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Everything posted by clmergen
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We use a lot of NovoSeven for our heart and trauma cases but NEVER for the reversal of Coumadin.
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We also use a default UNLESS it comes with a specific volume on it from the supplier.
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I remember a patient at a hospital I worked at that had something similiar. We never could identify an antibody. A phenotype was done and for some reason, anti-c was the suspected culprit (don't remember all the details). We transfused washed c negative units and the patient did fine. I always thought it was a little bit of voodoo medicine but it worked.
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Ask again next week when I actually get it loaded. Not sure I like the extra 6 minutes of incubation time.
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Wow, our partial D patients with Anti-D tend to test as 4+, they don't need weak D testing at all.
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And here I thought we were the only ones doing that.
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We have had our Echo for about 18 months and can't imagine life without it. We have installed them in 4 of our 8 hospitals, one more being installed next week with 2 more planned. Only our newest hospital acquisition will be the only one without an Echo. That being said, we are still working through the growing pains of what to do with those extra sensitive extra reactions that we do get. But we have that almost finalized. There are some other quirks that we have discovered and are dealing with but they were easy. We have had minimal down time, oldest instrument recently had some intermittant problems that took a few weeks to completely resolve but we were only down about 5 days total. And Immucor's response was quite good. I do occasionally get irritated with Tech Support because they think the first solution to EVERY problem is to remove and reseat the probe. And then invariably the probe crashes and needs replacing.
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I am finalizing this procedure right now. I stated that we would run 10 samples in tube and on the Echo. Differences needed to be resolved and documented (rouleaux, weak antibody, etc). The one hospital with 2 Echos will have a QC comparison done. I am not doing any statistical analysis or anything at this point because of the low number of data points. I will do some kind of system comparison and have it signed off by the various medical directors. This is being required in Micro also, it is a CMS requirement and CAP wants to keep their CLIA standing.
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Why to add first serum when grouping and crossmatching
clmergen replied to fiza's topic in Transfusion Services
I wanted the Anti-A,B sera to be green because everyone knows yellow and blue make green. -
I didn't realise this thread started last year. But yes, we are automated with download results without human interpretation whenever possible. If the instrument can not interp, then we tube test. We are just in the consideration phase but Transfusion seems to be problematic at the smaller sites, specifically getting well-trained personnel on the evening and night shifts. At the main hospital, we have techs around the clock dedicated to just Transfusion Services so we think we may benefit from this.
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We are considering this for the future, when we upgrade from Cerner Classic. With smaller hospitals using generalists covering more than one department at a time, we think this may actually be safer.
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If you read the standard, it says "as applicable". So we inspect panels but do not QC them. As long as they pass visual inspection they are good to go. And that is defined in our policy which is signed by our Medical Director.
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Except in the US, some donor centers are using 500mL bags so I assume that 500+/- 10% would stand?
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I just found out that we are challenging the RFI so we shall have to wait to see what happens.
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I have been through two EMR implementations. The first one was Cerner with a simultaneous Cerner Millenium upgrade from classic. The second was Epic while lab stayed on Cerner classic. My strong suggestion is make sure Lab and Transfusion Services are represented as MUCH as possible and keep with you the standards of AABB and CAP or whatever regulatory requirements you need. Input early on is the key. During the first implementation, we had a lab representative on almost every group and if there was a question he couldn't answer, he would contact the appropriate department. It was much better in the end than the other way around.
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We have something similiar written into our procedure but this JC team didn't like that. And the same team will be inspecting a second hospital by the end of the month. My understanding is that they did not cite a specific regulation or standard but we still have to "fix" it. After nursing, Transfusion, and IT discussed the "comment" the decision was that we weren't the people to solve the issue. They tried to pawn the entire problem on my Medical Director but I promptly deflected that. My MD can "advise" but not override a physician so I think the problem needs to be addressed by the Medical Staff. Our EMR team has a Physicians Advisory Group (PAG). The problem is being presented to the Vice President of Medical Affairs (VPMA) of the hospital who can then consult with the VPMAs of the other hospitals and they can consult with the TS MD. And then the PAG can decide how they want to fix the EMR nursing order set.
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This is the following that was cited by Joint Commission at one of the hospitals in my system: MM (1 EP) bFinding: Orders for blood products did not include a rate of administration This is the first JC since we have been on an EMR with physician order entry. We are considering putting in a default comment of "transfuse 150mL per hour, not to exceed 4 hours unless otherwise indicated" for the blood products. Any ideas on if this will work or any other suggestions? This caught us by complete surprise as this we have never required this before. When the physicians were handwriting they sometimes put how long to transfuse the unit but not always.
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We call all STATs. I can't be expecting an RN taking care of a critical patient to be checking the computer to see if the component is ready. Actually, I call whenever I have a blood product ready if it is to be given the same day. And we only tube to a few locations, so if I am tubing it I always call so they are waiting for it and it doesn't sit in the tube station.
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My first thoughts are similiar to Malcolm's, I would check for rouleaux and then a cold antibody. We have had a B patient in the past be strongly reactive with any O cell and negative with B cells because of an auto-anti-H.
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I was watching Days of our Lives recently (I am still looking for a life) and someone got shot. They called ahead to the hospital to get the patient's blood type and have blood ready vs using Oneg for the 20yr old female. And then to add to the insult they realised her biological mom was telling the truth about parenthood because they were both ABneg (I think). At least a soap opera doesn't claim to have a technical consultant so my outrage only lasted a few minutes.
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My Medical Director is always available via pager unless he is out of country. Luckily we have 4 more Clinical Pathologists that share call with him. They cover multiple hospitals 24/7. But in cases that we know may be beyond the covering Clin Path, we call our TS Medical Director even if he isn't on call. I think that schedule should go missing pretty fast.
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As fast as the patient can tolerate as determined by the patient's physician.
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We have had blood at the bedside for delivery. We used the mom's last name, baby mom's first name. We issued it with a blood bank id bracelet and strict instructions that the bracelet be put on the baby prior to the transfusion. That way we met the 2 identifiers with ease.
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You are QC'ing your methodology along with the reagents. I don't know if it is spelled out in those terms but I would not tube test without QCing the reagents again in tube. And in our case, we sometimes have different lot numbers on the Echo than on the bench reagents so it would be required.
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Patients with Sickle Cell Disease
clmergen replied to rravkin@aol.com's topic in Transfusion Services
52 year old black man was coming in for a transfusion yesterday. He has a history of chronic anemia. No one thought until recently that he could have sickle cell disease. Working him up for the first time after many years of transfusion. I believe his antibody screen was negative, but we did a complete phenotype on him and started following the proper protocol.