Linda0623

Hi Logan, I am an AABB perioperative assessor (and laboratory manager )that works at a facility in Boston MA that uses cell salvage on over 3,000 cases annually. We have 11 machines, and although we are not (yet) accredited by AABB, with the work we have done with our program, we are hoping to be accredited for periop by our next BB inspection. I got involved in this because our SVP for surgical services asked me, as the resident AABB SME, LOL, to evaluate effectiveness of cell salvage at our facility. She wanted us to adhere to the AABB standards and thought I was their best candidate to lead the effort. 6 years later, the past practice is truly history. To answer your question, we do QC quarterly on each machine that we have in use--- Hgb and Albumin. AABB allows you to decide what and how much is needed, but for quality purposes, you really do need something to make sure your equipment (and operator) is obtaining the best possible product for the patient in between PM's. If you would like more information on our approach, I am happy to share what we do, just message me and I will give you my work contact information. Between Cell Salvage and other specific PBM strategies, we have reduced our organization-wide transfusion ratio per adjusted patient discharge, from 0.78 to 0.17, in ~5 years time. ( Caveat: The cell salvage program overhaul took some time and was truly implemented last). I actually like to think it is because Blood Bank is involved, but honestly, it takes a village and I had to build influence up with the surgical services team and make really good use of my role as Transfusion Committee Facilitator to make things happen. Best, Linda

Hi All, Does anyone out there have a critical value for CPK (Creatine Phosphokinase)????? If so, what is your cut off value? We do not currently have a critical value for this test, but our medical director was asked by a specialist to consider a cut off of 2000mg/dL where he considers that a very high abnormal for patients he typically sees. However, we do orthopedic surgery here and do not think this is a good place to start, if we add this at all. Any thoughts would be very appreciated!!!!! Linda

Absolutely fantastic news and well deserved! Congratulations!!!!

Marking my calendar as we speak! It will be awesome to see and hear you lecture again Malcolm! As Kate says, Providence is "just down the road a piece" from Boston

Hi All, Though i don't have experience with this specific product, it sounds as if it could fall under the same types of products as platelet gel, bone marrow aspirate concentrate etc. Maybe AABB periop folks or the hemovigilance folks would have some ideas?

Good Morning- I have attended the UBS course, and have found it extremely valuable. I am a blood bank manager and we do NOT have either a TSO position in our hospital, nor have we a formal blood management program. I used the knowledge I gained to empower transfusion committee to push for several blood management strategies to be implemented, and our organization is realizing great benefits since I attended the class in Sep 2014. We have reduced transfusions by over 50% and are still realizing continued reductions 14 months later. We are predominantly orthopedics based, and after a presentation to our arthroplasty group this past fall, we are in the process of writing/publishing our process improvement project as best practices in orthopedics. The class was comprised of~50% each RN's and Blood Bank supervisors/managers, and there were sessions included to help each background learn/understand each other's roles and what they bring to a TSO position. The rest of the class is very good as well---highly technical and indepth in many subjects despite the actual brevity of the full course. Strong BB, donor collection, and quality tools is helpful as the course does help push you to the next level. My belief is the best background for the TSO'---IF the basis of your program is to also advocate for strong blood management processes to be employed, can be either professional background as long as they are set to colloborate well between BB and various medical disciplines, because without their buy in, the benefits of a trememdous amount of hard work that needs to be put in, may wind up being minimal/unsustainable. Just one colleagues journey--hope it helps and if anyone has more questions on the course or how I used the lessons learned, I'm happy to try to help!

I believe it does, because we actually had the FDA approve our process with the Blood Supplier doing the irradiation before they started performing the task for us :-)----because they do not enter the product into their inventory as a distributable product, only as modified, we retain the responsibility of tracking through final disposition.

I will be there----Hopefully achieving my goal to become an AABB assessor for both Blood Bank and Periop activities! :-)----I got accepted into training, the rest is up to me, lol!

In our practice, we ensure BOTH facilities information are on the final label. We collect blood, but do not irradiate on site. So if I need our blood supplier to irradiate a unit that we have collected, our LIS allows us to make the component and enter the modifying facility's ICCBBA/FDA information in the bottom right quadrant of the label, and it is linked in the audit trail of the modification of the product. It also adds the statement "Further Processing By:" preceding the FDA license/registration information. Because we are the collecting facility to which the DIN and collection /FDA registration information is linked, I would think we would be mismatching the origin of the collection if we were to scratch out the information attached to the collecting facility. For cswickard----we use our FEI number as the registration number on our labels, and have had no issue during FDA inspections---and our irradiated labelling has been evaluated by them successfully as well. Hope this helps!

