Max001

Oh, and let me tell you why I retired (I joined administration an was much happier). I put a bag of blood that was in process of being screened for Kell, which was XM negative on a patient with a 4+ Kell antibody (so it had to be negative) on the 'ready to go shelf' but the antigen screening was still in process. It did NOT get issued, it did not cause a problem and in 15 min the screen was verified as Kell-neg. BUT the boss called me in and said 'I've lost all confidence in you...'. This was the ONLY error I made in 28 years on the job - I kid you not. The boss tried to fire me but my adviser and the head of the labs convinced her not to. This kind of error (putting a unit on the wrong shelf) occurred many times a week but I was singled out and I do not know - to this day - why. I was a favorite around there and a supervisor who had been downsized. Maybe they thought they were paying me too much.

This is an old topic so pardon my bringing it back. I retired from BB in 2001 and BOY was I glad. Why? Well we were required to enter SO MANY lot numbers BY HAND that it became impossible. A human makes a certain tiny number of errors no matter what you do. Let's say you make 1 transcription error per week - you write the lot number of your blood bag as 12x345872 instead of '12x354872'. You get 10 error before you get written up, it doesn't matter if they're FDA reportable (such as the wrong weight on an issued bag of plasma). Three write ups and you get fired. I don't know of ANY person who is always 100% particularly when they're literally writing thousands of numbers on a clipboard each week. I BEGGED them to get bar code scanners but NO-o-o. Hopefully they did do that before driving some poor OCD-bloodbanker (bless their hearts) mad. Is it any better 10 years later?

By 'screen' do you mean the CUE, interview, checklist and/or blood testing? On a sequential plasmapheresis even for a dedicated donor (say for their child) we screened each time. And I can't speak for the nurses, but they probably ran through the checklist by saying 'anything changed' or some dumb thing. The CUE was signed every time. CFR mandates it. One might as well run the serology each time, because you have to draw a set of samples anyway for Hct, plt count and so forth.

I BEG your pardon folks. (smacks forehead) Told you it's been a long time. We used three not one to rule out. It's been a long time, almost 7 years. Sorry.

Just wondering: 1. How many of you have an online procedure manual? 2. What 'language' is it in? (.pdf - adobe acrobat; text - word processor; hypertext - html, windows help - .hlp file, windows html help - chm file; built in context sensitive popup files built into your BB software.) 3. How usable is it, how often is it used. 4. Who is still using a paper manual as their primary manual. 5. How many would like to have an on-line manual? I created a very robust hypertext BB manual back in 1994 but the lab discontinued use due to funding problems, paying a nominal fee to keep it updated (They changed stuff weekly). TIA PS, this is not an attempt to sell the concept. I don't do it anymore.

Thanks. Cool. I think a near perfect system can exist, it would just have to be highly customizable. Too often we have to get in line to get enhancements made and they may take months, years or never get added. A system which has a customizable interface would be very nice, including one with a macro capability. (i.e able to record your actions and play them back as clicks or keystrokes. So much of what we do is repetitive). You are prob. right, there's no one-size-fits-all right now, even if we just consider BB systems of different sizes. A small hospital may reject a robust system because it is too complex and has too many features. Still I think there is hope, although (dare I say it) it might not be programmed before Blood Banking is superseded by a blood substitute which perfectly mimics real human blood, or we go to all bloodless surgery (but we'd still have traumas right? ) Having said that, I was fearful back in the 90s when it looked like plasma expanders and perfluoros began development and again when automation started taking over, but it appears that BB-ing, may be too complex for artificials and automation. Thanks for the input!

I agree with John also. Too often BB-ers are reluctant to give up the 'belt and suspenders' but it's understandable. Our 'extra-careful' natures are often the only thing that stands between a patient and a problem. In fact you could make a case for dropping the IS and the albumin phase of reading on tube testing. You still incubate, you just don't read it. Has everyone turned to Gel testing? It was becoming the norm when I left the field in 2002, but we still did some tube testing, some antibody panels, routine T&S. Just curious.

I agree, but as far as I'm aware every major hospital BB follows that two sample rule on patients without a transfusion history. I'm surprised that people are still debating this. Did I miss something. This was SOP even in the 1990s and before. Don't know when that advisement was put out but as far back as I can remember we required a separate T&H and no one ever complained.

