RR1

From the UK BCSH guidelines (these can be found in the reference section of BBT- Library/ UK/ compatibility guidelines):
7.7.2 The specificity of the antibody should only be assigned when it is reactive with at least two examples of reagent red cells carrying the antigen and nonreactive with at least two examples of reagent red cells lacking the antigen. Note that,wherever possible, the presence of anti-Jka, anti-Jkb, anti-S, anti-s, anti-Fya and anti-Fyb should be excluded using red cells having homozygous expressions of the relevant antigen.

For some hospitals however the the responsibility for ensuring compliance is forced down to the staff with the suggestions that if you can't cope with the regulations then you aren't suitable for the job. The 'resource' word isn't allowed. Goodness knows what will happen to staff at these places whene their CEO does actually get a talking to.
This UK collaborative document, which I do fully support however will potentially create an additional financial burden for BBMs on top of everything else- how much does it take for staff to finally give in?

From the UK BCSH guidelines (these can be found in the reference section of BBT- Library/ UK/ compatibility guidelines):
7.7.2 The specificity of the antibody should only be assigned when it is reactive with at least two examples of reagent red cells carrying the antigen and nonreactive with at least two examples of reagent red cells lacking the antigen. Note that,wherever possible, the presence of anti-Jka, anti-Jkb, anti-S, anti-s, anti-Fya and anti-Fyb should be excluded using red cells having homozygous expressions of the relevant antigen.

would it be correct to assume that ALL IT systems that affect the blood bank should have similar access controls, post service checks, disaster recoverability checks etc. This would include any document control systems and most importantly the hospital system where specific 'work areas' store forms, reports, inspection reports, BCR's documents??
Also would this include DATIX?

He was a wonderful lecturer and made things really easy to understand-  I feel privalaged to have attended one of his talks. 

He was a wonderful lecturer and made things really easy to understand-  I feel privalaged to have attended one of his talks. 

Human Error Categories.docx  
 
And look for system issues that set people up for human errors.  There are certain things the human brain/body tends to mess up.  I will attach a list I created of what I think are basic human errors that we need to help ourselves prevent by how we design our systems.
 

We do essentially what you have described.  We complete the "paperwork" when the emergency is over.  We document the release time/date on the emergency release form.  If we get a specimen, we will begin wokring on it starting with a stick type for ABORh.  Once we have this we will attempt to issue type specific.  Fortunately we rarely have to go this route . . . it would become a problem if there was more than one pt receiving unxm rbcs (in either ED or OR).  We would have to delay and place a pt name label on the units beside the unxm sticker. 
 
It was like pulling teeth to get my staff to release the blood without having labels and completing all the release documentation.  When someone is in danger of exsanguination the few minutes delay becomes a critical issue.  You know the staff dealing with the emergency is only interested in getting the blood into the pt - their documentation will be sparse too.  We passed our Trauma Designation inspection with flying colors and I quote one of the inspectors "I wish I could get my emergency department to provide service like this - they don't understand." 
 
If you haven't worked in a trauma center it may seem unconscionable to release unlabeled blood.  In the past I have grabbed 20u and run to the emergent areas because that was the fastest way.  In these situations the pt needs the blood more than you need the completed paperwork.

In the US we also have quality requirements (more extensive requirements every year) that are not supported by staffing. Supervisory functions aren't even included in our workload calculations. Somehow we are just supposed to magically find the time to get all that extra 'stuff' done. Keeps me off the streets at night!
 
And we have automated blood bank testing - they would remove that instrument from this lab over my dead body!

I was just curious.  I know that in facilities without automation, no matter the size, it can be the solution to staffing problems.  Or at least a help.  I'm not surprised that the non-technical aspect of the job has grown all out of porportion since I left.  We are seeing it even in small rural POLs.  The bottom line is, I think many, not all, but many of the problems you are seeing with staff is 2 fold.  First, a generational culture change and second, the work load that includes a lot more stuff that is not directly related to patient testing.  Please note that I said patient testing and not patient care.  These can be viewed as two very seperate things. 
There you have it.  A little more philisophical drivel provided free of cost. 

I'm curious, how many of you who feel you and the staff are over whelmed with work load have embraced automated testing in your blood banks?  I'm asking because my transfusion service was the first to embrace automated testing in the intermountain west (USA).  In 1999 I was at the point of needing to do something and my choices were more staff or some other way of testing that aided the staff.  Immucor had just recently come out with their ABS2000.  I was able to convince administration that we needed to leap into the 21st century a year early.  What the automation did was help provide the staff with more time to perform the tedious tasks that all the new regulations etc..  forced upon us.  Yes we still had the occasional human error, you always will when humans are involved, but they were few and far between.  As far as I'm concerned "multitasking" simply means you are doing multiple things not very well.  The use of automation allowed the staff to stay focused on all their other duties while the instruments was performing the routine testing.  I may be an old, semiretired romantic but I really don't think that anyone really wants to make mistakes. 

