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Current edition is acceptable as long as you document you reviewed the current edition & no changes were required or you document you made the changes. AABB makes this easy for Standards with the Changes in Standards. We review that anyway to see if we need to make changes so just document the review. We always review & document new versions of manufacturer's directions also. I am sure we have all shared policies but we know to make them site specific with correct references. I was working in a corporation & asked to share all the Blood Bank policies with another hospital in the corporation because they had not updated their blood bank policies when they computerized & got an automated instrument. Since they were not maintaining their policies, I wondered if they could reference my hospital's policies & make me responsible if they made an error.

One day I was training a new tech at the end of the day. They called a reaction & I was going through the process saying how much easier it is now than when I started Blood Banking & the work ups didn't take much time. Positive post DAT. Negative elate. I decided to test some low incidence positive cells & there was an anti-Diego a in eluate (and in pretransfusion plasma when we tested that with those cells). I just told myself to "never say never" in Blood Banking.

Congratulations! What a change!

We were having some failures with QC & found it helped to change the tubes weekly.

We put the transfusion information on the form because an assessor couldn't find the vitals in the chart. I then started reviewing the back copy of the transfusion forms daily & sending the incomplete information to the charge nurse. Our compliance rose to 97%. Then, in our next assessment, the original was not scanned into the chart they pulled so we were cited. (I still had my complete copy on file, but it was not in the chart so policy was not followed.) So, I started reviewing a percentage of transfusion forms on the scanned chart instead of a copy of the form returned to Blood Bank. Our company did not buy the blood administration module for the computer, but recently added a place in the computer where the transfusionist could document some of the required info, but not all. First I knew of the change was when a nurse asked why they now had to document certain info in the computer & on paper.

We used the percentages of antigen negative and staffing in deciding rather to screen in-house or order antigen negative until a couple of years ago when our blood center let us have access on their website to the historical antigen types for units in our inventory. This information made a huge difference in how we handle this situation and the number of antigen types we perform. At first, the techs were reluctant to use this search feature. Then a second shift tech had an anti-c. I told her to try the search and if there weren't any in the historical types to order the antigen negative units. Our blood center must have been cleaning their shelves of c negative units because 10 of the 20 O positives in our stock were historically c negative. Unusual situation, but it sold the techs on using the program. Of course, we confirm the types before crossmatching, but if we happen to find extra antigen negatives in stock, we do segregate with a note as to what the Blood Center found and the unit needs confirmation. If there are no antigen negative units in stock and we decide to antigen type, we use the antigen positive info to skip typing those units.

I have had MLTs who were better at antibody identification than some SBB's I have hired. Experience & individuality mean so much in Blood Bank. However, in this blood management era, pathologists should be involved in the transfusion of all blood components. I would have greatly appreciated our Pathologist interfacing with the physicians when we lowered the hemoglobin level for red cell transfusions. One tech in the department working on several patients should not be the person involved in multiple phone calls with the nurses & physicians as to whether the patient meets the hospital's criteria to give the component.

When using manual gel, before getting the ECHO, we kept doing the IGG crossmatches if the gel screens were negative later. Now, if we have an ECHO inconclusive, gel negative who has negative screens on the ECHO later, we switch to electronic crossmatches. When the ECHO is reacting with multiple screen & panel cells with inconclusive interpretations & the gel screens are negative, the ECHO crossmatches are invariably compatible & the DAT is negative.

Since we staff with so many part time techs, we require a second sample on neonates to keep the policy consistent. We don't get transfer babies so we would have the cord or a previous hematology specimen. On adults without a second type we give O Rh specific. However, we routinely do electronic crossmatches & we have to do an immediate spin crossmatch without a second type. The computer requires overrides, even with group O units.

For the original question, we use the ECHO so do a full panel. If we get an anti-D on an OB patient, we call to get a history & they usually ask the patient if & when she got RhIG. It would be difficult to get previous antibody screen results. My computer has either "anti-D due to RhIG" or "anti -D". We interpret anti-D with a comment the patient received RhIG with the date. In the computer resulting "anti-D" requires an AHG crossmatch where "anti-D due to RhIG" is an electronic crossmatch. I would be okay with the above "anti-D post RhIG" & an electronic crossmatch, I just have a problem saying RhIG caused the anti-D. I think I am too picky.

