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We don't perform many of these and, according to the latest update from the manufacturer, the cells I have should still be in date when they start shipping. However, I had decided that if we did not have in date complement control cells, we would send the tests to our reference lab. They have more resources than I do.

Management and accountability go together. If you document errors and the director just shrugs his shoulders, the techs know they can slide by with inferior work. Neither our Director nor Assistant Director were ever supervisors over other techs. They sit in offices down the hall from the lab and write, what I am sure, are outstanding reports. There is no on-site technical laboratory management. Recently, a replacement Hematology position (this Hemo tech is also trained in BB to cover for me when I am off) was advertised for 0600 to 1430 with the tech working in BB from 0600 to 0630 to help me do the morning work before going to Hematology. I had asked for help in the mornings for years because I am by myself over 80% of the days I work and I often arrive at 0600 to multiple same day of surgery patients, reviewing all work (including antibody identifications), maintenance, temperatures, QC, etc. In addition, third shift only works on STAT patients leaving all early morning work for me. The new tech came at 0630 and went straight to Hematology. The Director took 9 months to inform me (after multiple questions as to why she was not coming at 0600) that it made the new tech happier to come at 0630 and he didn't see any reason to make her unhappy. Then this tech made multiple errors on a day when she had to cover BB while I was having a medical procedure. The new tech stated she is not in there enough in the mornings to know what to do. (This tech had made multiple previous errors where the Director's response was a shrug.) This day, the Director informed me "I believe she is a good tech but as you know it can get stressful in your department and having the knowledge and forethought to resolve some issues can be difficult for someone who works limited hours in blood bank." DuH!!! That said, I honestly believe the second and third shift techs (all generalists) know I hold them accountable when they work in BB and they work hard to meet the standards in the BB. However, these same techs may be late for work over and over, or just not show up for work, because they know there will be no repercussions from laboratory management.

Can I come, too? Should be able to make it Friday night. Thanks,

We had a company wide validation when we went on Cerner ME, but you still have to validate the computer crossmatch works in your facility using your policies. There were some options in the electronic crossmatch program that needed changing before we went live that passed the company validation. There is one option where you can't add on units using the electronic crossmatch after issuing a unit without an override. That had to be changed. We use a Blood Bank bracelet and they didn't have a spot in the electronic crossmatch to enter the bracelet number so it would print on the tag. We resolved those problems and then validated in-house. The techs were given an in-service and had to pass a written quiz. We waited a couple of months just to get everyone used to the new computer before changing to the electronic crossmatch. Some of the facilities went live without validating in-house and were calling me to see why they couldn't use the electronic crossmatch after issuing a unit.

MAC - my son convinced me to switch last spring and I am so glad I listened to him. I use Office for MAC. Word and EXCEL files switch between the work computer (Windows) and my MAC with no problem. It took a little getting used to, but the MAC is more user friendly to me.

When Immucor sent out its letter stating it was going to require PBS for the fetal screen kit, we switched from the Blood Bank saline to PBS for everything. Some of the Immucor antisera inserts require a saline pH of 7 so I had been checking our saline's pH for a while and it wasn't consistent. It just seemed easier to switch to the PBS for everything.

We have techs who rotate through different departments who won't touch a unit of blood without gloves. However, they leave their cell phones by their work stations in Micro and Hematology and talk and play on them while gloved. I realized this one day when a tech in Micro texted her friend who was in Blood Bank that day and the tech in BB picked up her phone and replied. I have asked them not to use their cell phones at the bench, but they say the lab safety manual does not address this issue. This thread reminded me of that problem. Is this issue addressed at most places?

No solution for you. My main one is when a covering physician orders irradiated and then the regular physician returns and has no idea we are giving irradiated. We review the original order when they first order something special because our order entry personnel kept checking off the special needs with no orders. Once we add a need, it can only be removed by physician order. So, if a physician orders irradiated, the patient gets irradiated until a physician writes an order that irradiated is not required. However, if the regular physician doesn't realize we are giving irradiated, he doesn't know to stop the order. If we think a patient's diagnosis doesn't require irradiated products, we can take the info to the pathologist to double check the orders.

AABB Standard 5.11.4 requires us to retain patient samples and a segment from any red-cell-containing component at refrigerated temperatures for at least 7 days after transfusion. So, if specimen draw date is day 0 and you can issue until midnight of day 3, you need to keep until midnight of day 10, at least. We do the rack rotation and keep a segment when we crossmatch. Some places remove a segment when issuing and keep the segs 7 days. We can extend samples on pre-ops that meet criteria and when we do that, we have to keep those samples and segments in a different location so we can keep them the correct amount of time. At one place we could extend for 14 days and we kept 28 days of samples, but that took a lot of refrigerator space.