I think you are probably right Malcolm,but at least the requirements  will be documented, and if not adhered to and we can't sustain our QMS activities... then I suspect the regulators won't be very happy chappies!!
 
I hear the MHRA are now beginning to give Major non-conformances against staffing levels being minimal leading to staff being overloaded and there being a risk to quality........only a matter of time for these to be raised as Crital deficiencies if significant folk don't listen. 

Good luck with the staff capacity plan Rashmi! My own experience is that the plan is NEVER good enough to get more staff, but those that are far less efficient than you get a staffing increase. NOT BITTER, OF COURSE!

To look at this differently- could it be that we all have so many other tasks to do now that we don't have time to do anything properly?
 
I can't remember having to clean fridges when I was training - I don't think we even considered these things before regulation! though I have probably cleaned more in my BBM role than ever before... I don't remember having to accurately trace blood units,let alone read SOPs (they didn't exist!), auditing, and what was Incident reporting?? .Though I do see the need for all of these  activities and they do make sense.
 
I am in the process of writing a staff capacity plan to obtain more staffing (!!!) and this really shows where the gaps are in our lab activities;  if we weren't all trying to juggle so many tasks, performance would improve, but, I do agree there is a need for a lot more professionalism to be shown by some staff.

Rashmi, that could happen in the US as well, so those agencies have a mechanism whereby they can be contacted anonymously. Our hospital has a similar system in place where any healthcare worker can report an unsafe condition anonymously.

I tell anyone who refuses to do a job they think is beneath them to look at their job description, or look for another position.
 
I am a Band 8b, and I regard this to mean I am prepared to do any job from a Band 1 up to a Band 8b; in other words, I may not be qualified to do something a Band 8c or above, but I can sure as Hell clean down a bench.

Right then Rashmi, at long last I've got time to answer.
The answer to your first point is "NO". Part of the diagnosis of hyperhaemolysis (which is largely a diagnosis of exclusion, rather than inclusion) is that the post-transfusion Hb is ALWAYS lower than the pre-transfusion Hb.
The answer to your second question is also "NO". There is an increasing body of documentation that suggests that hyperhaemolysis is caused by hyperactive macrophages.
The patient to which you refer, as far as I know, has fulminating AIHA (remember, a negative DAT does NOT rule out AIHA). He did indeed have an anti-S-like specificity that was detected with papain-treated red cells only, and the reason we tried U- units was because, according to some work published by Jill Storrey a few years ago, this particular specificity is often an auto-anti-U that reacts preferentially with either S+ red cells or s+ red cells.
In this case it wasn't, because U- red cells, together with all the panel cells, reacted with the elution (unless, of course, the auto-antibody detected in the eluate had an Rh specificity that was also on the U- red cells.
I must admit that I am a bit surprised that he wasn't already on IVIG.

So much for quality!

hey Rashmi, you are back !

Do you think that maybe the lab has some significant issues that need resolving? Just keep filling the incident logs- and ask to see the corrective actions (remember to keep a note of your incident reference number), as I know sometimes reports can go "missing". Every incident reporting system should be open to scrutiny by any member of staff. Sometimes as managers we don't always make the right decisions and it is good to have someone else look things over from a different perspective. 
 
The error with issuing normal blood for a patient requiring irradiated- should be MHRA/ SHOT reported- also, the incident should be addressed by ensuring your LIMS prevents this happening- ask to see what corrective actions were done for this one.
 
Since you obviously care, then it may be that you have to set the cultural changes and standards in your lab.

Sorry about that.  It should be set at 20MB now.

Just a note from personal experience. My wife, a nurse of course, has, amoung her other antibodies, anti-D. This developed due to the birth of our son. (Long story I won't burden you with here.) Four years later our daughter was born 6 weeks early and required a double exchange transfusion due to the anti-D. This little girl is now 27 with 2 kids of her own. Having anti-D is not nearly as devastating as it once was. Please keep us posted. You have our interest.

Another tech and myself were discussing the possibility of insuring that a patient that was sent to the OR prior to any pre-OP testing was done. It just so happens that this patient is a known patient that has a known Jka. We were discussing what would be the outcome if they suddenly had to have units on the patient. The Micro supervisor was sitting close by, and remarked "Well cant you just give them some O Negs?" We nearly broke our necks swinging them around to see who had uttered such a ignorant comment. She even went so far to say that the O Negs would be best because they did not have any antibodies in them. Now, I could have expected a nurse to come up with a comment such as this, but a Med Tech with over 50 years of experience.
Any other "ignorance" going on out in BB world?

I was at the Frontiers in Laboratory Medicine where the report was launched.
 
Great ideas - a small, readable report with recommendations. I think it is very good.
Link is http://www.england.nhs.uk/wp-content/uploads/2014/01/path-qa-review.pdf
 
Cheers
W Eoin

We also have the "too posh to wash" comments... .. staff who think it is beneath them to clean fridges etc- because they went to Uni !!! 
 
It is all about culture.