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mcgouc last won the day on August 9 2018

mcgouc had the most liked content!

About mcgouc

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  • Birthday 02/28/1951

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  1. 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.
  2. 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%.
  3. 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.
  4. We had a log book and white board also. Each shift had to sign the book, but, I think, the most important aspect is overlap between shifts in the department. If the next shift doesn’t arrive on the bench until 15 minutes after the previous shift has ended, what was written in book 15 minutes ago may be out of date.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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”.
  12. 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.)
  13. mcgouc


    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.
  14. Congratulations! You deserve it!
  15. 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.
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