ltechlin

How do you verify that this scale is taking temperatures accurately? Do you have to send it out annually?

For a LISS crossmatch, we bill for the incubation of crossmatch. We also bill for the AHG charge. For a gel crossmatch, we bill the immediate spin and the AHG.

One of our trauma surgeons would like us to do what your facility is doing. The idea of the transfusionist putting the name on the transfusion tags haven't been brought up as a possibility. The surgeon wants us to head to the ER and then get some chart labels from the secretary, label the units and then bring them into the trauma room. We have resisted, there is no work space readily available and I just see it as a place for a tech to make a mistake under pressure. Interesting route your facility took. How reliable are the transfusionists/nurses with getting the patient information on the transfusion tags? Is it required that they write the patient information on the transfusion tag prior to transfusion or can they do it after? We aren't that big of a facility, but we are a level 2 trauma center and occasionally have more than one patient that requires an uncrossmatched cooler in the ER at the same time. Relying on our nurses to label the units would make me a little nervous. R1R2, some months we are at 90% unused as well. It is a bit better now that they have classified our traumas into two different groups. One group always gets a cooler, with the other it isn't automatic. They still need to call the blood bank with patient name (J. Doe) and MR# before we bring a cooler down. Yes, a lot of wasted work, but it keeps the staff in practice for the real deal.

First a question for you, am I understanding right that you may bring a cooler down without having patient ID on each unit? Do you put patient ID on each unit down in the emergency department? Our trauma surgeons would like us to do this, but we haven't agreed. In response to your question, at our facility we are transitioning from a paper authorization form for uncrossmatched to electronic documentation. The electronic documentation for authorization is part of the uncrossmatched blood, Initial Resuscitation Cooler (2 O neg LRC / 2 AB FFP) and MTP order. We many more requests for the Initial Resuscitation Cooler than just uncrossmatched or MTP. Probably 9 times out of 10 nothing is used out of the IR cooler. Our ER also thought they didn't have to order it if it wasn't used. If we brought the cooler down, we want it ordered so we have record of the authorization. Although the doctors are suppose to put through the order, we have increased our success at having the IR Cooler put through when we got the rank and file staff involved and explained why we needed the order. They have instant access to the doctors and have helped our cause. Note, these three orders are simply for the product, they are not orders to transfuse the products. Our trauma services department is also looking for the MTP order in the hospital computer for their tracking purposes. That helped get the docs on board to get it ordered. It isn't always timely, but usually within 20 minutes of the request for the products. Same thing with the IR Cooler order, we usually see it 10-15 minutes after we get a phone call to bring the cooler down. I credit the secretaries and nurses for prompt phone calls!

I'm answering this from home, so I don't have a copy of the form, but it basically is as follows: I _____________________ take responsibility for identifying the patient and changing the blood bank armband from ________________ to __________________. There is also a place for date and a patient sticker (name, MR # and DOB). We use this form for name changes (Doe to actual name) or if a band needs to be removed (to place an IV). Our hospital policy dictates that a John Doe isn't changed to his actual name in any computer system until he is admitted to an inpatient bed. This prevents us from dealing with a name change during a MTP in ER or OR. It was a battle that crops back up every 5 years or so, but nursing is good at following this. Policy also dictates that nursing calls us as soon as they learn the patients' true identity so that we can do a history search, but we don't have as much success with that. When we get an Armband Change Form, we update the armband (and name/DOB if needed) in our computer, on the specimen and reprint tags on any crossmatched products. If we haven't had a chance to go change the BB armband, but nursing has updated the Doe name, we hand write in the true identity name on the transfusion tag, next to the Doe. This rarely happens. Merges of MR #s for a patient (a newly issued Doe MR# with a historic true identity MR#) doesn't happen until the patient is discharged. This way we always have two identifiers, the MR# and Blood Bank armband number that is consistent.

What do you do with thawed FFP (right out of the water bath) and platelets?

Does your report give a transfusion recommendation?

We have used Rhophylac for years as well. We don't have an OB department, so it is only being used in the emergency room. Even with this low usage, I only have had one phone call where the nurse was having trouble with figuring out how to use the device. By the time I walked down to the ER, she had it figured out.

How are name changes handled in your facility? Handled by registration and lab is notified via computer system. Does your policy indicate that the compatibility label always match the identifiers on your specimen? Specimen, patient armbands (hospital and blood bank) and Transfusion Record Form attached to blood product must match Does a name change always require a redraw? No, we allow an Armband Change Form to be completed by the person changing the blood bank armband. From this we update the specimen and Transfusion Record Form on the unit. Of course, we are checking the information sent from the registration department's computer system to ensure that the information is correct. Does your system process name changes automatically? Not in the blood bank. General Lab, yes, it is automatic. If you use an additional Blood Bank band, do you require a redraw so the Blood Bank band identifiers match the patient identification band after the name change? No, we use the Armband Change Form to maintain an audit trail. We only redraw the patient if the Blood Bank armband has been removed without utilizing the Armband Change Form. Is your policy the same with Trauma? Yes, with the exception that hospital policy states that name changes are not done until the patient is admitted to a floor, discharged or transferred to another facility. This way we shouldn't be having to deal with a name change until after the patient is stable and the urgent need for blood has passed.

