luhubert

I think you must NOT accept a historical blood type without confirming it, especially in an emergent situation. I have many stories to share about scary situations involving people using other people's identification, tubes being mislabeled, admission mistakes, etc. I won't bore you by relating them here but my experience has certainly convinced me that historical blood types should never be used without confirmation.

You got all the right answers, but I can't imagine what prompted the question in the first place. all blood banking teaches that once an antibody, always an antibody. One of the answers was right on with the comment that it's a scary place out there. Can you imagine the amenestic response that woman might develop if she got E positive blood? I don't want to imagine it.

We use our pre-op type and screens for 10 days. If the question had been worded so that previous transfusions and pregnancy had been addressed, we could have answered the poll more easily. I can't answer the poll because, it the patient was pregnant or transfused in the last 3 months or if I don't know, then the TS specimen is only good for 3 days. Crossmatches are held for 3 days in our facility with the exception of autologous which stay crossmatched on the patient until discharge.

Is CAP changing its requirements, too. I hate to disagree with JCAHO but isn't this overkill? At the present time, we have two racks and QC 1 of them each day, alternating days. The same lot number is on each rack. We QC new lot numbers before they're put into use. With the type and screen reagents I've never seen a QC failure in my 20 + years as a blood banker except a contaminated A and B cell when someone had switched the tops and those were still useable. This rule is going to be time and reagent consuming for those places which use 10 - 20 racks. I didn't know JCAHO went so in depth in the Blood Bank, I thought they left that up to CAP, CLIA and AABB. Lu

I just heard that one of the accrediting organizations, maybe JCHAO is going to require the use of blue ink. The reason given was that copies are now hard to tell from originals and a blue ink signature will be easy to differentiate. Anyone else heard of this?

Yes, and I'm sorry this is only anecdotal, we had a woman who was pregnant and had a 1:16 RPR titer, a negative MHA-TP, a strongly positive DAT with no specificity and we never got an answer about her diagnosis.

We do exactly what mtheriault does. What we're getting and when we get it is maintained through our purchasing department. Lot numbers are maintained when doing QC. The appearance and acceptability is noted when the first QC is done before being placed into use. We have a statement on our spreadsheet for Blood BAnk QC that says "Reagent appearance acceptable? ___ Y/N" If No, document problem and resolution below. I personally don't think we need more than that.

We use the Charter Neonatal syringe set, get an irradiated unit from our supplier with 4 - 6 aliquot bags attached. We push into an aliquot bag and then take our syringes from that, leaving the rest of the bag intact until original expiration. We made our own label using Word and card stock. Copy attached. We attach it to the syringe with string through a punched hole in the corner of the tag. We put the assigment/crossmatch information that prints on adhesive labels on the other side of the label. Aliquot tags.doc

We had a similar problem with a tech who worked infrequently in BB. We certainly didn't dismiss her. We did a root cause analysis, found some procedural changes to make. Made the Blood Bank techs different levels of competency and certain levels can only perform certain things. We put all our highest levels (3 of them) on a rotating call schedule to help techs that are on lower levels. I don't think dismissing is the answer unless the errors are done willfully or repeatedly without improvement.

I'm looking for ways to ensure that nurses notice and document reaction symptoms. We get so few reported, something like .2 of 1 % that I know under-reporting is going on. I've read the 2% somewhere, too, but can't remember where. We present symptoms at a competency fair, have them written in a nursing manual, have them in a "lab manual for nurses" on each floor and give periodic inservices. Other suggestions would be welcome.

Several years ago we made a concerted effort to have the "reaction" reported to the Blood Bank no matter what the physician decided to do. Even after 7 years, we still hear the nurses tell us that the doctor didn't want a reaction called. We've moved away from the word reaction and told the nurses they are just reporting symtoms, which indeed they are, and that the Pathologists and doctors will decide if it's a true "reaction". The syntax has helped a lot and the nurses are now not so reluctant to tell us what they have observed.

The proposal to change from RhoGam to Rhophylac is going before our OB/Gyn doctors at their next meeting. I'm going to print out all these answers and include them with the proposal. I'd like to hear from someone with some long term use. The hospital using it for a year was a really good endorsement.

I agree that the California e-forum is a "Great" site. Go to CBBS and you'll find it. You can sign up too. It's run by Dr. Ira Shulman, a noted transfusion medicine author.

We use an additional Blood Bank Band when a Blood Bank specimen is drawn. Since that puts up a barrier to transfusing the wrong patient. With the band in place, we only type the new patients twice from the same tube.

There used to be a Quality Department but then there was reorganization and the Blood Bank supervisor took over doing all the blood bank oversite and statistics which are reported to the Blood Utilization Review Committee. She determines if the C:T ratio is OK and if transfused blood meets criteria - if it doesn't, the chart is taken to the Committee where peer review is done. She also looks at low hgb. which aren't transfused and why. She also reports those results to the B.U.R.C. along with trans. reactions, reports on Quality Indicators and the kitchen sink.