lgabbert

Thanks to all for the responses!

We are not a trauma center. We use Meditech, and issue with emergency release. We had someone sent from the floor to get "Universal Blood", but that person had no information about patient, not even a name even though patient was in house, so they were sent to get info. Now nursing wants to change policy because it took too long. I think education would be better here than changing policy. Thanks for input.

I am being pressured to do emergency release units without a label. I have contacted CAP, and they said I need two identifiers. What policies are out there? Do any of you give O neg units without two patient identifiers?

Love it!!

We had a woman who was 2.6 g/dl. She drove her husband to the doctor's office for his appointment, but she was the one who ended up in the hospital. Can you believe she was driving?

Our hospital has Meditech 5.6. We want to know what others are doing when a patient comes in as outpatient for preop type and screen, then is admitted after surgery and then receives blood transfusion. Since these are two separate accounts, how does billing handle this, and also, if we want to set up TAR, how does nursing find the correct account when the blood bank is on the out patient account? Currently, someone transfers billing from the outpatient account to the surgery account when the patient is a presurg. However, when the patient is admitted to the floor, i.e. orthopedic surgery, we have issues. All advice is welcome!

We are a small rural hospital (80 beds), and recently had a patient in the ER with possible ectopic pregnancy. Dr. orders TS etc. Phlebotomy drew blood and banded. Patient stated name as "Smith," and computer labels are "Smith", therefore banded with that name. Before phlebot leaves room, admitting personnel enters, and patient says she has recently been married, name is "Jones." Phlebotomy comes back to lab with blood and wants me to tell her what to do. I tell her blood must be redrawn. She disagrees, because she knows blood is from that patient. ER changes name in computer system, so "Smith" is no longer being used. I made phlebot redraw and reband patient. My question is, where do I draw the line? Did I do the correct thing, or should I have let the phlebotomist reband and relabel the patient and blood tubes? I thought the phlebotomist should have rebanded and relabeled in the room before leaving the patient. What do you think?

We went live in Meditech about a year ago. We did not use Rh undetermined in our module. We added a Du test on the cord bloods. They default as "NP". If the baby is Rh neg, we do the Du, and result it. Meditech has a pop up box that warns the type is wrong when we enter an Rh neg, with no Du result. The reason I see for Rh undertermined is that if the baby is Du pos, we type the baby as Rh pos so the mother gets RhIG. If the baby returns when it is older, we would have to change the type because we do not Du test anything but cord bloods. A little confusing!

What do you do if the patient has an Anti D? Do you refuse to release the RhIG? I think our physicians would give the RhIG anyway. I believe we would have a problem refusing their order. In fact, I had a young woman in the ER having a miscarriage who was allo anti-D and the RhIG was given. The ER doc stated, "It won't hurt her will it?"

I mean no type and screen at the 28 wk visit. We do a type and screen on all the clinic OB's for their first OB visit. Therefore, we usually have records for the patients. What is the purpose of doing the T&S at the 28 wk visit, other than to confirm whether the patient has or has not been sensitized from the previous screen? As I understand, the reason for waiting until 28 wks for the antenatal rhogam is that the fetus does not have enough blood volume to produce an antibody reaction, so the chances of the patient being sensitized before that should be very low. If they have been sensitized, would the physician not give the rhogam? I think some of ours would still give rhogam. What are your thoughts on this? Am I on the wrong track altogether?

Our facility does not band patients for rhogam. It is difficult enough to get outpatients who are receiving blood to keep the wristband on, much less OB patients, especially for 72 hours! I bet you don't get reimbursed for the second type and screen either. I have been wondering if we can drop the antenatal screen altogether. What do the rest of you do?

Our hospital policy is the same as yours Stephanie. No one has ever questioned HIPPA violation.

Our pipette does not reach the bottom of the pink tube, so when the crit is low, the plasma must be removed also remove the cells in order to pipette them. How do others handle this?

I attended an Ortho inservice recently. They stated that gel cards should NOT be respun.

I would like to know if there is a time limit for length of transfusions. I have a transfusion checklist that shows a single transfusion took 8 hours!! I cannot find anything that states what is too long. Just recommendations that blood should be infused in 2-4 hours. I would appreciate feedback. Thanks.

I have noticed elderly patients at our hospital or from the nursing home with hemoglobins varying up and down, and have been curious as to why there is so much variation. I find these explanations very interesting!!

I would like to know thoughts and policies for reporting weak D on gel testing, specifically on OB patients. When we used tube method, we did not do a weak D test so the patient was typed as Rh neg and therefore received Rhogam if indicated. However, recently we had a male patient who was typed as a weak D on a previous visit, but in gel he was Rh pos. I also recently learned that the reagent for D testing is much more specific, and that different manufacutrers react differently with each D variant. Hence the confusion about mothers and when to administer Rhogam. Any suggestions would be appreciated.