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mcgouc

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mcgouc last won the day on August 9 2018

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About mcgouc

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  • Birthday 02/28/1951

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  1. Surprisingly, the change had little effect on our group O usage. We did not wash cells. We were allowed to use properly identified Hematology samples collected in the last 24 hours, at a different time from the BB sample, for the second type. We started a blood management program about the same time where Hgbs or Hcts had to be documented prior to issuing blood so Hematology samples were usually available, even on children. We did the second sample type on all type and screens so if they decided to transfuse we were ready. Different areas of the hospital had to be treated differently. For example, when we had a pre admit patient who needed a second sample, we did a type and screen on the preadmit sample, ordered the second ABO, called and had a note placed on the chart not to send patient to surgery until that was collected, and left a note in Blood Bank. By working with surgery, ER, and the floors, the change was not nearly as bad as I had feared.
  2. I thought it would increase our group O usage, but it only increased it a couple of units a month. We had to work with different areas of the hospital. We could use properly labeled Hematology samples collected at a different time within last 24 hours for second type. That covered most in-patients. (We had a blood management program where reason for transfusion had to be documented and if the reason was anemia, we had to document the hemoglobin). We did the second type on all type and screens so if they decided to transfuse, we were ready. If a pre-admit patient needed a second type, we ordered it for morning of surgery so it would be on our pending and had them put a note on chart. ER was a problem, but we worked through the managers and they adjusted. Even there, they usually got a Hgb result before drawing the Blood Bank sample.
  3. Years ago, I worked with a tech who had worked elsewhere where a tech went with the blood when it was issued and did a quick ABO slide type at the bedside just before the infusion was started. I never worked anyplace where this was feasible due to staffing and currently we need two types on file to issue non O blood.
  4. We used to do pre-transfusion, 15 minutes, every hour, at end, and one hour post transfusion. Then the lab was inspected and the Blood Bank was cited because the nurses were not documenting close enough to the specified times. They noted one hour vitals at 45 and 75 minutes on a transfusion and said that was not acceptable for one hour. It got too complicated with so many vitals to specify a tight time frame for one hour. We researched and dropped the every hour and one hour post transfusion and added checking the vitals documentation as a QA monitor. Whatever you do, just make sure the times are specific and being followed.
  5. I only used the cryo pooled by the blood center for the last several years and agree it is marvelous although it may be cost prohibitive if you give a lot of cryo. In the past, blood centers could make what we called "dry" cryo or "wet" cryo. If your blood center only makes the "dry" cryo, there is a very small volume in the bag and it is necessary to add sterile saline to the first bag and pool as you described. "Wet" cryo did not need additional saline added. Years ago, our local blood center switched to "dry" cryo for a while and the hospitals had them switch back to "wet" cryo because of the additional documentation, time, and expense required with obtaining and adding the saline to the bag.
  6. It was so hard when teaching students not to reach over and flip open that lid. Remember changing broken clips on the immufuges? Or the Dade Cell Washer that added the antiglobulin? I think that is why manufacturers started makng green antiglobulin.
  7. AABB recommends that so you don’t have to rewrite the references on every policy when they are updated. Like above, you can have a cover sheet with current edition info. Also, when AABB issues a new edition of standards, they publish a document detailing the changes. Before the new Standards implementation date, I would go through that and document on all the changes any policy affected, action required, and date completed. I had the Medical Director sign off on that when done. Most were “not applicable”, as we were not a donor center, or “no change required to policy XYZ”.
  8. We had a policy and form where we could issue on a RN’s signature with a place for the ordering pysician’s name. The RN was responsible for obtaining the ohysician’s signature once things got calmer. The Blood Bank did follow up if we didn’t get the signed form in a couple of hours. (Due to ER physician groups covering multiple hospitals, a particular physician might not return for weeks.)
  9. mcgouc

    Retirement

    Congratulations! You made it and will love retirement - once you get used to getting some uninterrupted sleep! It is so interesting to read what Malcolm says. My SBB program (in Texas) many years ago was headed by an Englishman and when he would say something we didn’t understand, we would just look at each other until someone realized what it was and would mouth it to the rest of us. The old days when we had a human instead of a computer in front of us.
  10. Congratulations! You deserve it!
  11. It depends on your policies and how you handle the documentation. You need documentation for each part of the process. If one tech can sign the form and document the inspection and another tech enters into the computer under his or her name, you don’t have a complete tracking of the unit. Also, if you are busy, there could be a delay in entering the units in the computer. If your policy states the one receiving and inspecting units enters them in computer on receipt, you don’t need the paperwork. There could be some other form for that documentation. The Blood Center is keeping a copy of that form and if you sign for it at 0530, you need to document what you did with the blood until you put it in computer at 0730.
  12. Check and see if your hospital uses a printing company so you can design your own forms.
  13. We also set up a rotation with our blood supplier. However, some suppliers will not do a platelet rotation.
  14. I have to second that my experience with the FDA employees handling BPD reporting was very positive. They do review, delete, and explain if they don’t find it to be a deviation. However, I am not sure how many facilities report them. In 2014, a new Lab Director who had been a director at several hospitals in the area told me to stop reporting BPDs because a QA tech at one of her hospitals said they are not required in transfusion services. I showed her it had been required since 2000.
  15. I was advised by one assessor to have an information sheet like the one mentioned above for the couriers (nurses, patient care techs, anyone who pick up blood) to read and sign. We gave them a sticky dot for the name badge and if they didn't have that, they had to read and sign the form. We required the form to be read yearly and they got a different colored sticky dot each time. It would be difficult to perform true competencies without following the courier to the floor to make sure they delivered the blood properly.
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