jalomahe

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

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.  

If the patient had a pre-delivery Type & Screen performed then we only do the fetal screen post delivery.

If the patient had a pre-delivery Type & Screen performed then we only do the fetal screen post delivery.

The IT department should not be able to NIX instrumentation selection for the lab. If the ECHO is the best fit for your lab then that's what you should go with. I suggest having Immucor Sales Rep get the Immucor IT folks to talk to the hospital IT folks so they can speak the same language and understand what the issues and whether or not they can deal with it until the new W7 version is available.

The IT department should not be able to NIX instrumentation selection for the lab. If the ECHO is the best fit for your lab then that's what you should go with. I suggest having Immucor Sales Rep get the Immucor IT folks to talk to the hospital IT folks so they can speak the same language and understand what the issues and whether or not they can deal with it until the new W7 version is available.

I'm not sure what IT has to do with it. They usually balk at versions for PCs that are used for normal PC use. That's because they are required to support those PCs when there are issues. Since the ECHO PC is only used to interface with the ECHO and the IT is not who has to provide technical support for the PC they shouldn't even be involved other than providing access for an interface and to an internet connection for the cisco box. Any problems with the ECHO PC will be handled by Immucor, not IT.
I think they've overstepped their bounds on PC requirements.
 

I'm not sure what IT has to do with it. They usually balk at versions for PCs that are used for normal PC use. That's because they are required to support those PCs when there are issues. Since the ECHO PC is only used to interface with the ECHO and the IT is not who has to provide technical support for the PC they shouldn't even be involved other than providing access for an interface and to an internet connection for the cisco box. Any problems with the ECHO PC will be handled by Immucor, not IT.
I think they've overstepped their bounds on PC requirements.
 

I'm not sure what IT has to do with it. They usually balk at versions for PCs that are used for normal PC use. That's because they are required to support those PCs when there are issues. Since the ECHO PC is only used to interface with the ECHO and the IT is not who has to provide technical support for the PC they shouldn't even be involved other than providing access for an interface and to an internet connection for the cisco box. Any problems with the ECHO PC will be handled by Immucor, not IT.
I think they've overstepped their bounds on PC requirements.
 

If the tube testing showed 2+ or less reactivity with anti-D reagents (same as used on Echo) I would suspect that the reason for the negative results on the Echo is that the reaction was shaken away during the resuspension step of the testing.
Remember that Echo has an algorithm that it follows for resuspension. Shake so many times, swirl so many times etc. This can cause weak reactions (their limitations and warnings state 1+ or less) to be interpreted as negative by the instrument.
Techs who are resuspending a button in a tube are visually looking for an end point and immediately stop shaking the tube when the cell button is resuspended whether that takes 5 shakes/swirls or 15 shakes/swirls......Echo can't read for an endpoint in that same way, it must follow it's algorithm. Additionally techs consciously or unconsciously will adjust the intensity of their shaking in response to what they are visualizing. A good way to demonstrate this is to take that same specimen and have a tech who doesn't know what the reactions have been resuspend it with their eyes closed. Tell them to shake it for say 15 seconds and then see what the reaction looks like. It's a fun experiment.
Having said all of that.....if you see this often you can always have your FSE come in and adjust the resuspension step.

Question. How likely are you to be doing titers on maternity patients that might have titers performed at another location? Since the sensitivity of Gel is higher than tube methods might you give the pt's caregiver confusing information if your titer is elevated due to method vs true rise in titer?
I only ask since this was a question in our region where there are multiple hospitals that do prenatal testing and sometimes patients/physicians don't stick to one lab. The consensus was that for prenatal titers the standard of care within the area hospitals is to perform the testing by the Uniform Tube method so that there weren't variations in titer strength based solely on methodology.

So I'm guessing you are a really small lab without many resources?
What is your plasma usage? How likely are you to need plasma during the outage?
----You could thaw one or two prior to the outage to have on hand in case they are needed. You'd have up to 5 days to use them. That would give you more time to thaw using cold water if you needed more.
----Ask supplier for liquid plasma for use during outage?
----Is there a water bath anywhere in the lab that you could use?
----Microwave water and keep it in a large thermos would work and then mix with cold water to get temp you need.
To late now but for future..... if you are not a high volume blood bank, Helmer makes a really nice plasma thawer that does 2 units at a time. It's not terribly expensive and has a small footprint. Would be a lot better/safer than a bucket with running water.
 