I agree that, as long as the unit is issued with correct labeling, they can syringe at bedside. We would issue the entire unit with one or more of the neonatal/pediatric syringes with a filter attached. They filter & measure volume in syringe at bedside. We are usually able to get aliquoted/ISBT labeled bags from supplier. We issue each aliquot with one of the syringes as needed. We average transfusing only one neonate a year.

The computer is set up by a central group with everyone using same tables, etc. Each facility has its own policies using different methodologies. They keep saying there are blood bankers setting the computer up & modifying result entry screens & truth tables, but they are long removed from the bench & the newer technologies. The computer is very confusing.

If you work for a corporation where the computer is shared between different facilities, the end user may have very little say in how the computer is set up & what changes are made in the computer. I would give my computer a C-, but I have seen the same system set up differently in another facility & would give that one a B+. That probably goes back to a blood banker controlling the computer options.

I have found that it is not so much the computer system but how it is set up. The user buys a shell & dictionaries/ truth tables/ result entry screens, etc. are set up by the user. The personnel filling in these holes should be blood bankers. If the personnel setting up dictionaries think the indicator control on the ECHO weak D test is a weak D control, the calculations for the weak D may require a positive weak D control result in the weak D result entry screen in the computer. Computer cross match is great!

We have had these problems intermittently with the ECHO. This will be our third winter to have it and these non-specific reactions seem to increase in numbers around the middle of February. I live in Texas and have wondered if the weather or humidity at that time of the year affects the testing. So far, we are not having more than the usual number of non-specifics. Disinfecting and cleaning the manifold may help for a day or two, but the non-specifics soon start again. We have a workflow for these problems. We usually perform a gel screen while we are doing the panel on the ECHO. Usually, the ECHO is non-specific and gel is negative. These patients routinely have negative DATs and compatible crossmatches on the ECHO, which seems to demonstrate the problem is caused by the screening and id strips. Very frustrating!!

Has anyone seen the volume of convalescent plasma they are infusing each time? I was wondering why the ABO incompatibility prevented its use as we often give ABO incompatible platelets & even keep A plasma for emergencies now. Our facility has now decided to do point of care testing for the rest of the lab orders & to give group O Pos or O neg red cells. One of the special care facilities they are establishing is close to our hospital so we think an identified patient would be transferred there. Hopefully, the ER would screen the patient before the original samples are sent to the lab & tested routinely.

Our pathologist takes no interest in Blood Bank. Our computer has warnings for clinically significant antibodies, but the techs can override them. Our policy has a list of antibodies with their clinical significance. The techs are trained to call our Blood Center's Reference lab for any antibody not on the list or if they have any questions regarding whether antigen negative blood is required or not. Realistically, if we have an unusual antibody, the Reference lab probably identified it and gave us their recommendations which we documented in the computer.

Years ago there was a cord cell on a commercial panel we routinely used as an I negative cell. Since we did so much room temperature testing, it was useful for cold antibodies & ABO discrepancies. After it was no longer on the panel, I started pre warming & just saying the problem was due to a cold antibody.

In the old days, we used red top clot tubes & were told to use serum so complement would be present. We separated & refrigerated as soon as we finished the testing to preserve the integrity of the sample. Of course we did 15 minute saline room temperature screens & crossmatches in addition to poly specific (again, anti-complement was important) AHG screens & crossmatches. We did have a few ABO discrepancies because we mixed serum tubes. Now, I use anticoagulated samples, don't separate plasma from cells, IgG crossmatches (if we need an antiglobulin xm), and computer xms. I really don't miss the Lewis, P1, etc antibodies.

For the question marks on the ECHO, we do as estiner does and check the number associated with the strength of the reaction. A lot of times when we have question marks on the screens, we have question marks on the panel which makes ruling out clinically significant antibodies difficult. I have been told by Immucor that if the questionable reactions have what appear to be a pie slice shape missing, it is probably the instrument. We perform the AHG crossmatches on the ECHO and we routinely get the units compatible when we are getting these "?" reactions in the screens and panel. While we are doing the panel, we perform a gel screen and that is usually negative. Since using the ECHO, I think we find more antibodies to low incidence antigens on the panels in addition to the antibody that caused the screen to be positive.

