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mcgouc last won the day on November 20 2019

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About mcgouc

  • Birthday 02/28/1951

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  1. If you set a time, such as less than 30 minutes, and they start the transfusion at 30 minutes, you can be cited by Joint Commission or FDA if they do a trace of that unit - unless there is a deviation from policy report on file. The 30 minute start time may be in the nursing policy, but when a tracer is performed, the deviation will fall back on the transfusion service to correct. Although we did ask that the nurses do the preparation before picking up the unit, there would be a phone call saying the start of the transfusion was delayed for some reason. (IV infiltrated while picking up blood is one I remember). When we started taking temperatures of returned units, we learned they were usually only acceptable to be returned for 15-20 minutes, depending on how they were handled after leaving the Blood Bank. After much debate, we changed the policy to start the transfusion as soon as possible with the emphasis on completing the transfusion within four hours of leaving the Blood Bank. We did require them to return the unit to the Blood Bank immediately if, for some reason, the transfusion were cancelled.
  2. When we started extending, the patient had to provide the mother’s maiden name when collected and when returning. We had that documented on our paperwork along with the no pregnancy/transfusion in three months information The extending and not requiring the bracelet to be worn continuously had to be approved by the Transfusion Committee and that was what the doctors approved. When we went to the electronic crossmatch that required a second type, we would check when we did the pre-admit work-up and order a second type for day of admit and attach a note on the chart for pre-admit to collect a type when the patient returned.
  3. Technically, physician ordered product and pick up person brought a copy of the order. In the real world, we knew nurses were entering transfusion orders. There was a handwritten paper order form for OR to avoid delays.
  4. Having a readily available back-up for the ABO and any antibodies, ABO discrepancies and special needs (such as irradiated) is required. Ours was done to a PC in the transfusion service in the background at 0400 every morning. It was a hassle to get IT to make that program for us, but I kept giving them documentation that the info is required to be available when the computer goes down. Had we not had the back-up, we would have had to keep making cards to check during downtime.
  5. Many years ago, I was told by a consultant that if I modified a form, I needed a new revision number and a track of what was revised and when it went into effect. The form was an attachment in a policy so I did have the Medical Director sign off on the change. Something I considered minor might have been considered major by someone else. It would have been great to have a compliance review but I did not have that resource.
  6. QC-97-13 - procedure for issuing not performed or documented in accordance with specifications. If your policy states the form needed to be signed prior to issuing, this is a general code to cover that. As stated above, they will let you know if it isn’t necessary.
  7. Could the unit be a weak A or B? How was its ABO performed and confirmed? Try crossmatching with an A and B patient if you don’t have a lot of different reagents.
  8. I had in my policy that we would review the Changes to Standards document published by the AABB and document on each change whether it affected us or not. (We did not draw donors so we just reviewed and put those changes as not applicable.). If we were already in compliance with the change, we would document no change in policy required with the policy number. If a policy had to be updated, we documented when the updates, training, etc were completed. The Medical Director signed this review and we kept it with our policies.
  9. Our blood center could provide units with one or more bags attached. (We did not perform many neonatal transfusions and ordered these for the neonates). The empty bags had labels and our computer was set up for the aliquots. We were fortunate that this only took a few hours. If an urgent need, your process sounds acceptable.
  10. I am retired but volunteered several years as an AABB assessor. Both CAP and AABB send the deficiencies from the previous assessment to the assigned assessor with the submitted plan of action to correct the previous deficiency. Most plan of actions have a time frame documented to correct the issue. We were supposed to make checking completion of the plan of action a priority. My first question would be if this individual had completed any work before his training records were completed. Then, I would ask for his competencies that were completed during the allowed time frames. If I performed a tracer on your FDA reportable, could you provide completed training and competency records for all the employees who worked on that patient? Your pathologist may be young, but he does not want repeat deficiencies. Document everything!