If the tube testing showed 2+ or less reactivity with anti-D reagents (same as used on Echo) I would suspect that the reason for the negative results on the Echo is that the reaction was shaken away during the resuspension step of the testing.
Remember that Echo has an algorithm that it follows for resuspension. Shake so many times, swirl so many times etc. This can cause weak reactions (their limitations and warnings state 1+ or less) to be interpreted as negative by the instrument.
Techs who are resuspending a button in a tube are visually looking for an end point and immediately stop shaking the tube when the cell button is resuspended whether that takes 5 shakes/swirls or 15 shakes/swirls......Echo can't read for an endpoint in that same way, it must follow it's algorithm. Additionally techs consciously or unconsciously will adjust the intensity of their shaking in response to what they are visualizing. A good way to demonstrate this is to take that same specimen and have a tech who doesn't know what the reactions have been resuspend it with their eyes closed. Tell them to shake it for say 15 seconds and then see what the reaction looks like. It's a fun experiment.
Having said all of that.....if you see this often you can always have your FSE come in and adjust the resuspension step.

If the tube testing showed 2+ or less reactivity with anti-D reagents (same as used on Echo) I would suspect that the reason for the negative results on the Echo is that the reaction was shaken away during the resuspension step of the testing.
Remember that Echo has an algorithm that it follows for resuspension. Shake so many times, swirl so many times etc. This can cause weak reactions (their limitations and warnings state 1+ or less) to be interpreted as negative by the instrument.
Techs who are resuspending a button in a tube are visually looking for an end point and immediately stop shaking the tube when the cell button is resuspended whether that takes 5 shakes/swirls or 15 shakes/swirls......Echo can't read for an endpoint in that same way, it must follow it's algorithm. Additionally techs consciously or unconsciously will adjust the intensity of their shaking in response to what they are visualizing. A good way to demonstrate this is to take that same specimen and have a tech who doesn't know what the reactions have been resuspend it with their eyes closed. Tell them to shake it for say 15 seconds and then see what the reaction looks like. It's a fun experiment.
Having said all of that.....if you see this often you can always have your FSE come in and adjust the resuspension step.

If the tube testing showed 2+ or less reactivity with anti-D reagents (same as used on Echo) I would suspect that the reason for the negative results on the Echo is that the reaction was shaken away during the resuspension step of the testing.
Remember that Echo has an algorithm that it follows for resuspension. Shake so many times, swirl so many times etc. This can cause weak reactions (their limitations and warnings state 1+ or less) to be interpreted as negative by the instrument.
Techs who are resuspending a button in a tube are visually looking for an end point and immediately stop shaking the tube when the cell button is resuspended whether that takes 5 shakes/swirls or 15 shakes/swirls......Echo can't read for an endpoint in that same way, it must follow it's algorithm. Additionally techs consciously or unconsciously will adjust the intensity of their shaking in response to what they are visualizing. A good way to demonstrate this is to take that same specimen and have a tech who doesn't know what the reactions have been resuspend it with their eyes closed. Tell them to shake it for say 15 seconds and then see what the reaction looks like. It's a fun experiment.
Having said all of that.....if you see this often you can always have your FSE come in and adjust the resuspension step.

Without seeing the well images and/or the reaction strengths the Echo uses for grading reactions I can't say. Did the "0" result look at all grainy? Since the reaction strength for a "0" (Neg) is 0-2 and for a "?" is 3-9 perhaps your patient might have fallen at the upper end of "0" and the lower end of "?". I like reproducibility in instrumentation also but you will get variation at the low/high ends of cut-off ranges in all instruments. Would you have been as concerned if the difference was between a 1+ and 2+ reaction? Also remember that Immucor recommends reviewing all reactions prior to reporting your results just to make sure that it's not reporting a very weak reaction as negative. I'm not saying that happened in your case but it has been reported to happen. And remember, if the instruments were perfect all of the time they wouldn't need the techs LOL!