We use the ECHO for the majority of our testing with manual gel as a back-up for antiglobulin tests. We are a smaller hospital where I am the only dedicated BB tech. We perform basic antibody ids and antigen types. Since we used manual gel for antiglobulin testing for several years prior to installing the ECHO, the generalists were competent and comfortable with gel so we just kept it as the back-up. Any back-up methodology is going to have problems and require extra validation and competency testing. I had originally dropped the 0.8% panel to use with gel (thinking we would just perform panels on the ECHO), but when we were having so many problems with the ECHO a little over a year ago, I started getting that again.

Thanks to everyone for your advice. I am going to ask the corporate employees in charge of the reviews and changes for a root cause analysis as to why computer changes keep occurring with little or no notification and validation. If the only response is for me to be counseled (another tech at another facility has already been told she was too harsh in telling her manager she would report to FDA if this continues), I will escalate the complaint. Corporate has a change control program - they just do not follow it. We are supposed to submit a change report, a standards committee reviews it, it is loaded into "test" and a production notice is sent to affected sites that it will go into live on a certain date - usually about a week. When I went into the "test" system to validate the ABORh recheck the other day (even though it was in live already), there was a third version in test. The A,B column was added, but the reverse testing reactions had been removed. We perform electronic crossmatches so I guess I should be thankful they didn't load what is in test into the live system with no notice. My Medical Director has not been at work since I completed this validation. (Plus, I had to perform another validation Friday of a change that went into effect today that I had known nothing about before Friday morning.) I never worked in a place where an employee says he can't do something and my first thought is that they changed the computer again.

Does anyone else have this problem and what do you do about it? I work in a hospital for a corporation where multiple hospitals use the same computer system. Local hospital BB employees do not have access to see, much less change, the truth tables in this computer. However, corporate makes changes in the BB computer system with no notice (or discussion of the change). The other day we were performing the second ABORh on a patient and there was a new reaction column (that we don't use on recheck types) added to the result field. When we entered correct results for the test with a NT in the new column, there was a warning "no pattern match". A few minutes later, these reactions worked. I did various tests to ensure calculations were correct. About 6 hours later, after I had left for the day, corporate emailed me that they had changed this test and we needed to validate it immediately. Last week I was on vacation and it would have been 6 days before I saw that email which was the first notice I had received about the change, forget having input. Recently, second shift couldn't issue uncrossmatched packed cells (even O negs) because somebody somewhere accidentally changed something. When I demanded an explanation of what happened, they couldn't track when and who made the change. I know the way these changes are made do not meet any regulations. My Lab Director shrugs his shoulders. I have talked and talked to the computer people and demanded explanations and am told they are trying to get BB under more control, but nothing changes. We do not have a lab IT person so I am trying to do all of my other duties while working a bench and handling these problems. I document all of these as deviations, but that goes nowhere in this facility. I finally modified my validation policy to include a section on validating changes made by corporate with no notice. Any ideas on how to handle this problem?

Before we went on our current computer system we used "incompatible". Unfortunately, our computer won't let us put the unit in a crossmatched status so we can issue it if we interpret as incompatible. So, we moved backwards & now interpret it as "least incompatible" so we can issue (with an override).

I do understand the need to monitor blood utilization. I just don't know if it is worth placing patients at risk to have the sole tech in the Blood Bank checking all the pertinent lab values prior to transfusion, calling the floor to determine the need for the transfusion if the lab values do not meet criteria, and then leaving the lab to go to the Medical Director's office down the hall to get approval to transfuse the blood. This has been mandated by our Laboratory Director. The other day, I was working on 4 patients, left to go get the approval and came back to a line of floor personnel waiting on me to issue blood to 3 patients. I am often the only one in the lab who can issue blood, answer any Blood Bank related questions, or perform any Blood Bank testing. I often do the daily reviewing/paperwork after second shift arrives and there is no overlap in Blood Bank between the first and second shift schedules in the Blood Bank. There are 2 techs in Hematology and two in Chemistry during the day, but the Laboratory Director states they are unable to get the Pathologist's approval because these technologists do not have the pertinent information on the patient. When I told the Lab Director today that it adversely affected patient safety for the day shift Blood Bank tech to be interrupted so much while working on multiple patients, I was told I talk too much about patient safety. How do other places handle reviewing all values pre-transfusion while performing all of the work in the department?