Dr. Pepper

Yes, #7 can lead to some interesting responses. So long as they don't end up on the front page of the Croydon Daily Times, though, they still give you another point of view to consider (however twisted and unprofessional it may be!).

One could add to the fine monitors already listed: 1. Transfusion process audit: follow a unit from issue in the lab to start of transfusion to ensure nursing and BB are following proper procedure. This should include any off-site locations as well (like blood supplied to private dialysis centers). 2. Review of transfusion reaction investigations: again, ensure that nursing and lab did and documented everything they needed to do: post-rxn check of donor and patient ID - performed by nursing in our hospital - did they document it on our form? Did the lab accept the blood bank without the documentation? Was a blood culture on the bag performed if indicated? Reactions get reported on our Record of Blood Transfusion Form, so this also serves as an audit of nursing completing other documentation on the form (date, time, nurse discontinuing the transfusion, etc). 3. For the cases where your appropriateness review gets to chart review of transfusions not meeting audit criteria, you can also check documentation of informed consent on the chart. 4. Some non-automated blood banks will separate serm/plasma from clot/cells for processing and storage. You could periodically check that the aliquots have the same label as the original tube and that there was phlebotomist ID on the tube. 5. Have a QA database (I built one in Access), establish whatever problem types you wish, and pull up summaries periodically to look for trends (i.e. 3 of the same problem in a quarter = a trend, which needs written followup). 6. Reagent supplier issues and incidents. 7. Customer satisfaction surveys.

Rhetorically, we all resuspend gently. Alas, in the real world, it's yet another reason to get away from tube testing, where you can have one tech seeing things that aren't there and another who beats the **** out of the tubes and doesn't see things that are there.

As does a very gentle hand resuspending.

We retrospectivelly audit at least 10% of RBC transfusions (~40-50) and all FFP and platelet/month. Those not meeting criteria go to our medical director (no transfusion committee any more) for chart review. We used to do 100% of red cells, but we'd end up with 30-40 outliers, most of which were deemed justified on chart review, and it was a lot of work for the reviewers. When the committee was disbanded, it fell to me and my chief and we had to cut back to the 10% RBC.

No, I'm up north enjoying the fall foliage (and harvesting peppers) in the great state of Rhode Island. I was in Texas, though, for 40 minutes one time changing planes in Dallas.

I have a traceable digital thermometer from Allegiance (SP) that I believe was less than $100 (several years ago) and works fine for the yearly cal of the lab thermometers. We have a company that comes in yearly to recal the reference thermometers, tachometers etc. AABB and CAP have been fine with this. It's handled through our clinical engineering dept. Your clinical engineering dept might also let you borrow one when needed. (I use one of theirs with a fine wire-type probe for checking the temps in a few odd places where the shishkabob probe on mine has trouble getting to.) Go digital: you avoid mercury, columns seperating, and having to walk around carefully holding the thermometer in its padded box like you were presenting the crown to the king.

Congrats, new SBBers, and hi there Cottonball. It's a great site.

I agree with David: order and do the test or don't. We built a nonreportable test "BBJIC" (BB just in case) in our LIS. What it does do is generate a label for a BB tube and let you track it from the lab end. Our ED uses these all the time. If the patient ends up needing a type and screen or crossmatch we just add those tests to the JIC specimen number.

Terri makes a very good point, one that we've seen as well. Many people don't realize they've been transfused because they were anesthetized, comatose, or otherwise unable to realize or remember it happened. I'm curious as to the nature of the "nonspecific" antibody. Is it an alloantibody or autoantibody? Does it seem to be IgM or IgG? What technique(s) are you using to detect it? Could it be a reagent problem? There are many possibilities.

Welcome, newBB. Don't hesitate to ask questions that might have been asked before. A lot of us are relatively new to the site and might not have seen (or remember!) the earlier post. New people use the site, technology changes, and looking at an old issue again may generate new ideas and discussions.

Malcolm, you must know by now there's two ways to do anything: your wife's way and the wrong way.

One never graduates.