We did both of the above. Patients who were scheduled for surgery would wear their banding system home and not remove it. Otherwise a new sample would have to be drawn on the day of surgery for anyone who might require blood. Frequently the patient or even the OR staff would cut off the bracelet when preparing for the OR. (ironic, no?) We've had distraught surgeons and anesthesiologists run up to the blood bank with the cut off band in their hand, demanding that we use this sample for the XM. (rolls eyes). They just don't get it. Transfusing a blood product is hazardous and must be done 100% correctly all the time, no matter what, unless you have battlefield conditions and everyone gets O packed cells and AB plasma.

One thing a surgeon will tell you is that the hallmark of a procedure which is not really ready for 'prime time' is the sheer number of ways to do the procedure. IOW, if there are 10 ways to do heart surgery, it means that some of them are still searching for the right method and once the procedures mature, there are only one or two methods which are 'right'. If you extend this analogy to BB Computer systems, it appears as though there are -too many- and that no one has 'hit' upon the right method or type. The problem with 'Windows' based system is the way they do their menus. If you want to make a choice or two and each time you have to re-navigate the menu each time, you're spending a lot of time going back to the same place. One vendor even tried to get MS to use 'tear off' dropdown menus but they never received wide acceptance. It appears to me that every system available must have some rather substantial flaws or we'd have one or two emerge as 'the' systems to use and all others would drop off. I wonder what the problem is? Am I correct, do all systems leave you wanting? I only have experience with three of them, only two of which I can recall, that being Hemocare and Sunquest. It's unfortunate, since the Bench tech is the one who suffers. Maybe it's just that BB-ing and Transfusion Service lab work is too complex to be a good fit? (though this seems unlikely). Is there a 'big list' of all the systems available? Thanks!

I've looked at some BB automation systems in the 90s so I'm out of date. I'd like to hear from an experienced BB-er if they think that agglutination testing, panel interpretation or other BB functions can -ever- be automated. I don't think it's impossible, but so much is a matter of interpretation and I don't know if all the truth-tables and algorithms we use to handle the 'difficult patient' can be automated easily enough to serve as a day-in-day-out system, replacing the Bench Tech, and still be economically feasible. In fact, I still don't know of a robust algorithm (which has to be coded by humans) which can take the place of an experienced reference lab tech. For one thing, how do you get a machine to do the battery of tests a human can do from variations on serology, incubation, enzyme enhancement and just 'seat-of-the-pants' or gut-instinct on what to do next, including transfusing antibody positive blood for the first 10 units for massive transfusions (> 1.5x blood volume) and oddities like that. Now, it may be I'm trying to be too all-inclusive, but the automated systems I saw required one or two full-time techs to go over the results and didn't result in any appreciable money or time savings.

