krichards

I know I have seen somewhere that relabeling FFP when thawed (with 24 hour expiration) is not required. However, now that I need that source I cannot seem to locate it. Can anyone tell me where I can find this in black & white? My lab manager was told that JC requires it, and would like to have some documentation to the contrary.

I, for one, am thrilled to see this site expanding. Not every user on this site is confined to keeping up Blood Bank rules, regs, etc. I oversee both BB and Microbiology, and will greatly benefit from a similar access to the wealth of knowledge found in this site. Thank you! Thank you! Thank you!

For your VP pondering this idea: Do you require the techs to look at the physician's written order for every CBC, CMP, etc? Do you require pharmacy to look at the same orders for every drug dispensed?

Thank you all for your input. I have an exceptional Micro staff, and they have been extraordinarily helpful in covering my deficiencies and general lack of knowledge. With two exceptions, they have all been with us for over 20 years. I am relying on them heavily for any and all input. It is, however, embarrassing that I cannot answer a simple phone call without having to run back and get a quick lesson in order to provide even the briefest of answers. Hopefully, that will improve with time. My primary problems lie with the rules and regs (they can only tell me what we are currently doing), and in "updating" some of our processes. I've already had 2 vendors tell me that we are holding some of our cultures longer than anyone else. With 2/3 of the staff eligible to retire, I need to start finding more streamlined processes to help the techs when we have to start running with fewer and/or less experienced staff. Unfortunately, they're going to fight me on any and all changes, but I am responsible looking at the bigger picture, and have no intention of implementing anything that will not, ultimately, make all their lives easier.

I was recently "awarded" our Microbiology department in addition to my BB duties.:eyepoppin I have not done more than plate cultures since school. To top it off, I began maternity leave just a couple of weeks later. Now, I am 4 months behind in 2 departments, and still have very little idea what I am doing in Micro. Does anyone know if there are any sites similar to this for Micro? Or if there are any other similar resources out there than can help me get up to speed and get questions answered fast? Needless to say, I need all the help I can get!! Karen

You might also want to look at Thermogenesis. We've been using them for years, and love them.

Our PI director has told me that there are benchmarks out there for appropriate levels of wastage. However, I have not yet been able to find any. I may turn this over to her, since she says she has seen them before. I'm in agreement in that this may not be appropriate or meaningful for our facility. Our blood utilization committee would like to establish an acceptable waste threshold, based on those at other facilities or national benchmarks, because they do not want to have to discuss product waste at every meeting.

Does anyone have any benchmarks for what constitutes an acceptable level of waste?

Our facility merges "No ID" trauma patients with their old records only AFTER calling the BB. If the patient has a current sample, then they wait until the sample expires. If the patient does not, then we give them the ok to merge records.

We had a physician tell us recently that he could not donate because he was too busy saving patients' lives!

We run a DAT on the Echo in lieu of an autocontrol.

Our Transfusion Committee was disbanded about 5 years ago due to lack of interest and participation. Every time the issue comes up, our pathologist chooses not to re-create the committee for the same reason. Our stats are currently presented in our Quality Council and Patient Quality & Safety Council...the former is physician-only, the latter being primarily dept. administrators. Because the BB stats are only a small fraction of what is covered each month, our medical director and lab director present these stats in the meetings, not me. When I have all my reports completed each month, I simply email them to the lab and med directors with my comments. These comments are then repeated almost verbatim when they are presented. For us, this arrangement has worked well for everyone involved.

We have been using our Echos for close to a year now. We identify an average of 4-6 Kells each month...some id'd when we were still using gel, and many that were not. Like others have commented, we have discovered antibodies not detected by gel: Jka, C,and E. Yes, gel sometimes catches something that the capture does not. However, we feel that we are detecting many more antibodies with capture than we are missing, and that those we are missing are most likely IgM.

We allow phlebotomists, and anyone else who has documented training, to collect BB specimens. We are 350+ beds, with about 10,000 units transfused annually. We would never consider allowing, much less requiring, our BB techs to do their own draws. We rarely have more than one tech working, and if they are out drawing, who is going to get the blood ready for the next trauma or bleeder that walks through the door? Can the nurses or phlebs work up antibodies??? You do have two good options: You could have all the patients delivered to the BB so that your techs could draw them. Or, you could ask the COO, with his BB experience, to do these draws for you. We did implement bedside scanning this year. However, our nursing units, most notably ER, refuse to use them. Their list of excuses goes on forever. I'll never understand why so few nursing personnel understand the importance of patient safety. As always, our safety measures are only successful if they are used by everyone all the time.

