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Posts posted by mcgouc
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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.
- Texas Lynn and BankerGirl
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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”.
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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.)
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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.
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Congratulations! You deserve it!
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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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Check and see if your hospital uses a printing company so you can design your own forms.
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We also set up a rotation with our blood supplier. However, some suppliers will not do a platelet rotation.
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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.
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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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Our IT department created a new blood supplier (we just called it CAP) for the unit so we could scan all the information on the CAP unit label. Just follow your policies. Pay a lot of attention when completing the CAP paperwork as that can get confusing.
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We didn't have the medical director sign. The patient's physician signed. The Medical Director was not always available and felt the patient's physician should be held responsible. Since the work-up takes a while, we started discussions and getting signatures on an " Incompatible Blood Release" form early so there wouldn't be an additional delay once we had appropriate blood.
Just a few comments about sharing Blood Bank computers with other facilities. I am now retired, but a couple of years before leaving , I added a section to my validation policy titled "post-implementation validation". I wanted an assessor to see it and ask why I needed that section. I wasted so much time and energy trying to explain to corporate and local management that all affected facilities needed input and knowledge of changes prior to the changes being placed in the live system.
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I agree "least incompatible" is not an appropriate term to use. We had stopped using it until we got a new computer shared with other facilities and the only way to issue these units in the computer was to interpret as Least Incompatible. We kept the same paperwork for signatures stating "Incompatible", but had no choice in the computer. Personally, I think interpreting as Least Incompatible gives a false sense of security.
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The wrong unit was issued in the computer and left the Blood Bank. It is FDA reportable. It does help if you can scan the unit itself when issuing. Some computers also print a form when issuing that can be checked with the unit prior to the unit leaving the Blood Bank.
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Only way we could do it was to double check with floors regarding the mother/baby medical record numbers and put a Blood Bank comment on the neonate's medical records number with the Mom's information and when it was performed.
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We used Typenex but also went to the second specimen drawn at a separate time or a historical record. The transition was not as difficult as I had thought it was going to be.
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After entering results, I always printed & read results from the computer print-outs to someone else to check my data entry. I totally agree result entry should be grouped by patient, not test.
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For years, we had a policy for determining the 37C reactivity, but we had a lot of generalists rotating through Blood Bank & there was no time to document their competency on a test they might do once in a great while. So, we went with B for AB and O for A. We were a small hospital & I determined it was only about 10 extra O units a year.
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As long as the segments are kept seven days post-transfusion, it is up to the facility to determine how to meet the requirement. When we were preparing for the electronic crossmatch, I knew our method of keeping the seg when we crossmatched was not going to work so we started pulling extra segs when we processed as described above. I did think it would be difficult retrieving the segs when needed, but i would dump the segs in the correct day's bag on a counter & it wasn't bad. Thankfully, I didn't have to do it often, but on delayed reactions, I would pull segs to type transfused units.
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We used the AABB publication as a guideline. When validating we sent a tech to the floor to time how it took & the unit's temperature. We required a request/order and the floor had to sign an area that said unit appeared acceptable and information checked, time it, and return when they received the blood. We called when we tubed it & followed up if the form was not returned in a few minutes. We kept the completed form with our transfuse orders. We only tubed to two locations. That said, the blood bank has no control over the blood once it leaves. One day we issued a unit, got a request for another patient, waited until we got the completed form for first unit back, and issued, called & tubed the unit for the next patient. A few minutes later, the first nurse called wanting to know where her blood was. She had delayed getting her unit & the second nurse had grabbed it & completed the form. Two people had signed the bedside check area, but the first unit was hanging on the second patient. Thankfully, it was group O & the patient had no antibodies.
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We used to think cold antibodies & complement were important. We did room temperature screens & crossmatches & we had to identify room temperature only reacting antibodies. We could not use EDTA tubes in Blood Bank. So, we used clots, separated, & refrigerated immediately. One day I asked myself why we were still separating the EDTA specimens increasing chances for mislabeling & mixing plasma tubes and couldn't think of a good reason so we changed our practice. Thankfully, we did not separate specimens sent to the reference lab.
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I used to work at one of the above mentioned reference labs. When I started about 25 years ago, they were using pooled cells on prenatals. We agreed that was not an acceptable practice even then & changed to the two cell screens. We sometimes did 300 screens a day in tubes so that was a huge increase in workload. Before I left, we had migrated to two cell screens on an instrument.
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You made it! Yea! I really appreciate you sharing your knowledge. I recently retired & it is fantastic. No more unpaid 24/7 call. No more having to come home early at night cause I have to be at work at 0600 the next day. Enjoy your new life!
- dot, John C. Staley, BBR and 1 other
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Addition of sterile saline when pooling cryo
in Transfusion Services
Posted
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.