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Posts posted by tbostock
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1 hour ago, goodchild said:
Have any of you gone away from paper transfusion tags attached to the blood products and instead using label/sticker technology and the transfusion record is either completed electronically or as a distinct nursing/blood bank form?
This is the road that I want to go down but I'm wondering if there are any others out there I could learn from.
Yes a few months ago. No more transfusion tag; we now have a label that goes out with patient name, MR#, DOB, "crossmatch compatible", unit #, patient's blood type, unit's blood type. We have SoftBank and it prints when we crossmatch the unit. We send the unit upstairs and they scan everything into Epic BPAM and document everything there. We review documentation compliance daily.
- goodchild and John C. Staley
- 2
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On 2/26/2016 at 4:09 PM, DMR said:
Is anyone not placing their CTM temperature probes in liquid for their blood refrigerator monitoring. If so, how did you validate that the probe w/o liquid temp matches the temp within the blood bag? Were you able to obtain information from the vender concerning the validation process that was performed. Also are these CTM systems FDA Approved?
They won't work very well without being in fluid (which I think is regulatory); as soon as you open the door, they will alarm as soon as they are exposed to external temp.
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On 2/23/2016 at 4:04 PM, StevenB said:
Definitely no reason to apologize, Dr. Pepper. Anytime I hear or read about using the prewarm technique I tend to go on full alert....can't help it. It's the reference tech in me, lol. We see all too often the technique being used for the wrong reasons, so I have this almost "knee jerk" reaction to the topic. Baritone/Bass here...as I've gotten older my "ear" is not what it used to be....maybe the back of the choir is a good spot for me too!
I'm the same way; when I hear a BB tech say that they want to "prewarm something away" when they don't know the dangers makes me a little crazy.
My other pet peeve is the term "least incompatible"...but that's another rant.
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On 2/19/2016 at 11:07 AM, David Saikin said:
Transfusion documentation is a part of the Medical Record - have your HIM dept flag all the incomplete transfusion documentation and send the charts back for completion.
We had/have some interesting vagaries that Nursing tries to side step, e.g., when they sign in to document transfusion info the system posts the time they sign in. One of their boxes to complete has to do with the timing of vital signs. They want the sign in time to be the documented time - we told them no because that is not what the documentation requires. I think they finally understand that, but then there is the new staff. Another consideration is to look at how transfusion are documented during surgery - I have to check the anesthesia record. sometimes it has a unit number, sometimes it has rbc #1, etc. Dealing with that issue now. And we still have some areas that continue to use the old paper recording method - I'm not fighting that one yet.
David, what EMR do you use? We have Epic and we were told that it cannot flag incomplete documentation?
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Yes, we dilute glycerol for our probe bottles. We add a small amount of bleach so that they don't grow cooties (aka mold).
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11 hours ago, Liz0316 said:
We are developing a protocol, where by we get a baseline sample on the patient, have molecular genotyping done and once the drug is started, we will be testing with DTT and issuing K- red cells. I'll keep watch on the thread and try to keep up with our progress on the protocol.
Liz
Hey Liz. I want to bring DTT in. I'm having a hard time finding a source for it; is there any vendor that sells it already pre-mixed, or do you have to get the PBS and powdered DTT?
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My advice from 2 years ago still holds true. Be honest with them, smile, breathe, and ask a lot of questions. If they cite something, there's no harm in asking them for how others do it. AABB assessors are not allowed to offer suggestions, but if they are ASKED, they are allowed. They won't put it in writing, but they will be very helpful.
- dragonlady97213 and amym1586
- 2
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Yes, we had to upgrade our POC Coordinator position to a POC Supervisor position with a bachelor's requirement to cover this because we do moderately complex POC tests.
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Yeah, we were just given the mandate by administration to call the transfusing nurse at the 4 hour mark and tell her to complete all documentation for every transfusion. Then we look in the EMR and if still incomplete it goes all the way up to the head of nursing. At least we can show an inspector that we take it seriously and have started a corrective action already. The BB staff is NOT happy though.
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We went live with electronic blood admin documentation a couple months ago and we are stuck at 40-50% compliance for accurate documentation. Ugh!!! Since the Blood Bank/Lab will get cited, sadly it is my burden.
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We have an Anti-Jk3 and an Anti-AnWj. Both are just so much fun.
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Our temperature monitoring system takes a temp every 5 minutes and alarms immediately if out of range. Other non-BB equipment we have set to 15 minute readings.
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I also am not a fan of "least incompatible". Gives a false sense of security and really means nothing.
In this case the patient should get Rh negative.
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I just took it this past October and passed. It was crazy hard.
Study everything; the last two weeks, identify your weak areas and dig into them. The test is very intuitive, quickly identifies your weak areas and tailors your test to torture you.
My test was all molecular, complement, and HLA. I had only one calculation and one question about panels. A few of my classmates took the test: one had all donor stuff (her weakness), someone had a lot of calculations (his weak area).
If you can get a hold of the AABB Annual Meeting SBB review, I would recommend memorizing what's on there.
Wishing you the best! If you want any specific details about the format of the exam, etc, private message me.
- Maureen, heyheyhelena, amym1586 and 3 others
- 6
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In my state (NY) they would have to get licensed as a limited transfusion service. Very lengthy process, lot of regulations. I wouldn't want to touch that either. The only way I would consider it is if they had the Hemosafe system (blood vending machine). The Puget Sound system uses these for some of their locations.
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We use RALS
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I am not a fan. We got rid of ours about 4 years ago and are very happy. They were nothing but problems...nurses and patients cutting them off, requiring too many redraws.
We made the decision to get rid of them when we put other safety mechanisms in place:
- New BB LIS that requires 2 independently drawn blood types before allowing non-type O red cells.
- Drawing specimens at bedside with barcoding and bedside printing. No more grabbing the wrong patient's label if you are doing it right.
- Very strict labeling policy with no corrections allowed. Any mislabeled BB tube is reported to quality team, which monitors them daily and follows up with the nursing directors.
We don't extend the 3-day window for PST samples. They are drawn at PST and then again on OR day.
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On 2/9/2016 at 11:44 AM, Teristella said:
I like this idea, but was wondering how you decide which to screen (essentially, do you pull from the 'middle' of the shelf expiration-wise) and if you segregate them afterward if they're negative, or just tag them? We use hang tags that aren't really visible if the units are on the shelf, but I don't like the idea of having another 'set' of units to worry about rotating weekly (we already rotate trauma units, liquid plasma, platelets, antigen negative units on hold, the list goes on!). Maybe we could tag these in a different manner...
We screen the new ones, so they will be in inventory for a while. We enter them into our LIS so the techs can search online for E neg units. We put antigen labels on the units as well. We don't segregate them, they are just in with the rest of the inventory if needed.
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We just started using TheraSafe therapeutic phlebotomy sets. It's a 17 gauge needle, a smaller gauge and also a shorter needle. There's also an air vent on it that removes air from the bag and increases the flow. Each bag is individually wrapped which is nice. And they have graduated markings on them so you don't need to use a scale. They are distributed by Genesis.
http://www.genesisbps.com/therasafe.html
- AMcCord, David Saikin and amym1586
- 3
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I think you're fine as long as they are separated and your shelves are clearly labeled.
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Our criteria lately seems to be staffing. Sometimes it would probably be more cost effective to screen units, but if it takes a tech a couple hours, then other work waits. So we have to balance that.
Once a week, we screen about 10 type O units on our Tango for the Rh/K antigens. So we always have some K and E neg units around to grab.
- Teristella, Sandy L and AMcCord
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New from AACC
in General Information
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Welcome aboard!