Dr. Pepper

They do fly but they spin around in the opposite direction.

They do fly but they spin around in the opposite direction.

They do fly but they spin around in the opposite direction.

They do fly but they spin around in the opposite direction.

We hired one last week for 3rd shift.

We hired one last week for 3rd shift.

I just found a red Phano brand china marker in my desk drawer where it has slumbered undisturbed for decades. Can't remember the last time I used it but it had to have been before Prometheus brought the sharpie to mankind. I looked online, Office Depot and Amazon have them and I'm sure others.
I agree with the above: go tube and dispose unless your resources are totally limited.
And do you remember Folin-Wu tubes, colloidal golds, protein-free filtrates, changing dialyzer membranes on 2 channel autoanalyzers, leukocyte reduced cells by inverted centrifugation, the fall of Rome, the discovery of fire and the other items that may mark us as ancient and should be retired like that guy's cell washer in another thread?

We also get a list of CPTs from the reference lab and pass them on to fiscal. But as AMcCord points out, whether your hospital gets paid for them or not is another matter entirely.

Thank you, everyone, for your responses. You have all corroborated my interpretation of the CAP requirement. I will be following up with CAP, as Quality Guy suggested. I will post with CAP's answer!

I have not looked at a CAP checklist since last summer (and may never do it again as Ibegone2016 at the end of the month), but it sounds like an overzealous inspector transposing his opinions into the CAP standards. Happens a lot. Follow Goodchild's advice.

I have not looked at a CAP checklist since last summer (and may never do it again as Ibegone2016 at the end of the month), but it sounds like an overzealous inspector transposing his opinions into the CAP standards. Happens a lot. Follow Goodchild's advice.

I'm interpreting the <3 days to mean your specimen is still within the usability window but a day or two down the road from the original type and screen. We have never had a billing issue with inpatients, I think mainly because they're DRGs and no one pays on a per item basis anyway. I think the biggest issue might be getting the charges for the blood posted on the correct patient account. If your specimen was from, say, an outpatient preop PAT and then they get admitted (could be > 3 days), or an outpatient draw for an outpatient transfusion the next day, the blood charges unfortunately will follow the original specimen and get posted on the wrong day of service and the wrong patient account. We used to do the crossmatches on paper ahead of time in these situations, then put them in the LIS on the day of service  when the new account was created, a awkward system just asking for a secretarial error to happen. Now we can do them on the original type and screen and Fiscal happily (I guess, it was their idea) transfers the charges to the proper account behind the scenes.
Keep in mind you don't have to tack the units/crossmatches onto a type and screen; they can be ordered on another specimen just by themselves. We create a new specimen on the desired account and date and order the units, along with a nonreportable informational test "SPEC USED" so we can record the old specimen we actually used for the crossmatches. Our Meditech trainer told most customers do it like that.
I would not want to do another type and screen if there was a valid specimen that was still within your time limits. Extra work, expense, and a stick to the patient.
I also agree with Scott - get everyone on the same page with a system that works for you and your fiscal dept. Trust me, the third party payers will let them know if something is amiss with your blood charges.

..............And how do you know if the pager breaks down at the same time as the remote monitor breaks down at the same time as the fridge breaks down!!!!!!!!!!!!!!!  Eventually, you have to trust a system, or send the inspector to the psychiatrist for assessment!

Perhaps a good answer may have been something like "we follow all manufacturer and regulatory requirements to ensure that the alarms work properly"?  Did you end up getting cited? 
We do alarm checks daily (I know: "and how do you know they work between daily checks...").  Like many Labs, we also have a remote monitor that pages an engineering associate if an alarm goes off.
Scott

I'm interpreting the <3 days to mean your specimen is still within the usability window but a day or two down the road from the original type and screen. We have never had a billing issue with inpatients, I think mainly because they're DRGs and no one pays on a per item basis anyway. I think the biggest issue might be getting the charges for the blood posted on the correct patient account. If your specimen was from, say, an outpatient preop PAT and then they get admitted (could be > 3 days), or an outpatient draw for an outpatient transfusion the next day, the blood charges unfortunately will follow the original specimen and get posted on the wrong day of service and the wrong patient account. We used to do the crossmatches on paper ahead of time in these situations, then put them in the LIS on the day of service  when the new account was created, a awkward system just asking for a secretarial error to happen. Now we can do them on the original type and screen and Fiscal happily (I guess, it was their idea) transfers the charges to the proper account behind the scenes.
Keep in mind you don't have to tack the units/crossmatches onto a type and screen; they can be ordered on another specimen just by themselves. We create a new specimen on the desired account and date and order the units, along with a nonreportable informational test "SPEC USED" so we can record the old specimen we actually used for the crossmatches. Our Meditech trainer told most customers do it like that.
I would not want to do another type and screen if there was a valid specimen that was still within your time limits. Extra work, expense, and a stick to the patient.
I also agree with Scott - get everyone on the same page with a system that works for you and your fiscal dept. Trust me, the third party payers will let them know if something is amiss with your blood charges.

I do a similar thing with a blue coag tube - poke a hole in the top with an arm of a pair of narrow scissors, lube the thermometer up with a little silicon, and insert. If you insert a syringe needle (no barrel) in the stopper while you do this it gives the air displaced by the thermometer somewhere to go and the top will never pop off. Never evaporates, never spills.