We are using Echos and prior to that we had a Galileo. There's an interesting phenomenon that can occur with automated solid phase that can cause a positive screen and then a negative panel. I have personally seen it happen at least twice. If there are bubbles/foam on the top of the specimen the instrument will pipet the bubbles/foam and this underpipetting of specimen can actually cause the absc to be look positive. When the panel is performed, the bubbles have already been removed and the instrument pipets the plasma correctly, the panel is negative. All of our techs are taught during training to inspect the specimen for bubbles/foam prior to placing on the instrument but sometimes it is a step that is overlooked when it's busy.
Another cause of false positive can be using cold undermixed indicator cells. If a new bottle of indicator cells is placed on the instrument without allowing them to warm the cells may not resuspend completely prior to being pipetted. Since the instrument pipets from just below the surface of the reagent it's possible to not have the proper amount of cells. This also occurs when bottles are loaded without a stirball having been added to the bottle.
Just a couple of other ideas for troubleshooting.

The question was about the ambiguity of the AABB published temperature requirements for transport.
AABB Stds state storage is 20-24C and Transport  "As close as possible to 20-24C"
What is considered to be "as close to possible"? If it is received from the supplier and the temperature is 18C is that okay? What about 16C? or on the upper side of the range....Is 26C okay or how about 28C?
How do I tell techs what "as close as possible" really is for transported platelets?
 

I'm the Lead Tech of my department and I have my phone number posted in the department so the techs can call if they have questions. I tell them I'd rather they call me and I solve their problem/question quickly (hopefully) instead of them either spending a lot of time dithering about it  and delaying results/care or doing something incorrectly, especially in the LIS, and it taking me hours later to sort it out and make the corrections. Additionally I live close by and have told techs, especially on evenings/nights that if they have something come in that they are having trouble handling to call me: example trauma/massive with antibodies. Some techs are comfortable calling me so will be more likely to call, others not so much and won't call even when they should have. I am never upset with someone calling even if they wake me from a sound sleep because if they are unsure enough to call me I don't want them to hesitate because they think I might yell at them. If it's something that they should have known how to do or should be able to follow the procedure I take that up with them the next day/shift that they work. But at the time they're calling me it's all about patient care and getting done what needs to get done.  I was a third shift tech for many years so I know what it's like to be having a problem in the middle of the night and needing someone to ask for help. Luckily no one abuses the courtesy of having me available 24/7 so it's never been an issue for me.

I'm the Lead Tech of my department and I have my phone number posted in the department so the techs can call if they have questions. I tell them I'd rather they call me and I solve their problem/question quickly (hopefully) instead of them either spending a lot of time dithering about it  and delaying results/care or doing something incorrectly, especially in the LIS, and it taking me hours later to sort it out and make the corrections. Additionally I live close by and have told techs, especially on evenings/nights that if they have something come in that they are having trouble handling to call me: example trauma/massive with antibodies. Some techs are comfortable calling me so will be more likely to call, others not so much and won't call even when they should have. I am never upset with someone calling even if they wake me from a sound sleep because if they are unsure enough to call me I don't want them to hesitate because they think I might yell at them. If it's something that they should have known how to do or should be able to follow the procedure I take that up with them the next day/shift that they work. But at the time they're calling me it's all about patient care and getting done what needs to get done.  I was a third shift tech for many years so I know what it's like to be having a problem in the middle of the night and needing someone to ask for help. Luckily no one abuses the courtesy of having me available 24/7 so it's never been an issue for me.

I'm the Lead Tech of my department and I have my phone number posted in the department so the techs can call if they have questions. I tell them I'd rather they call me and I solve their problem/question quickly (hopefully) instead of them either spending a lot of time dithering about it  and delaying results/care or doing something incorrectly, especially in the LIS, and it taking me hours later to sort it out and make the corrections. Additionally I live close by and have told techs, especially on evenings/nights that if they have something come in that they are having trouble handling to call me: example trauma/massive with antibodies. Some techs are comfortable calling me so will be more likely to call, others not so much and won't call even when they should have. I am never upset with someone calling even if they wake me from a sound sleep because if they are unsure enough to call me I don't want them to hesitate because they think I might yell at them. If it's something that they should have known how to do or should be able to follow the procedure I take that up with them the next day/shift that they work. But at the time they're calling me it's all about patient care and getting done what needs to get done.  I was a third shift tech for many years so I know what it's like to be having a problem in the middle of the night and needing someone to ask for help. Luckily no one abuses the courtesy of having me available 24/7 so it's never been an issue for me.