I built an interface between the Echo & Sunquest this summer. Let me start by saying that I am not an IT person, and have never done anything remotely like this before. I was introduced to a lot of Sunquest functions that I never knew existed. Our biggest difficulty was getting a connection established. Once we finally got the connection established, I pretty much followed the directions SQ gave me, and had absolutely no trouble. Both Immucor and SQ were extremely helpful when I got stuck. If you have any questions, let me know. I'm more than happy to help, and it's all still pretty fresh. Karen

Although I should, I do not know what Texas' requirements are. However, I can tell you what goes on here in the western part of the state. Our hospital (350+ beds) requires a BS, MT, and 5 years experience. However, many of the smaller nearby hospitals have MLTs as BB supervisors, and there are even a number with MLTs as lab directors. With the shortage of techs, I see this only becoming more common, especially in the more rural areas. In the 10 years that I have lived here, no one has gotten into any sort of trouble because they don't have MTs in these positions...if there are regs, they are not enforced. Let me also add that I have both an MLT and an MT...and went to school for both. Sad to say, I learned almost everything I know from my MLT program. The MT program added very little, if anything, to my knowledge base. It is the quality of the program, not the number of years it takes to learn it, that makes the tech. Our lab is staffed almost entirely by MLTs...and that is not an issue, as they are all excellent techs. I have worked with MLTs who knew more about BB than I ever will, and MTs who were incapable of doing the minimal job requirements, and vice versa. Sorry for the rant; this has been a touchy subject here also. Karen

We have this happen occaisionally. I'm pretty sure I remember others posting similar remarks in this forum, as well. There doesn't appear to be much you can do about it. For me, this is just one of the Echo's quirks. (Every methodology has something!) I gave the idea of repeating all Rh testing in tubes some thought (not much). It's just not worth it in my opinion. For the patient with no history, we would consider the patient Rh negative, and never know one way or the other. If the patient has a history of Rh pos, then we will retype in the tube. We have seen <10 of these since our go-live in May. Of these, probably 1/2 typed as <2+ in the tube. If you were not already aware, the Echo only reactions 2+ or greater positive.

Our validation process was almost identical to dmpollock's. We validated approximately 50 samples for each test. We also have chosen not to run cord bloods or crossmatches on the Echo. It may help to know that our installer told us that the Echo will not reliably pick up "fake" antibodies that you make up with antisera. I have not yet tested this to see if that's really the case. Because of this, we froze some of our known patients until we were ready for validations, and had no problems. Once the LIS interface was built, I validated with about 50 more samples for each test. The entire implementation went very smoothly. Since our techs were eager to try out our new "babies", there were plenty of volunteers willing to help out with the validations!

Our procedure manual is available both on paper, as well as online as word documents. This is a very recent addition for us. As many of our techs are highly experienced, I am not sure how much use either version gets. I can tell you that our newer techs prefer the online version; our more senior techs tend to prefer the paper...probably a case of old habits dying hard.

As a blood banker who was born in the 70s, I view life without computers as incomprehensible. How did anyone keep track of all their blood bank data on paper??? How was that possible??? It hurts my brain to even think about it. Don't forget, there's always Prozac and Xanax;) However, I will never give up hoping for the day when all lab personnel (and especially us blood bankers) are paid what we're really worth. Double the pay would be a good start, though.

John, The main reason for implementing the second draw is a recent series of major errors. Of course, all patients involved were drawn by the same ED employee....one of those people who have access to, but refuse to use the handhelds. Currently, our handhelds are only accounting for around 60% of our patients. The rest are coming from ED, outlying outpatient areas, pre-ops, nurse collects, etc.

I have been looking into instituting a second sample requirement for retyping our patients with no history. I have some questions, though, and would like to see what other facilities are doing. Our phlebotomists are using handhelds for all their draws. In my mind, because the patient has been positively identified prior to the label printing, these do not need a second draw. Is that correct? Outside of the ED, the nurses will not have handhelds available for their draws. Is it too complicated for everyone if I institute a requirement for second draws for only non-handheld collected specimens? Since the handheld labels look different, the techs will not have any trouble distinguishing. Has anyone else tried this? Has anyone had much luck getting other departments to use handhelds? Our ED currently refuses to use them, claiming that they are too slow. I'm almost sure I can cure them of that, though. How are others handling their pre-op patients? These seem to be the majority of the patients we see without previous histories. Our surgical staff is already overloaded, and I'm afraid if I put the burden on them to collect a retype at the time of admission, that they may run out of the hospital screaming. I appreciate any input. Karen

We do a full workup antibody ID for our Rhogam Ds. If they have a known history on their chart of RhIG in the past few months, then we report the antibody as "Anti-D, possibly due to Rhogam". We leave it to the docs to follow up with a repeat should they have any questions regarding passive or active immunization.

Last month I developed a ref lab agreement with an neighboring facility. When it came time to figure the charges, I realized that we had not cost-per test available for our antigen typing. It was a massive headache, but in the end, I am satisfied that my number is quite accurate. We used that figure to determine how much to charge the other hospital. I chose to include all our antigens at one set price. However, it is also acceptable to divide your antisera into different "levels" based on cost, etc. If you are interested, I will be more than happy to share my spreadsheet as well as how I calculated this. Karen

Thank you so much for the information! I have been beating my head against the wall with this one. Adding the charge to the product itself will definitely make things easier. The AABB Billing Guide is just not that explicit. Thanks again.