John C. Staley

This was a few years ago but when we changed our way of doing things I reviewed every transfusion for 3 months to get a base line and identify any issues with the change such as nurses needing more training or stronger threats. After the initial 3 months I reviewed every transfusion for one month quarterly then after a year of that I did the month long review every 6 months. Seemed to work for us. This was in a 300 bed level II trauma center with a 28 bed NICU and active heart program. I'm not sure if there are any new requirements but generally such requirements never seem to be specific enough to really give in guidance. At least that's how I remember things.

I have never heard of any such requirement but like Kathyang I have seen studies indicating that anything over 10 hours was not a good thing. The last 14 months I worked is was Friday, Saturday and Sunday from 1800 to 0600. It was a small hospital and I was not consistently busy by any stretch of the imagination but I can tell you that the last 2 hours were the most difficult. That may have be age related more than anything else. Having spent many years in facilities where the nurses in the most critical areas (ICU and ER) work 12 hours shifts, most of the nurse related mistakes I had to deal with as Transfusion Supervisor were with those nurses.

The smaller the facility the more likely this is. Even in the very small facilities some one is responsible (read supervisor) for each department and it not unusual for some one to be responsible for more than one such as blood bank and hematology which would require them to be proficient in both and possibly more. Personally, I always preferred being very good in one department instead of competent in many but that's just me.

I have found this to be true regardless of the inspecting/assessing agency. Whenever you are dealing with people personal bias will be involved at one level or another. Some are better at controlling it while others make no effort in that direction. Good luck with your inspection. Do the best you can to prepare but always remember....... They can't kill and eat you, it's against the law.

Merry Christmas to those of you working today. You are not forgotten or unappreciated. Thank you for taking up where many of us have moved on. It is comforting to know we have left our stations in very capable hands. THANK YOU.

I'm curious, can you possibly detail what you mean by "misses a positive antibody screen"?

I used to tell new staff, primarily the recently graduated, that they should be competent in 3 - 6 months, comfortable in 6 - 12 months but never complacent and think they have "seen it all".

Cliff, it's still early and there is plenty of winter yet to come.

Odd, I'm looking out my window at over 8" of snow on my front lawn. Maybe we have it all. Next storm I'll send east.

Just out of curiosity, does anyone remember why it was included in the first place? At one time, long ago, the weak D test was thought to be useful in detecting fetal maternal bleeds but that is long past.

I have never seen a need for an exclusive blood bank arm band. If the universal hospital arm band provides the needed info and is used appropriately then why needlessly complicate a process with a blood bank exclusive arm band? Complicating process never makes it better. To answer the original question we required Patient's full name, DOB, and MR # along with the phlebotomist's initials and date/time of the collection. Utilizing the biologics arm band system (pre barcode tech) the 1st three were provided on the label made directly from the patient's armband. The last 3 were hand written by the phlebotomist. I'm certain the technology has changed but I'm confident the bar code systems function very much the same. As far as regulations go I believe that CAP or maybe JACHO required 3 identifiers and 2 of them had to be full name and DOB. I may be mistaken in this but that's what I seem to remember.

As I recall the taking of vitals as it relates to transfusion was determined by the local (state) nursing guidelines. Consequently, as the Transfusion Service Supervisor I had very little input in these types of decisions. I imagine they received information from national level nurse organizations. I believe that our protocol was just prior to the start, 15 minutes into the transfusion and then hourly until completed. Our biggest issue was where it was documented. Originally we had a place on the "bag tag" for documentation but then the nurses began complaining that they were documenting the same info in multiple places so we dropped it from the bag tag. Actually it made my job easier and made the bag tag much more user friendly.

If this is such a rare happening my suggestion is, if it ever does happen, simply do the best you can with what you have. If you come up with some procedure then you will have to review and train with it on a regular basis and I would suggest that once per year is not enough. Bottom line, you cannot prepare for every eventuality your fertile mind can come up with. The key in the rare circumstances is to not panic or get bullied into doing something you know is not correct. You can drive yourself crazy with all the "what ifs". I am all for preparation but it must be reasonable and realistic.

I'm just curious but are any of these people, Transfusion Safety Officer, Blood Utilization Manager and Blood Utilization Medical Director, part of the Transfusion Service with a blood bank background? If not, what is the Transfusion Service's involvement in the process?

It's always safest to follow manufacturer's instructions but, generally, it's OK to set your own expiration dates as long as they don't exceed those set by the manufacturer. The easy thing to do if you feel the need to have one sample expiration date for antigen testing would be to check all of the antisera and set your date for the shortest listed.