Hi, guys, thanks for the supportive posts, but if you check my post in 'Introductions' you'll note that I started in the 70s. From that you may deduce that I'm retired. I have been since 2002. I switched careers in 2001 to go into hospital administration and then into IT. I helped introduce our first computer system in late 1980-something, I can't recall, might have been 1990. I -believe- it was the compiled Basic program from Hemocare and it was pretty good. Up until then we did everything by hand and I must have gone through a standard BIC pen every month or two. That's a lot of writing. It was that transition which was most stressful, because you had to know where you were going in those menus before you went there or you had to back out and even a month's practice did not prepare you for going live. Later, we all became so good we could do all the entries needed to get the transfusion slip to print in a continuous stream of keystrokes. But I kid you not about it causing me to have a nervous event and I actually went into a type of mode where everything was augmented and I actually felt I got more alert and smarter. I stopped sleeping and eating for at least 3 days and went on to only require 2 hrs of sleep a night for about three weeks. It seems my body actually jumped up a notch to help me cope. By the way I was already used to computers, being a guru in DOS and the IBM PC. So, while I appreciate the kind words of support, it is not something I plan to go through. (smile) Been there, done that. I have the greatest sympathy and respect for anyone who would go into Laboratory Medicine and Blood Banking these days. Little did we realize how complicated it would become. My friends over in the hematology/chemistry section tell me of a very frightening system put in by Toyota called the 'Lean production' system. They put the techs in the center of a bank of analyzers, no chair, no cell phone, no pager (they actually search them) and there they stand for 2-3 hours doing nothing but flying back and forth in a two-foot radius. Many of my colleagues who are brilliant and dedicated workers are retiring or fleeing to other jobs, it is so stressful. In the BB area, once we did the cGMP procedures, just thawing a unit of plasma went from a quick task to a laborious record-keeping process of writing down long series of lot numbers and data on a clip board. If someone at the Red Cross put the wrong weight on the unit (we weighed them again) and we put a different weight on the TX tag, even off by one number, it became an FDA reportable error. If we transcribed a number on the clipboard, off by even one digit, it became an in-house lab error, and you only get 20 of those before you are asked to leave. Well, humans, even OCD bloodbankers are not perfect, so it didn't take long until people got to their limit. People were so stressed when I left that they were even forming prayer groups in the staff lunchroom, atheists and believers alike holding hands and praying and sweating (I kid you not!). So maybe you guys are a different breed, but as smart as I felt I was, HS deans list, high SAT scores, Ivy League University grad, it had become so complex to do the data entry with zero errors, I felt my brain could no longer cope. (I was performing as a supervisor at the same time). Even the supervisory duties, reviewing page after page of clipboard records of data entries of lot numbers, had become onerous to the point of nausea. Outside of something like NASA, I don't know of any job where slipping up even a little, could result in a potential for a patient mis-adventure, even death. I am proud to say that nearly 30 years in the profession, I got out before anyone who I worked with caused any reportable error. Yes I saw a few patients die, but those were errors made by the nursing staff who mis-identified the units we gave them and yes a few patients did get an out of group plasma. But no Blood bankers caused any serious patient sequelae. If I had it to do all over again, seriously, I would never have gone into Blood Banking. I'd have taken up something less dangerous, like Lion taming. Though I never had any nightmares during my working years, I did have them for about 3 years after I retired, finding myself on the carpet explaining myself to my director. (go figure). I have to say I was clinically traumatized from working in such a lab, with that palpable undercurrent of patient death hovering over us all the time, if not from an error, from failing to get blood out the door fast enough on a trauma patient with a multiple antibody. I don't mean to be maudlin, but people just do not realize the level of stress we all face, even if we don't realize it. For one thing, with look back procedures, anything you do can be scrutinized for 10 years after you do it. Anyway, interesting to see a BBS devoted to Blood banking and sorry to be long.

Hi Kellpos, glad to see a fellow OT-er from the 70s era. Are you with me in being amazed that no one seemed to come down with Hep B or C in those days from the really poor bio-haz control? We had techs, supervisors who had open styrofoam cups of coffee next to the sero-fuges and knowing what we know now about micro-droplet spray, I'm -sure- they were drinking a mixture of serum and coffee. (yuk)

It's been a while but we used one negative cell to rule out for all but Kell, IIRC. We'd routinely store about 20 panels, many of them well past their expiration date, in the cold room for rule outs. We used to have three different manufacturers, each in use too, Ortho, Gamma and Immucor.

Hi all, IMO, going live with a new computer system in Blood Banking and Transfusion/Donor Services is one of the most frightening and stressful things you can do in a Lab; in fact maybe the most frightening thing you can do ever outside of being in a war. You have to perform up to speed, and you can't make ANY mistakes, and if you can't figure out how to do something all you have left is to panic. The first time we went live, I nearly had a nervous episode and stopped being able to sleep or eat for almost a week (we were manual before then). We had one tech shouting at the Director 'If I lose my baby (she was preg) over this I'm suing you!'. (This was a long time employee with an MT degree and normally very quiet and non-confrontational). In addition there's 'Downtime' (shudder). When the computer goes down everyone had to suppress the urge to run for the doors. A lot of time it takes a full day and lots of overtime to re-enter all the data when it comes up again. That and the fact that BB has a risk of killing a patient and I'm of the opinion that BB-ers should have double the pay scale of ordinary lab techs. How does everyone cope these days with this and all the new GMP regulations?