krichards

I had no idea! I thought I was old when I did it at 32! Thanks for the info! My question now is: How many women are doing this in their 60s? Is the risk high enough that I should consider revising the age limit? And if we do, will they just start doing it their 70s???

HELP! Are there any billing-proficient people out there? My lab director wants to start billing a processing and handling fee for all our blood products transfused. However, our billing people seem to think this is not quite legit. I, of course, am just the person caught in the middle of this mess. I have a copy of the AABB Reimbursement Guide, but it does not list the proper CPT codes that the billing people say are required. I have not been able to find any additional information so far. Is anyone doing this? If so, are you billing separately, or is it included in your product charge? If you are billing separately, what revenue code and CPT code are you using? Do you know of any resources that could better explain this to me? I really appreciate any help!

We have a Terumo SCD. It is 13 years old, and has never had any problems. We couldn't function without it! Our tube sealer is currently a Genesis. It is 2 or 3 years old, and has not given us any problems either.

I agree! The best way to get your administration to approve any expense is to prove to them that the expense will actually save them money. I know it's a real pain, but you need to sit down and figure out how much you are spending in tech time, dry ice, lost products. Calculate your actual expenses, as well as potential expenses. Put the right spin on things, and you can make the potential expenses seem so large that your request for funds seems small by comparison. Another thing I've found highly effective is to mention patient safety as often as possible. Our administration, like most, is highly supportive of anything required to maintain patient safety. Potentially compromised or unavailable products definitely falls into that category! If you can combine both money and safety, then I am sure you will succeed. Also, be sure to submit documentation to back up your request, even if it is not required. This way, you can highlight how detrimental the current situation is. Good luck!

We issue emergency release blood for traumas, and any other situation that warrants it. We just require a page or phone notification for the request. If the patient has no ID available, we will not release the blood until registration enters the patient as a "No ID" and we have 2 forms of identification and a patient armband. We use a hand-written emergency release form. A copy is retained in the blood bank, and the original is put in the patient's medical record. We also label all units with an "Uncrossmatched Blood" sticker. We have recently modified our "women of childbearing age" limit to <50 years. Surely we're getting them all now!

I have been working on a similar release for crossmatch-incompatible units for our WAA patients. Now, I am being told by our Patient Quality Care/Safety person that this form is all wrong. She seems to think that the release should not be to ensure that the doctor is aware of the risks and accepts responsibility, but rather re-phrased into layman's terms to inform the patient of the situation, and then have the patient sign accepting responsibility. She says that the physician, because he has an MD after his name, is already fully aware of the nature of WAA, and does not need to sign any sort of release. Has anyone else run across this? I've been pondering this for a couple of weeks, and have yet to come up with a simple way to explain a WAA in a sentence or two (or even a paragraph or two) that explains the situation well enough for the average person to make an informed, educated decision to accept the blood. I would appreciate any input on this. Karen

We have all generalists on our evening and nights shifts. We made the switch from gel to the Echo this spring, and have had absolutely zero problems with any of our techs adapting to the change, generalist or not, experienced or inexperienced. The change in methodology was a non-issue for our facility. Karen

We have the same transfusion criteria at our facility. Although I don't recall ever getting a dialysis patient with a Hgb >10, we would simply pass it on to our pathologists for approval. Our pathologists pretty much automatically ok any renal patient, as well as any other conditions which result in chronic anemia.

We are a 350 bed facility, and we do not keep AB or B neg on hand either. Actually, do to lack of demand, our blood supplier does not keep these on hand either. Our local blood supplier serves a large geographic region with a mostly rural population. Many of the facilities they supply are <50 beds. The solution our area has found has been to supply the smaller outlying facilities with fresh stock every two weeks or so. The unused, shorter-dated units are brought back, re-processed, and then delivered to the larger hospitals (usually us), where they can be used before expiration. We only rarely have a unit expire on our shelves. You may want to talk to your local blood supplier to see if a similar arrangement can be worked out.

We have set our TAT at 45 minutes for all stats. The exceptions being positive antibody screens and antibody histories. While we could probably move it to 30 minutes, I have chosen to leave it where it is for now. We monitor our ERs at least once per week, and 95% is the benchmark our facility has set for all lab testing, not just BB. I have not bothered to monitor the rest of our stats. I assume that if any other stat was delayed, the techs were busy with a higher-priority patient. After all, the fact that over 90% of our samples are stat has more to do with the nurses wishes than the doctor's actual orders or the patient's condition. Karen

Thanks for all the information! I checked the Echo's manual, and it has the same limitation on tube reactions of 1+ or less. I think the solution for our facility will be to hurry up and discontinue weak D testing as quickly as possible. This way, we will catch fewer of these situations. If no one knows there's a discrepancy, then we'll all sleep better at night!

I know the standards have changed since our last policy revision. I had planned on getting us up to date on that in the very near future, but am now hesitant to take any action until the problem is resolved. We can't get enough Rh neg units to take care of our true Rh neg patients without adding false Rh negs to the mix! I'll be very interested in what Immucor has to say.