I totally agree that our BB reagent QC doesn't usually fail, but we have a policy to follow if there is a problem. Part of our daily QC is to document the lot number, expiration date, and visual checks. If reactions are not acceptable, we document the original reactions and repeat the testing. Usually, this resolves the problem - the tech remembers he forgot to add something and this is documented on form. If this doesn't resolve the problem, our policy is to test a new vial of same lot number and a vial of a different lot number (if these are available). If the product does appear to be "defective", we quarantine and attempt to determine reason - is one bottle contaminated or whole lot number not reacting correctly? If we contaminated a bottle, what did we do to contaminate it? If we cannot resolve the problem, we notify reagent company. All control failures and corrective actions are documented and trended on a spreadsheet. Looking back over the past 4 years, I don't find any times where the problem with daily QC wasn't tech error. However, during the same period, we have notified manufacturers regarding problems with screen cells and fetal screen kits that were not detected when we performed reagent QC, but were found in routine use.

That is about 10% of the components we transfuse each month. The 40 components usually represents about 15-20 patients which is a little over 10% of the patients we transfuse. We try to make sure each floor is represented according to the number of units they transfuse. However, since we don't give much blood to OB patients, there is almost a 100% audit of their transfusions. A floor that transfuses a lot would have a lower percentage of their transfusions audited.

I can't believe you found vendors to provide lunches. Our blood supplier brought us some candy and that was the only vendor who gave us anything. We get lunches a few days and the techs brought items for sundaes one day. Unfortunately, I was too busy in Blood Bank to participate - after I brought the ice cream. Last year, our hospital provided massages to the nurses during their week. Today, there was a huge banner regarding Volunteers week and they are having an off-site luncheon. Imagine, having lunch and not having to go issue blood or answer the phone while you are eating! I would appreciate that more than them providing lunch!

After our JCAHO inspector couldn't find the transfusion information on several charts he pulled, we switched to doing what John does. Only we review about 40 transfusions per month after the charts are scanned in the computer. Since we have all the transfusion information on the tag, we check for the tag to be in the medical records and have 9 items we check on the tag. Some of the items we check are: the two signatures for identification at the bedside are on the form, the transfusion was completed within 4 hours, the vitals are complete and "on time" per policy, etc. We use this as a quality monitor. We found we were getting the back copies in the lab, but they weren't getting the chart copies in the appropriate place on the chart so it didn't make much sense for us to be checking the back copies. Currently, the copies are usually on the chart and the completion stats are much better, but I don't know if we will ever reach 100% on the information being complete. As John says, it does give us interaction with the nursing staff because we take the incomplete forms to the floors. We include all floors that transfused blood in the audit, but everything else (shift, component transfused, etc.) is random. On the last JCAHO, they checked several charts and the info was there.

A different tech gets each CAP specimen and I keep a spreadsheet so I can make sure each tech gets a variety of CAPs - if the tech got a DAT last time, then they may get a fetal screen this time or one of the "J" samples. The techs complete the paperwork as if it is a real patient, but there is no way they don't know it is a CAP. The only problem we have had is that we did get low on the "donor" cell one time with each tech doing his own antigen types on the donor. Now we put one of our antigen typing stickers on the donor red cell bottle so we don't antigen type the donor multiple times. If it were a real donor, we would label the unit with the antigen types we had done so I decided we could do that.

Lisa, that is a nice webpage. I had an outpatient OB patient in her first trimester who had reactions like this. Incubating the reverses at room temperature and 4C with an autocontrol didn't help. Absorbing and elujting with antisera and her cells yielded nothing. Had this been an inpatient I would have called the floor before doing all this testing to see if she were immunocompromised or had had a bone marrow transplant, but I just assumed an outpatient OB wouldn't have had a bone marrow transplant. When I finally called the physician's office for her history and explained the problem, they didn't have any information. A few minutes later they called me back, laughing, because they called the patient and she had had a bone marrow transplant in her teens and never bothered to tell her OB doctor. Don't know it that is your problem, but it did teach me not to assume anything about patients and their problems..

The OCD 0.8% Surgiscreen cells are suspended in a low ionic strength diluent according to the manufacturer's directions. The limitations of the procedure state "addition of other potentiators to the gel test card is not recommended and affect these test results." The anti-IgG in the gel cards is suspended in a "diluent and buffered gel solution".