I'm interpreting the <3 days to mean your specimen is still within the usability window but a day or two down the road from the original type and screen. We have never had a billing issue with inpatients, I think mainly because they're DRGs and no one pays on a per item basis anyway. I think the biggest issue might be getting the charges for the blood posted on the correct patient account. If your specimen was from, say, an outpatient preop PAT and then they get admitted (could be > 3 days), or an outpatient draw for an outpatient transfusion the next day, the blood charges unfortunately will follow the original specimen and get posted on the wrong day of service and the wrong patient account. We used to do the crossmatches on paper ahead of time in these situations, then put them in the LIS on the day of service  when the new account was created, a awkward system just asking for a secretarial error to happen. Now we can do them on the original type and screen and Fiscal happily (I guess, it was their idea) transfers the charges to the proper account behind the scenes.
Keep in mind you don't have to tack the units/crossmatches onto a type and screen; they can be ordered on another specimen just by themselves. We create a new specimen on the desired account and date and order the units, along with a nonreportable informational test "SPEC USED" so we can record the old specimen we actually used for the crossmatches. Our Meditech trainer told most customers do it like that.
I would not want to do another type and screen if there was a valid specimen that was still within your time limits. Extra work, expense, and a stick to the patient.
I also agree with Scott - get everyone on the same page with a system that works for you and your fiscal dept. Trust me, the third party payers will let them know if something is amiss with your blood charges.

One of the more useless of CAP surveys, since you know perfectly well what should happen if you try to give an unscreened A Pos to an O Pos with anti-E, particularly since you probably did the hundred pages of validation for your system. (I know, you still have to check and do the survey, but.........)
We have 2 hospitals and use the mock patients in our test area in the LIS. Each site has different product mnemonics so there's no confusion (or peeking). So what you could do is:
Use different names/mnemonics for the products (1st or second donations) for each site. Use different numbers as suggested above. You are not testing your system's ability to read a bar code, but rather its ability to prevent the issue of an inappropriate unit of blood. If you can't do that, have different fake patients and take turns using the same units. Release the units and let the next facility have at them. Don't peek at the other guys results. Why would you even be tempted to, when, unlike other CAP surveys, you know what the answers to this one should be!

Ditto to Malcolm's comment. I don't think you have much to worry about. And remember the worst that can happen is that the CAP/AABB representative will find something, you correct it, your process gets improved, and life goes on. Also keep in mind that if you disagree with the ding from the inspector, you can always appeal it. You win, you win. You lose, you're back to "And remember...".
Good luck. I am in my AABB window myself. My window closes 3/31 and I'm retiring 4/1 - something tells me I could have timed this a little better!
Phil
 

Ditto to Malcolm's comment. I don't think you have much to worry about. And remember the worst that can happen is that the CAP/AABB representative will find something, you correct it, your process gets improved, and life goes on. Also keep in mind that if you disagree with the ding from the inspector, you can always appeal it. You win, you win. You lose, you're back to "And remember...".
Good luck. I am in my AABB window myself. My window closes 3/31 and I'm retiring 4/1 - something tells me I could have timed this a little better!
Phil
 

StephenB, please forgive me if I was unclear in my post , (although I can't seem to find anywhere in it where I advocated using the prewarm technique wantonly to eliminate "stray" reactions), as well as for taking the careless but convenient path of using "stray" instead of "occasional weak reactions whose pattern of reactivity does not suggest an apparent specificity". I agree wholeheartedly with everything you say regarding the potential pitfalls of prewarmed testing. (I am the slightly off-key bass in the back of the choir singing "Please don't prewarm that anti-E awayyyyyyyyy...........")

StephenB, please forgive me if I was unclear in my post , (although I can't seem to find anywhere in it where I advocated using the prewarm technique wantonly to eliminate "stray" reactions), as well as for taking the careless but convenient path of using "stray" instead of "occasional weak reactions whose pattern of reactivity does not suggest an apparent specificity". I agree wholeheartedly with everything you say regarding the potential pitfalls of prewarmed testing. (I am the slightly off-key bass in the back of the choir singing "Please don't prewarm that anti-E awayyyyyyyyy...........")

StephenB, please forgive me if I was unclear in my post , (although I can't seem to find anywhere in it where I advocated using the prewarm technique wantonly to eliminate "stray" reactions), as well as for taking the careless but convenient path of using "stray" instead of "occasional weak reactions whose pattern of reactivity does not suggest an apparent specificity". I agree wholeheartedly with everything you say regarding the potential pitfalls of prewarmed testing. (I am the slightly off-key bass in the back of the choir singing "Please don't prewarm that anti-E awayyyyyyyyy...........")

StephenB, please forgive me if I was unclear in my post , (although I can't seem to find anywhere in it where I advocated using the prewarm technique wantonly to eliminate "stray" reactions), as well as for taking the careless but convenient path of using "stray" instead of "occasional weak reactions whose pattern of reactivity does not suggest an apparent specificity". I agree wholeheartedly with everything you say regarding the potential pitfalls of prewarmed testing. (I am the slightly off-key bass in the back of the choir singing "Please don't prewarm that anti-E awayyyyyyyyy...........")

In the hands of an experienced serologist, a totally safe technique, despite, I'm afraid, what John Judd et al may say!