I'm the Lead Tech of my department and I have my phone number posted in the department so the techs can call if they have questions. I tell them I'd rather they call me and I solve their problem/question quickly (hopefully) instead of them either spending a lot of time dithering about it  and delaying results/care or doing something incorrectly, especially in the LIS, and it taking me hours later to sort it out and make the corrections. Additionally I live close by and have told techs, especially on evenings/nights that if they have something come in that they are having trouble handling to call me: example trauma/massive with antibodies. Some techs are comfortable calling me so will be more likely to call, others not so much and won't call even when they should have. I am never upset with someone calling even if they wake me from a sound sleep because if they are unsure enough to call me I don't want them to hesitate because they think I might yell at them. If it's something that they should have known how to do or should be able to follow the procedure I take that up with them the next day/shift that they work. But at the time they're calling me it's all about patient care and getting done what needs to get done.  I was a third shift tech for many years so I know what it's like to be having a problem in the middle of the night and needing someone to ask for help. Luckily no one abuses the courtesy of having me available 24/7 so it's never been an issue for me.

I'm the Lead Tech of my department and I have my phone number posted in the department so the techs can call if they have questions. I tell them I'd rather they call me and I solve their problem/question quickly (hopefully) instead of them either spending a lot of time dithering about it  and delaying results/care or doing something incorrectly, especially in the LIS, and it taking me hours later to sort it out and make the corrections. Additionally I live close by and have told techs, especially on evenings/nights that if they have something come in that they are having trouble handling to call me: example trauma/massive with antibodies. Some techs are comfortable calling me so will be more likely to call, others not so much and won't call even when they should have. I am never upset with someone calling even if they wake me from a sound sleep because if they are unsure enough to call me I don't want them to hesitate because they think I might yell at them. If it's something that they should have known how to do or should be able to follow the procedure I take that up with them the next day/shift that they work. But at the time they're calling me it's all about patient care and getting done what needs to get done.  I was a third shift tech for many years so I know what it's like to be having a problem in the middle of the night and needing someone to ask for help. Luckily no one abuses the courtesy of having me available 24/7 so it's never been an issue for me.

I'd say the fact that you are getting so many calls means that either training/competencies aren't up to scratch, or the SOP is lacking. You say that the tech had signed to say they were competent in the task - who had verified this? It sounds like you need to look at your own management, rather than blaming the techs.
I've been in the situation you are in as a young supervisor with people who are older (and more experienced in terms of years) below me and it is a hard place to be. Ironing out the issues with poor performers is the hardest thing to do and the only way to do it is with good competency-based assessments. Another thing to consider is including a list of changes when putting a new SOP out - you will find that 'old-timers' think they know the SOP so won't bother to read it (I've been guilty of that myself). Another thing I did was introduced an hour a day for each section where one person (on rotation) could spend the quietest time of the day (usually 11-12 or 2-3) getting up to date with any outstanding training. It meant that everyone (in theory) got an hour a fortnight. 
Do keep in mind that how they perform, and your response to it, will reflect directly on you - it's a good idea to keep them on side and make sure competencies are absolutely spot on. Anything that isn't can be brought up at their appraisal as a goal for the next year (not a stick to beat them with). Help your staff, keep them happy, and they will start having the confidence to trouble shoot themselves without fear of reprisals or looking stupid.
You could really make something positive out of this situation and get brownie points for it in your own appraisal.

I'm the Lead Tech of my department and I have my phone number posted in the department so the techs can call if they have questions. I tell them I'd rather they call me and I solve their problem/question quickly (hopefully) instead of them either spending a lot of time dithering about it  and delaying results/care or doing something incorrectly, especially in the LIS, and it taking me hours later to sort it out and make the corrections. Additionally I live close by and have told techs, especially on evenings/nights that if they have something come in that they are having trouble handling to call me: example trauma/massive with antibodies. Some techs are comfortable calling me so will be more likely to call, others not so much and won't call even when they should have. I am never upset with someone calling even if they wake me from a sound sleep because if they are unsure enough to call me I don't want them to hesitate because they think I might yell at them. If it's something that they should have known how to do or should be able to follow the procedure I take that up with them the next day/shift that they work. But at the time they're calling me it's all about patient care and getting done what needs to get done.  I was a third shift tech for many years so I know what it's like to be having a problem in the middle of the night and needing someone to ask for help. Luckily no one abuses the courtesy of having me available 24/7 so it's never been an issue for me.