John C. Staley

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.

I did not calculate blood bank TATs from order to completion. I started the clock when the sample arrived in the blood bank. I had no control over what happened between order and sample arrival. For the rest of your quest for info, I have been out of the loop too long to provide any current info. I'm looking forward to hearing what others have to say. Oh, my reference for my limited response was a 350 bed, level II trauma center.

I had never heard of it but it sounds like a great idea to me. Wish I had thought of it!

We started using the "current edition" designation quite some time ago and never had any problems. It made life much easier.

Been there, done that, thank God since I retired I'll never have to do it again.

We considered the AHG crossmatch as "additional testing". If any antigen negative units to previous identified antibodies, showed an incompatibility then a full panel was completed and more if indicated at that point.

I can't help you with the basis of your concerns but I do have to say that in Emergency Release situations I certainly consider the physician's signature as an integral part of the transfusion documentation and not a separate issue. Now, how to consistently get that signature has been an issue since the dawn of time or at least since the dawn of transfusions.