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jalomahe last won the day on October 17

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About jalomahe

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  1. We would report the gram stain as negative and the culture as positive with the identified organism. Actually blood bank wouldn't be reporting anything....microbiology would since they are the ones performing the testing. Our BB and Micro departments worked together to set up a procedure for handling transfusion reaction workups that required micro so that everything is consistent with best practices. Micro even takes care of notifying the patient physician in accordance with their critical call policy. After they notify the physician then they notify the blood bank so we can notify our blood supplier etc.
  2. Tracking Transfusion Orders

    We are a similar size hospital as you with a Level 3 Trauma. We use Sunquest with electronic crossmatch. What you are describing as performing the crossmatch at the time of order defeats the biggest advantage of electronic crossmatch ... inventory control. For patients who are electronic crossmatch eligible we only crossmatch the unit at the time the unit is requested to be issued for transfusion. So that clinical staff know that we are not "ignoring" the crossmatch order we created a comment "Blood will be crossmatched when the order to transfuse is released. Contact the blood bank when ready to transfuse." This comment is resulted on the crossmatch order and goes to the patient chart. We have a box on the counter where we issue units that we keep the original crossmatch order in so we know what patients are currently electronic crossmatch. The tech that works that bench goes through it every morning to weed out the ones that are expired. When we receive the transfuse notice we pull the order out, match it to the transfuse order, do the electronic crossmatch and immediately issue the unit to the location (we tube units). If the original order was for more than one unit, we update the number of units on the paper order to reflect how many units are left on the order. The computer of course keeps track of it automatically as units are crossmatched and issued. Works well for us.
  3. Antigen Typing Alternate Proficiency

    RCBCAT is required since CAP specifies that you have to do alternate if there is not a survey available. Now the RBCAT is available, you have to use it ....
  4. Pregnancy Termination and Rhogam

    20 Weeks. Theory behind it is that the prior to 20 wks even if the total volume of blood from the fetus were to have crossed the placenta and entered the maternal circulation it would not be enough to exceed what is covered by a single full dose of RhIg. Also we only issue full doses, we do not stock micro-doses.
  5. CAP Alternative Assessments-Help!

    CAP survey RBCAT twice a year, 2 specimens per shipment, multiple antigen typings on each specimen.
  6. Antigen Typing Alternate Proficiency

    CAP also has a separate survey RBCAT (Red Blood Cell Antigen Typing) its 2 shipments a year, 2 specimens per survey and each specimen has typing for multiple antigens
  7. Original validation of serological centrifuge is done to determine the correct RPM (or CF) and time for obtaining the optimal cell button. Unless you do something to the centrifuge that affects one of these two factors then re-validation is not required.
  8. RBC Inventory Practices

    We keep a 5 day red cell blood supply on the shelf. Our blood supplier sets the inventory levels annually based on the previous 12 months utilization. We are approximately 30 minutes from our blood supplier. They stock us daily M-F and then we can submit requests 24/7 if we have a need.
  9. New reagent lot QC

    All reagents are QC'd in accordance with the package inserts. We use Immucor reagents so our we use "corQC" to QC traditional reagents (ABO, Rh, antibody screen). We use reagent screen or panel cells for Pos/Neg QC for antigen typing sera. The only lot-to-lot QC we do is for Fetal Bleed Screen Kit with a lot-to-lot QC. We haven't had any problems with CAP inspectors with this QC plan.
  10. Rosette test quandry

    First, you have a discrepancy between the Mom's Rh type on the pre- vs. post-delivery specimen. That needs to be resolved just as you would need to resolve an ABO discrepancy. I would suggest that a new specimen be collected from the Mom and tested. If the new specimen's Rh type agrees with the pre- specimen, then it would indicate there was a problem with your post specimen either misidentification or contamination. Repeat the rosette test on the newly collected post specimen. If the new specimen's Rh type agrees with the original post- specimen then you have your answer that the rosette test is false positive due to the Mom having a weak expression of D which interferes with rosette testing. You are not detecting Rh + fetal cells, instead you are detecting Rh + (weak) maternal cells which would explain why the rosette test is positive but the KB stain is negative. You would also then need to follow up as to the pre- sample and whether it was misidentified at collection, etc.
  11. IQCP

    Welcome Skye Unfortunately you have posted your question under the Blood Bank section of this site and I'm afraid we will not be of much help with your question. There is a Micro section on this site. If you click on Home at the top of the page and then scroll down you will see it. The lab department sections are in alphabetical order so Micro is down the list a ways. Hope you get the answers you need.
  12. Antibody Titers Gel vs. Tube

    We do our titers in tube. Years back when a lot of places had switched or were getting ready to switch to gel there was a conversation about the difference in titers due to sensitivity of gel. The basic conclusion at least in our geographical patient care area: we didn't want physicians to be getting different titers from different labs solely due to differing methodologies as it could lead to unnecessary concern/procedures for the patient. So we all stick with tube method. In those instances where we detect the antibody by a more sensitive method i.e. gel or Capture but the titer is negative then we report the antibody titer as less than 1 (<1). Jan
  13. Sunquest Billing - Irradiation

    Our irradiation charge is built in the blood component code RAFI is Irradiated Red Cell which includes billing for the red cell plus irradiation plus our processing fee. When the product is issued all is billed. To fix the problem for units going to a patient that does not need irradiation we created two billing codes to back out the irradiated blood charges and re-bill the unit as a non-irradiated unit. CRAFI (credit RAFI) and BRAF (bill RAF). When the unit is issued these codes are used in the pop up charge window. So far it's working for us.
  14. Disinfecting Blood Bank Coolers

    We have a log book that we use to keep track of coolers. We indicate what cooler went where, when so we know when they are approaching 4hr being out of the department and if they go missing we have a way to track it down. When the cooler is returned it is cleaned and that is documented on the form also. COOLER LOG.doc
  15. Return and Reissue of components

    Nursing policy states they are to begin transfusion within 15 minutes of receipt unless the unit was issued in a cooler and if they cannot they are to immediately return the unit to the blood bank. Our nurses are very good at following this policy. That being said, there are times when the unit doesn't make it back to the blood bank in that 30 minutes but it will be back in less than 45-60. Red Cells obviously will not be within temp range so if returned they are discarded. Any other product, if it's within temperature range yes, it will return it to inventory for re-issue. As for Red Cells if they unit can't be returned in <30 minutes and the problem is they blew the IV and they are working on starting a new line started they are told to keep the unit at room temperature and transfuse BUT they MUST complete the transfusion within 4 hours (maximum allowable transfusion time) of when the unit was released from the blood bank. Any time a unit of blood/component is wasted an electronic Safety Report is completed that goes to multiple people to review: patient safety, nursing location manager, transfusion safety officer, laboratory manager, etc. for follow-up.