems / Software / ISBT128
We use Epic EMR. Nursing has a flow sheet for documentation of vitals. We use a " significant event" to document transfusion reactions. Signatures and start of transfusion are manually captured on the blood unit tag which is subsequently scanned into Epic. It is a very clumsy process and I am interested to see what AABB and CAP say during our upcoming inspections. -
5 day plasma, the debate still rages!!
clmergen replied to John C. Staley's topic in Transfusion Services
We use it for everything, traumas, plasmapheresis, cardiac patients, etc, without problems. -
Our nursing policy states that if the blood type does not come from an acceptable source, it must be repeated stat upon admission. Acceptable was defined as having a copy of the actual report from a laboratory. We are on an EMR now and have discovered that nursing can "enter" lab results in. They are clearly marked as having been manually entered. Then I noticed the compiliation prenatal H/Ps. So I got really worried about meeting the standard because we do leave the responsibility of identifying these women to the nurses. I did an audit of every woman in our post delivery nursing units of our 6 hospitals. Although a good portion of them had hand-entered results, all of them had a blood type from our system. I no longer worry about our nursing staff not meeting the standard. (and not all were from the current admission, we are a reference lab too, so some were prenatal care).
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Here is my generic procedure that also includes the EBA 21 requirements. (if it worked). Serofuge, Immufuge and EB 21 Centrifuge Quality Control.doc
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Congrats Heather! I think all the accredited programs out there are very helpful, I did the program at Florida Blood Services myself (and used those exact 3 books).
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We require a physicians signature on the form or alternately an electronically signed order in the MR for uncrossmatched blood. Documentation of vitals is performed by nursing in their usual manner which is in our electronic MR.
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AB patient with an Anti-A1 is what I would suspect. I would test the patient plasma with A2 cells, test patient cells with A1 Lectin and run an IS screen to rule out other cold reacting antibodies.
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One of the hospitals in our system uses them to spin specimens not for actually testing. They like it well enough. You do need to lightly lubricate the seal periodically (I think we specify monthly) in order to keep it from cracking.
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Terri, We have a generic plan that we just fill in with whatever we think is necessary for the equipment. Do you want that or are you looking for something more specific to the centrifuge?
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Are you at that beautiful new(er) hospital that i used to see when i would travel to Denver from Colorado Springs? I thought about applying there when it first opened but didn't want to miss work during those snow days when I wouldn't be able to get over Monument hill.
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We require all negative reactions with Anti-D sera to be repeated. Plus we require 2 ABORh's on record prior to dispensing blood products. Either of these may have stopped this error from occuring.
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We don't even carry FFP. I would have to special order it if a physician was insistent. And I wouldn't even do that until my Medical Director intervened.
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We have found more problems with reagents during testing than at QC testing time. I think with the forward and reverse type, you have built in checks for the ABO, we have check cells for the screening reagents. I don't see it as an issue to be concerned about.
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We call the ABSC positive. We result an Antibody ID as a "Footnote" and say "The Indiret Antiglobulin Test for "unexpected" antibodies shows non-specific reactivity using automated solid phase methodology but no manual tube methodology. This has no clinical significance". Then we AHG crossmatch and will be doing a Deviation Report for our Medical Director to sign.
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We almost always start with cyroreduced plasma and only use FP24 if the fibrinogen drops.
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We actually have a call into Immucor about this. I am expecting a call back tomorrow (our choice to wait until tomorrow). We have had 15 screens positive with Lot 88, all but one had reactions on either Ready ID 127 or Extend II DN40. All clinically significant antibodies ruled out, all were negative in tube using LISS.
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We seem to be getting an increase in the number of nonspecific reactions since upgrading the software. I have 4 that had reactions on the Ready Screen, but we were able to rule out all clinically significant antibodies the the Ready ID and/or Extend panels. LISS tube testing is completely negative. Anyone else seeing this?
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Thanks. And for the explanation. It explains why the large hospital I consulted with only tests against A2 cells. The transplant coordinator keeps saying Anti-A1 but that may not be the UNOS recommendation it may be Anti-A.
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We wrote into our QC procedure, if it fails once - rerun the test, if it fails again - open a new bottle, if it fails again - open a new lot number and notify your supervisor.
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You see my confusion....
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I have been asked to start doing Anti-A1 tiers for our kidney transplant patients. I asked what the UNOS recommendation was and didn't get any good information. Anybody have any idea? Do we want IgM and IgG for both B and O patients? Does anybody have a procedure they are willing to share? I might be googling wrong but I can't find any useful information out there.
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In trauma situations, the physicians don't always know what meds the patients are on so we don't even concern ourselves with that. And NovoSeven is usually given after the patient has had several rounds of RBC/FP/PLT infusions so coumadin effect is pretty much a moot point. It is a rare moment when we refuse to give NovoSeven and it would have to be an agreement between our pathologist and the attending physician.
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We wouldn't know if they are on coumadin or not, but so many of our traumas are young males so we assume not. If NovoSeven was requested for coumadin reversal, then the request would be forwarded to our Medical Director for appropriateness. But every order has to have approval from the Medical Director or another clinical pathologist except what we give in support of our Massive Transfusion Protocol. For MTP, we contact a MD or CP if they request beyond what is written in the protocol.