I agree with all of the above, and I will raise one other consideration: I manage a small but vital blood donor center as well as the transfusion medicine service. Therefore, we are also FDA registered. AABB with their advisory groups, etc. are like a translator for the CFR and blood guidances' "legal-ese" that we have to maintain. I will always advocate us to keep AABB accreditation as long as I am involved with donor collections and also with perioperative collections (cell salvage, PRP, BMAC etc.)---I oversee their (surgical services) quality program as well as mine. If you are going to maintain the standards anyway, why not continue with getting the credit for it? As a resource for so many things, especially cost savings through blood management, it DOES pay for itself.....

Thanks to all for responding so far! This will be very helpful to present to nursing. Best, Linda

Question series for you all on Issuing and Bedside Readback information, particularly for patients with antibodies: When issuing to a runner, does the tech issuing blood do a readback of patient and product demographics, blood type, DIN, etc. when they pick up blood?For Patients with antibodies, ( if you issue to runners vs. through pneumatic tube) do you include patient antibodies on the crossmatch tag/label, and if yes, is it part of a readback between the tech issuing and the runner?If you do not perform a readback at issue with the runner or you use the pneumatic tube, is the antibody status, or antigen negative blood requirement verified at the bedside by the transfusionist during the readback prior to the start of transfusion? Our dept of healthcare quality is asking if nursing should be verifying antibodies/antigens at issue/bedside, but we in Blood Bank think that this is outside of nursing/clinician practice and would be difficult to educate and set up training for this skill. Nursing admin has asked me to see what the Blood Banking community is doing as current practice, so I appreciate any practices shared Thanks Linda

We have always issued individual units in plastic biohazard bags---multiples for the OR go in coolers......we've never been cited by the JC for it, but we are entering our window for the next inspection so I too, would be interested in knowing what regulation is cited.

Hi Bev, I still have the factors in Blood Bank, although recently our Transfusion Committee chairmen, when achieving the goal of getting approval for bringing FEIBA in-house, has explicitly stipulated that he wants Pharmacy to handle it...... its an antidote not a blood product....etc.....and so the turf wars begin! (Our pharmacy prefers us to handle them). At any rate, I have a consignment contract through a company called Bio- Care. I believe Tufts and Children's use it as well. I stock our most frequently requested products, Humate-p, advate, novoseven, to name a few, and I can add FEIBA if need be. The Bio Care rep tracks use and inventory, and ships back close dated product herself to forward to a facility that can use it prior to expiration. Pricing is through our Premier contract, and I've never paid for anything a patient didn't use. I have had this contract since 2010, and am quite pleased with the speed to which I can get product when needed. Hope this helps. Linda

Thanks to all for your thoughts and prayers..... We are strong---BOSTON STRONG! Yes, Cliff and I are BWH'ers (Brigham and Women's Hospital) we had 10 trauma rooms going on Monday evening---an unusual occurrence, to say the least!!!!! ----By day I am Blood Bank at a neighboring Boston hospital, by night I am a Chemistry specialist at BWH. We were on lockdown all day Friday----having SWAT teams in your hospital and State Police manning the doors is still surreal to me, but that is what we endured all week last week and culminating Friday night. We are recovering----but it will be a while before we get back to "normal".......we are so fortunate to have had the resources to absorb the influx of injuries. From First responders to the trauma teams to the ancillary services, we pulled together and saved a lot of people. Here's to hoping that no other city goes through anything like what we just did......thanks again for all your support!

Count me in please! Another Bostonian that should be in attendance :cool: Kate: if you want help coordinating anything, please let me know

When I set my ISBT product code trees up, I emailed them to Pat Distler and one of her assistants verified that my code changes as I modified products were correct. I specifically confirmed with them that if we only thaw FFP and discard within 24 hrs, that we did not need to relabel. She said no, that the only allowable handwritten change on an ISBT label was to edit the date/time of expiration. If you take the FFP and extend the outdate for 5days thawed, you no longer have what is considered to be thawed FFP. Once it becomes thawed plasma, it becomes a modified product which requires appropriate relabeling under ISBT, even though you physically have only thawed the product. Hope this helps, Linda