I'm told the PC term for hen-pecked is "Well advanced in the training program".

bmarotto, we do the initial T&S on the outpatient pre-admit sample. Our admitting dept. also pre-registers the patients for the future OR/inpatient account. We do the crossmatches a day or two before surgery on that new account number. Name and MR# are our BB identifiers which don't change. We order the blood/crossmatches and an informational test (for our eyes only) "SPEC USED" to record the spec# of the original T&S. Works fine, no problem with reimbursement. We have Meditech.

mhc, I think that these are two different issues: 1. The antiglobulin crossmatch is done as an added level of protection if a patient has a present or past history of a significant antibody, instead of relying soley on a negative . The chances of having an incompatible AHG crossmatch with a negative screen have been calculated as 1 in 10,000. These odds change dramatically if there is an antibody: 1 in 10 with anti-K, 2 in 3 with anti-Fya etc. 2. The 3 day rule is an arbitrarily selected standard to detect newly appearing antibodies stimulated by recent pregnancy or transfusion. This really has no bearing on whether they currently have an antibody (or history) or not. So whether you do an IS or electronic XM or a full one, the same standard as quoted above by David should apply.

Liz, here's a true story: Remember the mediocre movie "Mermaids" with Cher and Winona Ryder, set in 1963? There's a scene where someone bursts into a classroom to say the president's been shot. Now that scene was filmed in my old Jr. High School where I was actually a 7th grade student and the same thing really happened to me. So I'm watching the movie with my kids, who were familiar with my hometown and the building, and telling them that the classroom in the scene might actually have been the one I was in when we heard the news...And my 11 year old daughter asks, in all seriousness, "Dad, that was Lincoln, wasn't it?"

Welcome Arthur! I wish we had BBT around when I started in blood bank. Of course, that was prior to the discovery of electricity, and perhaps fire....

It is automaticly downloaded to a free-standing PC, so if Meditech is down it's still available. All data in BBK history is there, plus patient demographics, specimen audit trails and other useful tidbits. It updates and adds any new data every 4 hours, so your backup (downtime) data is never more than 4 hours out of date. We've been up on Meditech for 4 years and did the historical conversion from our previous system (Mysis AKA Sunquest), so we have 15 years worth of data available.

We have the same thing on C/S 5.55, by far the best feature that an otherwise entirely mediocre system has to offer.

I agree with David. I always look at what's being repaired and how it affects the process. If you work on the motor, check the RPMs but the timer should not be affected. If they replace a touchpad, you should check the times but RPM would be unaffected etc.

We're not up to that version yet, but we have test ATP (antigen typing on patient) built to record the typing results. We order it in requisition tacking it onto the type and screen req, then we have a bill only test (ATPBILL) that we order and change the test count to the number of typings we did. The ordered number of the appropriate CPT bangs off on the BAR fiscal side. It's all manual, but really doesn't take much time - you're probably going back to requisition to order and result an antibody ID anyway.

I'm ditto with David. I think it's essential to get the OK from the med staff or get into your hospital's transfusion policies that all RBC units will be leukoreduced (or standardize your platelet dose, or whatever you ordering ambiguities or pet peeves are....). An electronic or paper order form with a LEUKOREDUCED RBC check-off box as the only packed cell option could help as well.

I too just revised my procedure, attached, mostly copped from the Tech Manual. Don't forget your associated procedures (cold and prewarmed backtypes, saline replacement for rouleaux, adsorption/elution for weak A&B ags, ID of anti-A1, test for secretor status, etc.). Resolving ABO Grouping and Rh Typing Discrepancies.doc

Which came first, the chicken or the egg: But no, I've just been very lucky. But I've worked hard, and the harder you work, the luckier you seem to get. Norman Wisdom I have an old saying that the harder I work, the luckier I get. John Engler I'm a lot luckier than most people, although I used to look at it the other way around-that so many people seemed luckier than me. Dana Hill Luck is a dividend of sweat. The more you sweat, the luckier you get. Ray Kroc Luckier than one's neighbor, but still not happy. Euripides The harder I work, the luckier I get. Samuel Goldwyn The harder you work, the luckier you get. Gary Player The more I practice, the luckier I get. Gene Sarazen To die is different from what any one supposed, and luckier. Walt Whitman (I'm not sure I agree with this one. One wonders what Whitman was basing this on, as no one seems to send post cards back...)