We have seen this problem twice in the last month on our Echos. The first case was a patient who had weak D testing performed accidentally, and the Echo reported it as weak D pos. The patient then typed as Rh pos in tubes using Immucor's monoclonal D rgt. If you happen to discover anything, please post, as I am very interested in this problem myself. Karen The second case is an oncology patient who also had weak D testing performed accidentally. In this case the weak D testing was positive. When the patient needed additional blood 2 days later, a tube retype found the patient to be Rh pos. Currently our policy is to perform weak D testing on all females <50 years with no previous history. If it were not for our techs forgetting the age requirement, we would not have caught either case. Although not detrimental to the patient, our Rh-neg blood inventory needs all the help it can get. I mentioned this in passing to Immucor, and they did not know of any problems with this. If I find any more occurances, I will be putting in a call to tech support.

The Echo does have a bidirectional interface. Since I don't have HCLL, I could not tell you about their end of things. We have 2 Echos at our hospital, and this has allowed us to run our STATs without little or no delays. I don't feel the Echo is a true walk-away, but I just moved back to BB from chemistry...the difference in technology is huge. However, it takes just a minute or two to start a run. You just have to come back when you're ready to result, or add on more testing. We only have 2 day shift techs at our facility. So, it definitely has not saved us a tech, but it has enabled us to keep up with our ever-increasing workload. (Although we still need a third tech!) That will depend our your demographics, however. How much time is also spend doing other component prep, issuing, etc.

Kate, I am also using Sunquest, and am very interested in how you do your antigen typing charging. We currently charge for each sample tested, unit or patient, and for each antigen tested. For some of our patients, this can take several minutes of counting and adding. How does your method work? I would like to continue to capture all possible revenue, but would like to streamline this, if at all possible. Any help would be greatly appreciated. Karen

It looks like they took the measures of their site when the poll closed a few weeks ago. If you like, I have a copy I could fax to you.

Because we still do some tube testing, we still subscribe to the manual J-series CAP, which is rotated among all techs. We also purchase Tech-Cheks from Immucor which contain simple antibody workups, ABO discrepancies, etc. These are also rotated among all techs, so that each tech receives a minumum of 2 Tech-Cheks and 1 or 2 CAP samples yearly. This provides each tech with an opportunity to prove competency on a regular basis. Of course another, more inexpensive, option would be to provide your generalist techs with samples you make up in-house for competency purposes.

I would also greatly appreciate a copy. I am about to start revising ours as it is several years out of date. krichards@echd.org Thank you!

I will start using the HemoTemp indicators in the next few months. I have been wondering what the easiest way to go about validation will be. It already seems like all I do is validate, so I don't want to spend any more time on this one than necessary. I would be very interested in hearing how you went about your validations, David.

We are using the Echo. We also have a manual workstation that uses that Capture strips used on the Echos. We have not yet set up this manual station, but plan to in the next few weeks. We are also keeping all of our tube testing reagents for those situations where the capture technology does not suffice. We have eliminated all our gel reagents and cards due to the cost and additional equipment required. We do almost all of our antibody identifications on the Echos as well, and our techs are loving how much of the workups are now hands-off.

We do exactly the same...try to keep it to 2, but will give up to 8 if the situation warrants it.

We do not worry about transfusing our female neonates with Rh positive platelets as their immune systems are not sufficiently developed to produce any anti-D. We try to give all our babies either AB or type specific. If these are not available, we leave it to the neonatologist to decide what he wants to do...and if he wants to give anything else, he must sign an emergency release form. We use the Chartermed syringes with filters attached for our RBC and PLT aliquots. We've been using them forever, so I am not sure what validation method was employed when we put them into use. It was WAY before my time. We keep the 30cc and 60cc in stock, but there may be more options available. We use Pall filters for the FFP aliquots. Although, when unavailable, we have used the Chartermed syringes for these as well. I have never heard of saline for neonate use. Our nurses deal with all of that at bedside, since we no longer wash cells. We do not irradiate a unit until it is needed to give. Once irradiated, we assign it to one (or sometimes two if they are not very sick) babies within the first 2 days. After that, we will use the unit to expiration (28 days) for those babies. Our neonatologists are willing to risk the increased K+ levels in order to reduce total donor exposures. To date, we have not had a single baby with K+ problems that were traced back to a donor unit. We are using the Terumo SCD. We have had this since the mid-90s, I believe, and have had no problems with it. I highly recommend it. I hope some of this will help.

Our chemistry dept does a body fluid PT that includes pH. Can I borrow this survey for our pH testing and document for PT purposes? Or is that unnecessary?

I received a notice this week that CAP is now offering proficiency testing for bacterial detection in platelets. Our facility relies on our blood supplier for culturing, and we only check the pH of the unit prior to issue. It has never crossed my mind that we are not participating in any type of PT for this. For that matter, we have not even been performing QC. My lab manager would now like to look at PT for the platelet pHs, but does not want to spend the money for a full survey if we will just be using one component. Is anyone using the urine or body fluid survey as PT for the platelet pHs? Is anyone using a different method of PT for this? What QC methods are being used? Is a urine QC sample considered acceptable? I appreciate any input. Karen

JCAHO has proposed 19 new measures related to Blood Management. These are now available for viewing on their web site. Additionally, they have posted a survey inviting public comment on these until Aug 19th. Since I have not seen any mention of these measures on this site, I wanted to make sure everyone knew. Since the BB will be the primary area affected by these measures, it is important we get our two cents worth in now. Karen