We have used HCLL for about 10 years. Prior to that we had Mediware's Hemocare product, so I can't compare it to another vendor's product. As with all computer systems, there are always a few things you'd like to see changed, but overall we really like HCLL. It does a good job for us! We didn't have the time or manpower to interface results from HCLL to our hospital computer system 10 years ago, but will be doing that later this year. We also do not have their stem cell software. If you have some specific questions, feel free to ask.

We label using a digitrax printer as well. Love it! We have consulted with iccbba.org for help in choosing the correct thawed code when we have had a question. If you don't find the answer to a specific question, the people at ICCBBA will help you out over the telephone or email.

Thanks cthherbal!

I'd be interested in exactly what product this is! Do you have an item # or name of the product?

The locks look pretty slick! Great that your facilities will purchase them. Thanks for the information. Our nurses can currently scan medications at the bedside before they administer them, we'd like to get there with blood products as well.

So BloodLoc and Final Check folks, the unit of blood is inside a bag that can only be unlocked with the correct code from the armband. Are these locks reusable?

We do 6-8 positive antibody IDs twice a year. We double dip and use them as unknowns for staff competencies. Honestly, we haven't included a negative sample in our method comparisons! The last couple of inspectors have asked to see our comparisons and neither of them have said anything about needing a negative sample... but I think I will start including one!

Does anyone use the Typenex Barcode Plus Condensed blood band at their facility? Or any other blood band that does not require patient demographics on the blood band? https://www.typenex.com/products/pdf/barcode-plus-condensed-dfu.pdf We currently use a barcoded blood bank band that requires the patient demographic information to be handwritten on. It has a carbonless sticker system. The sticker is peeled off and put on the T/S specimen, the carbonless copy is part of the armband. We have problems with clerical errors, name changes (especially after a John Doe is identified) and illegible handwriting. We are considering going to the condensed armband that just has the barcoded number on it for the blood bank. This will be used in conjunction with the hospital armband that has the patient name, MR#, account # and DOB on it. I'd appreciate any insight from those who have used the condensed band or a similar product.

I love this idea of documentation when they order electronically! This is something we'll have to look into for our facility.

We are TJC inspected also. We have been doing method comparisons between gel and tube.... but we are testing antibody ID, not crossmatches. We have had some anti-E and Kidds that were detected in gel, but not in tube. We make a statement about the gel methodology being more sensitve than tube and several different inspectors have been ok with that. At first we were just doing the comparisons randomly throughout the year as we had: 1. patients with different antibodies at our facility (not an E or a K!) 2. these patients had specimens that had excess sample available for tube testing 3. the need to complete competency testing of staff 4. time available for a different staff member to do the testing On our last inspection we were told to aim for making it two distinct studies over the course of the year. This has resulted in less variety of our antibodies tested!

We were doing comparisons between gel and tube for antibody ID, but didn't have an actual policy written up. TJC dinged us for not having the policy. We had some weak antibodies that didn't correlate and we had just made a simple notation on the spreadsheet, like Terri mentioned. TJC inspector mentioned it and was happy with our explaination/documentation.

I work at the same facility as Scott. To expand on his answer, when we set up QC for our cell savers we also consulted the equipment's manual to see what requirements the manufacturer had. We check that the hematocrit is greater than 50% to verify that the blood collected is washed correctly before reinfusion. We also have surgery draw two sets of pediatric blood cultures. One from the patient (maybe they are septic!) and a second one from the salvaged blood prior to reinfusion. The cell saver sample should have no growth unless 1) the patient already had septicemia 2) there was a skin contaminant (staph) or 3) a problem in surgery (such as the bowel being nicked). In the case of #2, the surgical staff assures me that a skin contaminant is an acceptable part of the process and TJC/FDA has never questioned this. In the case of #3, this should never/rarely happen. The surgical staff tells me that if something happens in surgery where there is question of serious contamination of the salvaged blood, they shut down the process and discard it. In the past 5 years of reviewing these QC samples, I think I have only seen one bowel related contamination. When we set this up, we initially did QC monthly. Once the lab and surgery had a good handle on the process and results were acceptable repeatedly, we changed to QC quarterly for each cell saver in surgery. Our hospital associates handle the cell savers in surgery, not a 3rd party. Although surgery is responsible for running this equipment, it falls on the blood banks shoulders to monitor the QC process. We also monitor competency with hospital education in the form of competency module on-line annually for the surgical associates. Off the top of my head, I believe that salvaged blood may continue to be reinfused to the patient while in the recovery room, but typically it is completed before the patient would head back to his room. Again, without rereading our policy (I am at home) the units are labeled with the typical patient demographics/ID and with a bright green sticker that states it is an autologous product (purchased from Shamrock).

Having our student watch this video tomorrow!

Getting back to looking at this topic again tonight and am remembering that someone from behind the scenes had called and asked for the NDC number off the Rhophyllac box not too long ago. I'm going to have to make some phone calls tomorrow!

Terri, you said "now that it is considered a drug"... I was unaware of that Rhophylac was considered a drug! If this is in the standards, would you please share which one. I am reading this from home and am off work for the weekend now. I'll have to do some internet searches. Rhophylac is the only product listed that we dispense from the blood bank, but ironically, a TJC inspector dragged blood bank into pharmacy's record keeping with albumin a few years ago! Thankfully, pharmacy kept the albumin and we didn't have to take it over.

Thanks Terri. We'll find out in the spring!