  11. Before getting an ECHO and using the pHix recommended for that, I did buffer the saline using a powder. It was several years ago but I think I got it from Hemobioscience. I started because some (Immucor) manufacturer’s directions specified a saline pH around 7. Our unbuffered saline did not always meet that pH. We checked and documented pH daily and when we made a batch. We also had standards to check the pH paper daily. We QC’ed the saline daily as before. We continued the pH checks after switching to pHix.
  12. We also only tubed to certain floors. We sent a form with patient and unit stickers with the unit that the person who removed the unit was supposed to time, initial, and return. We called when tubing and they had 10 minutes for us to receive the form before we followed up. If we tubed to a floor, we had to have the form back before tubing for another patient. To validate and to do QA checks, we sent a tech to each location and tubed an expired unit to each location with a temperature monitor. When we tubed, we called that tech and documented transit time and unit temperature on arrival. Things happen even when we try our best. One time we tubed a unit, got an order for another patient on same floor, received form for first unit back, tubed second unit - and nurse for first patient called upset because we had not tuned her blood. The nurse for the second patient had grabbed the unit for the first patient, signed the form without checking, returned the form, and started the unit on her patient, with two nurses signing off the bedside checks.
  13. I am retired but our corporation had set up a program and dashboard before I retired. We were using Cerner. We lowered the acceptable HGB level for transfusion in a non- bleeding patient to 7. We started physician blood ordering in computer and the physician had to select a reason to transfuse (as above). They could only order one unit at a time as they were required to do HGBs between units. At first, we pulled the dashboard and met monthly but, as we became more compliant, we met less often However, it took daily monitoring to become more compliant. Blood bank techs checked HGBs on all transfuse orders. We issued blood for fall outs (unless HGB was really high where we called Medical Director), but sent all outlying patient and doctor info to QA for chart review and follow-up on a daily basis. We also had hospitalists, but some doctors were having nurses enter the transfuse orders, so we started monitoring who was entering the transfuse orders. It was a lot of work for the techs in Blood Bank and there should be someone who is not working a bench available to control this program in-house and communicate with the nurses and physicians. For example, our corporation regarded order entry to be under the nursing educator and the Blood Bank had no input into it and was not formally trained, but guess what department the physicians called when they had no idea how to order blood. That made sense because the nursing educator was usually not available for phone calls and someone was always in the lab. However, the result of the monitoring wasgood and our transfusions decreased by 40%. Our numbers looked great on the dashboard after a year or so.
  14. We supposedly had physician order entry for transfusion orders. The order printed n Blood Bank and the nurse brought a copy to obtain the blood. We had instituted a blood management program with stricter reasons for transfusion. The reason was required on the order and we double checked the entry - if they marked HGB less than 7, not bleeding, and the HGB was 7 -9, we usually completed the order, but sent the transfusion for review. They could only order one unit at a time in a non-bleeding patients with HGBs between units. HGBs greater than 9 would require approval, if non-bleeding. We also documented whether a nurse or physician actually entered the order and that was reviewed -with doctors having nurses enter transfusion orders being contacted. There were other reasons for transfusing and we had a paper transfuse order for OR or downtime. Instituting this process was a lot of work at first, but we cut transfusions by close to 40%.
  15. We switched to using two samples drawn at a different time if there was no history several years ago. I had previously worked at a place that required two signatures, but we received a WBIT from ER with two signatures so I knew that had problems. There were different challenges in different areas of the hospital hen we added the second specimen type. We trained labor and delivery nurses to draw and label a tube when they started the IV. We were able to use previously collected (within 24 hours) Hematology tubes and most in-patients had those. When pre-admit patients needed a second type, we ordered the test for the morning of surgery, and called day surgery to flag the chart. The main problem was getting a second sample from ER, but getting a properly labeled sample from ER was always a problem. I learned nursing policies at my facility were changed a lot and the nurses appreciated getting notices and being trained on the change prior to the change. We did one type on an analyzer and a tech did a tube forward and reverse for the second type.
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