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Posts posted by Bill
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I went through this discussion several years ago with an oncologist and our pathologist. My question to both MD's, "What indicator do we use to report a suspected transfusion reaction, if not rise in temp? After much thinking and discussion, we all concluded that we had to work up the rise in temp as a suspected transfusion reaction. Good luck!
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We have Ci4100 and love it! For low volume i1000 tests, it is nice to load reagent while running. Very little down time; sample volume in the 150ul area for most tests. Only issue is when you have more than 25 individual tests running at once--it really slows down at that point. Error messages are not alway the easiest to interpret without using onboard reference manual. Any specific questions, send me private message.
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In addition to API, AAB (American Assoc of Bioanalysists) also has a program that is less expensive than CAP.
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Been there, done that! We had a patient that did exactly the same everrytime he came in for a transfusion (about every 3 weeks for >2 years). No matter what was said to him, he would go outside for a cigarette(s) as soon as 1 hour vitals were done. Usually, he would come back just in time for 2 hr vitals. Like you said, you can't tie them to the bed. On a more serious note--if you have this type patient, use a bed check to at least let you know he has left the bed.
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Same as Terri
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At least two labs that I worked in had evacuation plans--vertical, horizontal, and total. In the vertical and horizontal plans, we had built in to take blood refrigerator with us to specificed location and record temp when we got there--always within 5 min. Total ourside evacuation was to pack units in supplier boxes with ice, if time allowed.
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Case #2 is reportable because the CLS did not catch a hemolytic reaction prior to further transfusions--if the CLS had inquired into the history and knew of the transfusion days earlier, the need for elution would have been clearer. Also, we do not know if a full IAG crossmatch was performed due to lack of info. That would complicate matter even more.
The only reason Case #1 might be reportable would be because of hospital "visit number" not matching--leaving a discrepency in demographics. Also, this would depend on hospital/blood bank policy about the "visit number."
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Acetest tablets are again available. We have received 3 different shipments within past four months.
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According to TJC, worksheets from which conclusions are drawn must be kept 2 years. Thes antigrams are considered worksheets and do not need to be kept--however, the last place I worked as a manager, we did exactly as you--scanned it for future reference. (Saved on hospital network with 3 level back-up).
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One hospital that I worked at with this problem merged the Transfusion Committee with the Medical Staff Utilaztion(sp) Review Committee. The blood bank and nursing people attended the beginning of meeting with the transfusion business and left so the medical staff finished all the other UR stuff. Not much time to talk procedures, supply, vendor, etc issues, but the MD's did get involved with unnecessary transfusions better. We later added a subcommittee for all the non-UR issues to better address those issues.
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We have tried that but the MD's state they have to do something and giving FFP won't hurt them. Shows how well MD paid attention in coag class.
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I'm out of that loop--sorry
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This is the way Ortho (Kodak) has advocated for 30+ years. There method does include the Delta Bili that liquid reagents do not include. The method works very well except when you transfer a neonate to regional NICU whose lab uses liquid reagent methods--the coorelation of neonates is not that good. Overall though, my experience with this method vs liquid is much better. The test CV for the slide method is excellent.
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Does the Blood Warmer include an intergal pump? I have worked in 3 places now that OR uses warmer for all IV's including blood.
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1. Yes--90 ml/hr.
2. Only if previous transfusion with fever or hives.
3. Fever OK--look for 2 F rise in temp.
Hope this helps.
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Yep--that is same here for ALL therapeutic drugs.
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If you get a barcode hospital ID band system, I can almost guarantee that someone will find a way to work around it when it is more convenient. Nothing is foolproof if people get to take shortcuts. And they will take shortcuts if they don't agree with the value of the system.
Mabel--I have seen it with the Pharmacy system that you must Barcode Wand the wristband every time you open their medicine drawer. The RN's print a barcode label for each patient and keep it on the med cart. In my opinion, the only hope of compliance is to "Keep It Simple St**id.
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As a father of a soldier who was killed in Afghanistan, I have seen the "walking blood bank" work! My son was in the high mountains over 2 hrs away from any facility and 3 hrs from nearest hospital by helicopter. He transfused soldiers with blood from his squad on more than one occasion. It would indeed be very interesting how many of our brave men and women have been saved vs killed by the "walking blood bank."
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I agree with Scott--be very carefull what you put on this (or any) website.
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Here, all Blod Bank testing other than ABO/Rh & DAT is performed on mother's blood.
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In the old days, we were cited by TJC for using pH paper--the reason was that it was not sensitive enough. We gave up using random platelets at that time.
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Clinitest tablets are now available again--just received new shipment last week.
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The Blood Bank staff always seem to be put in the role of "policeman." Any documentation that needs to be checked is placed on the Blood Bank staff, whether it be checking MD orders, MD reason for transfusion, RN documentation of transfusion, etc. This is the role of Risk Management and should stay in that dept. Concurrent documentation checks is the best way to keep everyone out of trouble. I have seen this as a collaboration with the coding team and risk management. The increased revenue more than offsets the cost of additional people.
Workups for Antibody patients
in Transfusion Services
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They are worksheets upon which a conclusion is decided. According to New York State regs, worksheets only need to be kept for 1 year. I believe that TJC says 2 years for worksheets. Even if these are copies of reports, they only need to be kept for 7 years. Most blood bankers keep them "forever" for comparison reasons. If room is the issue, why not scan them and keep electronic copy?