Hi everyone, I am looking for suggestions........ my medical director RARELY requests blood cultures on units classified as febrile reactions because a large section of our transfused patients are treated surgically and non-surgically for infected joints. Many patients have low grade fevers to start with, and despite pre-medication, spike their temperature anyway......usually attributed to their infectious state. Does anyone know of any way to stratify this patient population in order to assess a fever likely to be a sequelae of the transfusion vs their infectious state? Thanks in advance.....Linda :cool:

We are also trying to set a policy for the handling of patients with either htla's or auto-antibodies that require transfusion as our patient population is largely geriatric and they are predominently orthopedic surgery candidates. Our patient acuity has been trending high for the last fiscal year, so we are seeing this more and more, and everyone's comfort level from anesthesia to the RN's responsible for hanging the blood are more than a bit put off by the idea of transfusinf incompatible blood. As part of our policy and education process, we too would like to have an urgent release form of some type as well as a consultant MD review, whether it be a hematologist or medical director review or approval that would cover the current admission. Does anyone have a specific release form and/or policy regarding the review/release of incompatible blood that they would be willing to share here or to email to me at llevinus@caregroup.harvard.edu? Many thanks in advance

For those of you who charge for the 86885 for rule in/outs....... do you: a) run both a full panel and charge 86870 for that and chg 86855 via multiplier code for the number of rulein/out cells tested, (but is it a reportable test? if so, how do you answer both tests if there is only one antibody present? or, do you order and charge for the full panel and rule outs by the individual reagent cell CPT 86855, and just result that as one "test".

For those of you who already use this, I have a question..... We have automated panels, but do select cells in tube if the automated panels are not enough (I have 3 automated panel ID options). I have 2 traditional panels received every month to pull selected cells. I would not be subscribing the service for my automated panels, just the 2 traditional ones. So, the search and standardized format of the select panels would be a plus. Is anyone else using this who has automated full panels and only uses the traditional panel cells for rule outs? Just wondering if the value will be there. We use Immucor Echo Ready Id's and Extends as our primary panels....

I don't have Cerner, however, I do have an SOP regarding the issuance for factor derivatives. In there, I state that the manufacturer's insert is available with each dose sent to the floor.Because the Blood Banker does not break the package seal, on the factors, we are assured of the availability at issue of each dose's inserts.

Hi Eoin, I have HemoTemp II Stickers that we apply to the unit before issue. They not only have read windows for current temp range of unit , 1-3, 4-6, etc. but if the temp of the bag reaches 10 or higher, there is an irreverible window marker that is activated. Has worked well for us, particularly with the OR who needs blood one minute, then decides against the next.........

I agree with Lara....We either use historical Blood type as the second or in the event of no history (in patient phlebotomists are trained to look in the computer before going to draw the patient) or in the event of unknown status of prior history,(ambulatory care patients, Emergency OR patients, etc) we use a "double ID process" where the patient's RN and the phlebotomist readback the ID off the Hospital wristband, and check it against the label/requisition. To document that the specimen has either been double ID'd or has history vs. none of the above, my LIS system has a test result space on the TS test nmemonic that the tech MUST answer..."Patient need 2nd Specimen?" If they say yes, there is a rule built that does not allow crossmatches to be ordered on the patient until a 2nd type and screen is ordered, and the question is answered as "NO". For patients that have been double ID'd but have only one blood type on file, the tech will order a reflex test called retype, which a second tech will perform if a crossmatch is ordered. This has been well received by both CAP and AABB......now I realize that someone could fake it and just order a second test (Blood Bank does all the test ordering in the LIS) without getting the second sample, or, could forget to say "yes" if the patient has no prior history, but nothing is 100% foolproof, and at least we have a process that works well assuming good technical integrity and allowing that you can't totally eliminate human error..........

Hi Rashmi. What I wrote into my SOP is that if a QC failure occurs, and they check certain requirements to ensure that they were not the culprit, (i.e. forgetting a stir ball in reagent cells, or continuing use of a particular bottle of reagent after exp. of acceptable "open" dating), and so they repeat QC and it passes but don't know the reason for the failure, then they MUST run patients with a third (repeat) run of QC at the end. This helps to insure that the patients being reported are reported under "consistently" acceptable QC, and helps the burden of proof that the failure was a "flyer" or random event unique to that particular run's processing. Would love to hear what others think, and if I'm missing something else to consider.....hope this helps, Linda