LCoronado

I will be asking the same questions in about a year and 3 months!

We are a small facility which uses manual gel technology. We rarely see titers ordered. However, when reporting an antibody on a pregnant patient (detected and identified in gel) we faced this dilemma: the antibody was so weak it was not detectable in tube. We then started using gel for titers with the understanding that it is the change in titer over time that is significant. For proficiency, we use the split sample method every 6 months. CAP and State (NJ) inspectors have been OK with this.

This dilution of the 3% cells is the advice given to me by Ortho Tech Support.

We discovered this issue last night and yes Ortho has had a number of complaints. The recommendation is to use a different lot of 0.8% cells or to use 3% cells which have been diluted to 0.8%.

A question for those of you who have the patient keep an armband on for 7 days or more, what type of armband do you use? Ours only have to last for 1-3 days and we've seen some tattered, battered sad armbands upon the patient's return.

Same as Banker Girl

David, Would you kindly let me know the source of this data? I was not able to find any references myself. Thank you.

Have worked with Korchek - they do a good job. I have also heard good things about S&P.

We have our freezer ranges set to +/- 5 degrees. We've had it that way for so long, I don't remember where I got the idea, but at our last CAP inspection it was challenged. However, while I couldn't find any references for the 5 degree range at the time, the inspector couldn't find any references or regs that stated it had to be 2, or that 5 was not acceptable. We did not get cited and we kept the +/- 5 range.

Our pathologist and the ordering physician must both approved transfusion. The approval from the pathologist is usually verbal and is documented in the patient's history, as is the report from the reference lab regarding underlying alloantibodies. The ordering physician must write a communication order that states "OK to transfuse least incompatible." We use this terminology as it is usually a recommendation from the reference lab (the recommendation is preceded by the phrase, "If transfusion becomes necessary").

In the olden days (when I was young) we did retest for ABO every time the tube was taken out of the refrigerator for additional crossmatching. I think the reasons included all those mentioned above. Now that >90% of our crossmatches are electronic, it really makes no sense. However, for the few patients who require a serological crossmatch, the rule is still on the books.

We do not have this as a written policy,thinking it's common sense, but I guess it could be an invitation to disaster. The real question is, "How much common sense needs to be spelled out for techs who are intelligent, educated people?" The answer is, "A lot more than we sometimes realize!"

David and Terri, We have been documenting electronically for four years. The learning curve was much steeper and more extended than anyone expected, due to the fact that our entire HIS had changed and there was much that was new to the nurses. The documentation went down to about a 50% completion rate before it started to correct. Then the method of documentation was changed again (still electronic however) and we went back to square one. We are now seeing about 80% completion; we have a committee dedicated to addressing these issues and do re-educate individuals as needed. The interesting thing though, is that the errors and omissions we are seeing are very similar to those that we found in the paper documentation: missing Stop Time, missing Amount Transfused, missing evaluation for signs and symptoms of transfusion reaction. Less frequently, we miss the Start Time, and all or part of the vital signs at required intervals. New since we went electronic: Scanning of the ISBT unit identification number (we get everything from the product code to the patient's account number scanned into that field). It's an adventure!

Yes Dr. Pepper - Have seen all that too. Our pen was not calibrated properly on the refrigerator temperature module and it was adjusted several times but poorly. I found a week where it was reading 7C, but the techs kept reading it as 3-4. Another week and it was recording a temperature of 0. The techs that week recorded it as - you guessed it - 3-4!

Auntie-D, Your post was so timely for me! Due to short staffing (a rant for another day) I worked at the bench for two days last week and was appalled at the the things I found that I had been trusting to the techs. Tasks are organized on a clipboard: daily, weekly, monthly, etc. The daily and weekly are apparently signed off regardless of whether done or not, and the monthly, quarterly and semiannual lists appear to be written with disappearing ink on invisible paper !!!!