I would wash and resuspend with diluent 2. There is another thread about concentrating .8% cells and I posted I had switched from a .8% panel to the 3% panel. . One of the reasons I switched was we had a couple of cases where we were getting reactions with all our .8% screen and .8% panel cells and referring them to our reference lab. They didn't get anything. Since our autos suspended in diluent 2 were negative, I decided to try diluting a 3% panel with diluent 2. Whatever the reason, we have gotten a few patients where the screen cells are positive, but the diluted 3% panel is negative. I first noticed this problem after the new formulation for the .8% cells so I totally agree with Malcolm that it might be the antibiotic they use now in the .8% cells. On the ones where the diluted 3% panel was negative, I did try washing the screen cells with the diluent 2 and testing them and it made the reactions weaker. Since I had done a gel and PEG panel and there was no reactivity in either of those, we just called it a reagent problem with the .8% diluent.

Is it acceptable to wash the cells with saline and then use the cells on gel? The insert for the 0.8% says to use the cells directly from the vials. If you are washing with saline, aren't you washing off the enhancement?

Totally agree. We also buy the .8% screen cells and 3% panel. We originally got the .8% panel, but after several issues, I switched to an Immucor 3% panel. Although we have to dilute the cells for the gel panels, there are times when we want 3% cells. We still do some of the antigen types in tubes so we don't have to concentrate the cells for the positive and negative controls. We have had several weak reactions in gel panels where a quick selected cell panel at room temperature was a perfect anti-M. I can also do a selected cell tube panel when I have an ABO discrepancy faster than I can concentrate the screening cells.

Gel may be missing a variant of the D antigen. We routinely use gel for our ABO/Rhs, but perform weak D's on the babies of Rh negative moms who test Rh negative in gel to detect those variants. Personally, I have never had one of these weak D's be positive. On the other hand, we recently had an OB patient who typed Rh positive (2+) in gel. Her prenatal work-up had her as a Rh negative and she had received antenatal RhIG. We did a tube weak D and the test was negative. Her baby was Rh positive (4+) in gel. We sent out a KB stain (no fetal cells detected) and gave her another dose of RhIG. I called customer service and they asked me what the pH of my saline was. Woohoo - we use PBS and it is 7. Then they said it must be a variant. Just wondering - did your patient receive Rh positive blood in the past and is the antibody screen still negative?

[quote This Supervisor stated that she had used a references that stated that it should not be drawn less than 1 hour post partum, but should then be drawn ASAP. /QUOTE] The package insert for the Immucor fetal screen kit references a John Judd article from a 1990 (I believe) Transfusion article that states this. Every place I have worked has always drawn the fetal screens with the next morning's lab work. However, since my current location does not perform cord blood testing on deep nights, a cord blood collected at 2200 will be reported after the morning collections so the fetal screen might not be collected until 32 hours post delivery. I read the reference for the insert hoping to find a specific number of hours to collect the sample. Since ASAP was not defined, I just said that the sample should be collected between one and 24 hours post-delivery. I never heard of any problems with drawing the sample for the test the next morning, but the 32 hour window for drawing the sample seemed a little long for an ASAP. We do type all OBs when they are in labor so I asked the techs to gie the phlebotomists.the Rh negative moms so they can get us a sample for a possible fetal screen test when they do the post-delivery morning collections. If they are candidates, they don't have to be recollected for the fetal screen. Not a perfect solution, but we have a policy signed by the Medical Director.

In the mid 70's, I worked at a hospital that incubated the tubes in a 37C waterbath. There was a reference (don't remember) that you had to add time (I think it was 5 minutes) to the incubation if you used heat blocks instead of water baths because it took longer for tubes in incubators to reach temperature. So they incubated in a waterbath to save the 5 minutes. That may be where this procedure originated. We also performed screens in duplicate, leaving one set at room temperature for 15 minutes; did a 15 minute room temperature saline crossmatch in addition to the AHG (polyspecific, of course) crossmatch; and performed minor crossmatches. Can't even imagine doing that now! Obvously, I am too old to be doing this job!

I have never worked in a hospital that gave the 28-week RhIG, but I worked in an outpatient lab where our routine work was type and screens on OB patients. Usually, the physician's office would draw the blood for the antibody screen and then give the RhIG to the patient on the same visit. Basically, they did a type and screen early in the pregnancy and an antibody screen (sometimes they repeated ABO/Rh) drawn just prior to the 28-week RhIG injection.

We get the 0.8% screen cells and a 3% panel. If we need to perform tube testing, we select cells from the panel to test.

We switched to this policy a couple of years ago and had the same results. We get and keep all the cords 10 days. If the mom is group O, Rh negative or has a clinically significant antibody, we routinely do the DAT on the cord. If the mom is Rh negative we also do the ABO/Rh on the cord. At first they would order an elution if an O negative mom had an anti-D probably caused by RhIG and the baby was an A or B positive with a positive DAT. They ordered a few of those elutions and then decided it didn't affect how they treated the baby so they stopped ordering them. They have ordered DATs a few times on cords of jaundiced babies who don't meet our routine criteria. There have been no complaints since we started this policy and the techs really like it. :)