John C. Staley

We found that certain specialties were not interested in our standard critical values and instituted their own for their patients. Not a big deal because there were not many. One in particular was Oncology. I don't remember their values but I do remember they were considerably lower than our standard critical values. They also indicated that they only wanted follow up notification if the values dropped significantly and they told us what a significant drop was. I'm sure you are aware that critical values is not a "one size fits all" and it is a case where flexibility can be your friend. Talk with them or better yet have your medical director talk with them and see what they would work best for them. I found over the years that a doctor to doctor conversation was often much more productive. Of course that assumes your medical director is willing to go to bat for you.

We started with Immucor's ABS2000 in 1999 and kept the manual / tube technology as a backup. Shortly before I left in 2009 we had up graded to the Immucor ECHO with 2 of them. A month ago my wife was having back surgery in that facility so while waiting I stopped in for a visit. There was only one Transfusion Service staff member still there from my days as the supervisor. They now have replaced the Immucor equipment with some Ortho stuff. (I almost said piece of crap but didn't). None of the staff are happy with the change forced on them by the cooperate mothership hospital fondly referred to as the Death Star since the day it was built. Apparently the first unit they got never did work and after over a year of struggles it was finally replaced by Ortho with another one and the verdict is still out on the replacement. If I had still been working there I'm sure the switch to Orthro would have precipitated my departure. I'm sure many of you are delighted with Ortho. This is just my opinion on them and their equipment. It all started when the Ortho rep told me that if we didn't become an all Ortho Blood Bank we were extremely stupid. (I am paraphrasing but maintaining the gist of his words.) Before I got side tracked with my rambling I meant to convey that Automation is a great advancement for Blood Banking. My Transfusion Service was the first to automate in the Rocky Mountain West and we never looked back or regretted it as long as I was there. The reason I left is a long and dreary story best shared over a pint or two in the local pub. Wow I'm on one today!!! Cheers to you all and a very Merry Christmas. My heart goes out to all of you who will be working the Christmas shifts. You are indeed the true heroes!!

Very sad to hear this. I spent, what I consider, a great deal of time with John and enjoyed every minute and learned more than I remember from him. The highlight was when I ran across him in Vienna in 2000. I was presenting a poster on automation in the transfusion service and he was attending as well. We had a most delightful conversation. In my estimation he was one of the great ones. It was his papers on dropping the autocontrol from pretransfusion testing that convinced my medical director that it would be ok for us as well. Thanks John Judd, you are fondly remembered. Thank you Malcolm for letting us know. Was he residing in the UK? I lost track of him when he retired.

I'm curious, who's idea was it to move the RhIG to the pharmacy? It never came up at any of the facilities I worked at or were familiar with. I know it's been discussed in these forums on occasion but I don't remember what the driving force behind it has been.

That was my only experience with the glass as well.

This does provide for an interesting dilemma and discussion. How do you register and bill a patient who never entered the facility? What is your facility's relationship with the transport companies? Are they owned and operated by your facility? Do you have a formal contract with them that includes providing blood products? These are just a few of the questions that come to mind. I have no problem with what anyone did in this scenario but I do wonder what a few of the various inspectors / assessors I encountered over the years would have to say about it. I'm not a big proponent of living in the world of "what if" but it can be interesting to visit there once in awhile.

Unless things have changed, I would consider the length of time from issue to completion of the transfusion more important than the time from issue to start. I'm assuming that a unit still has to have the transfusion completed within 4 hours. As for start time, that was initially instituted for returned units to be placed back in the refrigerator for reissue and as stated above 30 minutes is way too long. The 30 minute rule was instituted when blood was issued as whole blood in glass bottles and I doubt in anyone currently following this website ever saw that, me included! Time to drag a few nursing protocols into the 21st century!

I hate to be the mercenary here but who's going to pay for it?? Probably going to be one of those "cost of doing business" things.

As Joanne mentioned above, no system is fool proof and there are lots of creative, inventive fools to prove it. Keep your system as simple as possible which should minimize the need for creative people to find ways around it. Now to your question, does it actually help prevent problems? Probably a few but certainly not all! I've seen people become lax in their diligence when they assume they are protected by the system. They seem to assume that if they make a mistake someone down the line with catch it. This is something to be avoided if possible. The only way that I know of to prevent this type of mind set from developing is through education and convincing everyone involved in the process that their step is critical and by keeping it simple they will be more likely to perform their step as instructed.

I believe it's called "Computer Systems / Software / ISBT128". You may want to check there.

I was going in the same direction as well.

Any testing between 2014 and now? Were any units transfused in 2012 or 2014? I assume if either these questions are you would have mentioned it but I don't like working on assumptions.

Cliff, my 1st thought was to ask, who handles the financial aspects of your process? In other words who charges who for what concerning any blood transfused by the helicopter crew? What made me think of this was when you mentioned that BMF sold the plasma to a fractionator instead of returning it.

I'm just curious but what do you weigh on this scale that would make a range of +/- 5 gms unacceptable?

Something to consider. If the charge drops at XM you might get paid for it. If it drops at transfusion and the blood does not get transfused you will definitely not get paid for the XM. Something to think about. We dropped the charge when the XM was completed. Another little story from the past. Us old guys like little stories from the past. I was called to the billing office to "discuss" a billing issue with someone from the insurance company. She wanted to know why we charged for the XM when no blood was issued or transfused. I told her that the DR. had ordered the testing in the anticipation of needing the blood because the surgery routinely required transfusion. We did the work and charged for it. Her contention was that since the patient did not use any blood the testing was unnecessary! At about this time I asked to see her license to practice medicine. She became quite incensed when I told her that insurance companies had no business practicing medicine. That's when our conversation came to an abrupt end.