ANORRIS

We send blood around the system all the time and once one site has performed the retype after receiving it from the blood supplier the second does not have to. We share a computer system , Medical Director but all have different CLIA numbers. This never has been a problem with the accrediting agencies AABB and CAP, nor with the FDA. 

Hi Scott,
This is what they are stating here. Which tells me that they are not checking the blood before it gets hung. They say they use a white board but I'm almost certain they are not checking the blood with the white board and I don't think that's acceptable (I can't find literature on this at least). I'm concerned because several times they send a courier that is not involved with the case to pickup blood and if there are two patients receiving blood and the courier takes it to the wrong room, this can lead to some serious issues if they don't properly check the patients and the blood. 

I believe we do this during the time-out, before any wrist bands are covered up.  
Scott

Can you get a copy of the policy from your supplier that they use to validate their shipping containers?  Type up a letter for your pathologist to approve explaining it and give that to your Quality people.  Then if they want something more, ask them to show you the regulatory standard they are worried about.
Scott

Before I answered the question I wanted to wait and see what other people had to say.  BankerGirl, thank you for your last sentence.  It is a philosophy I had followed all of my career.  I understand the argument that everyone is responsible for the patient's well being but at some point you have to draw the line and make everyone responsible for their piece of the process.  

We phone once.  When a nurse signs out the blood (electronic) we have a place where they must confirm the consent form and the physician's order to transfuse is on the chart.

I think you need to demonstrate in Day of Use/Daily QC that the Anti-IgG Gel card reacts properly with positive and negative control, not only in the Indirect Antiglobulin Test (indirect agglutination with 37C incubation), but also in the Direct Antiglobulin Test (direct agglutination without incubation).

We phone once.  When a nurse signs out the blood (electronic) we have a place where they must confirm the consent form and the physician's order to transfuse is on the chart.

with our ordering scenario, the MD can provide the order to transfuse w the orders for components.  I do not f/u on orders, we do not have access to the MD order set.  The only time I call is to the OR.  Everything is electronic.
 

Hi Blood Bankers,
This question may have been brought up in the past, but I did not do a proper search of the forums to see if it has.
 
My Question:
As Blood Bankers, how do you make sure that the Nursing Orders to Transfuse (or Administer) Blood Products are followed - for example...Physician orders Products to be crossmatched but not transfused...Nurse sees that blood is ready (or receives a phone call from Blood Bank that they are ready), does not check the Administer orders and comes down and is issued the product and hangs it.
 
Or second scenario...Blood is ordered to be Administered (and of course is crossmatched).  Nurse never comes down to pick it up from the Blood Bank.  We do not call nursing a second time - once is our practice to call when the blood is ready (plus they can see it in the EMR on their side).
 
Thank you.

We must have a current ABO/Rh done on the current visit.

We must have a current ABO/Rh done on the current visit.

It is also easier to take inventory when they are standing up.  If they are flat you would have to pick them up to count????

It is also easier to take inventory when they are standing up.  If they are flat you would have to pick them up to count????

It is also easier to take inventory when they are standing up.  If they are flat you would have to pick them up to count????

It is also easier to take inventory when they are standing up.  If they are flat you would have to pick them up to count????

It is also easier to take inventory when they are standing up.  If they are flat you would have to pick them up to count????

The key here is they came to Linda and asked for help!  

Hi Logan,
I am an AABB perioperative assessor  (and laboratory manager  )that  works at a facility in Boston MA that uses cell salvage on over 3,000 cases annually. We have 11 machines, and although we are not (yet) accredited by AABB, with the work we have done with our program, we are hoping to be accredited for periop by our next BB inspection.
I got involved in this because our SVP for surgical services asked me, as the resident AABB SME, LOL, to evaluate effectiveness of cell salvage at our facility. She wanted us to adhere to the AABB standards and thought I was their best candidate to lead the effort. 6 years later, the past practice is truly history.
To answer your question, we do QC quarterly on each machine that we have in use--- Hgb and Albumin. AABB allows you to decide what and how much is needed, but for quality purposes, you really do need something to make sure your equipment (and operator) is obtaining the best possible product for the patient in between PM's. If you would like more information on our approach, I am happy to share what we do, just message me and I will give you my work contact information.
Between Cell Salvage and other specific PBM strategies, we have reduced our organization-wide transfusion ratio per adjusted patient discharge, from 0.78 to 0.17, in ~5 years time. ( Caveat: The cell salvage program overhaul took some time and was truly implemented last).  I actually like to think it is because Blood Bank is involved, but honestly, it takes a village and I had to build influence up with the surgical services team and make really good use of my role as Transfusion Committee Facilitator to make things happen.
Best,
Linda

What I quickly realized was that no 2 inspectors/assessors focus on the same thing.  As David noted, they seemed to focus on things they were either cited for or had cited others for recently.  Over the years I had been cited for something that had passed all previous inspections because the inspector simply did not like the way we did it.  When I challenged the citation with the inspecting organization the citation was often over ruled, not always but often enough to make the challenge worth while.  My best advice is to prepare the best you can and consider the inspections a learning experience and hope that David is your next inspector.  On a side note I was a Blood Bank inspector for CAP for 30 years so I had ample experience on both sides.  One last bit of advice, never ever argue with an FDA inspector!  

My main concern would be the cold ambient temp in the OR.

Check with your blood supplier.  During transport (up to 8-12 hours), platelets are not agitated.

I have been CAP and AABB for 30 years, and I only run pos QC,except both pos and neg for anti D.  Never had a problem.

Considering the push to using Low Titre O Whole Blood for MTP and trauma's, i'd say the benefit outweighs the risk.  I have personally seen two incidents where a panicked Blood Banker accidentally issued O FFP in emergency release situations.  In both cases, the patients turned out to be incompatible blood types (one A one B). Guess what, there was no adverse effect whatsoever in either case.  No sign of hemolysis or transfusion reaction weeks later. 
 

Report as Rh Indeterminate and treat as Rh+ for RHIG coverage of the Mom