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butlermom

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About butlermom

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  1. This thread is very timely as my hospital is a level 3 trauma center in active pursuit of level 1 trauma. (Yes, you read that right, we plan to skip level 2.) I am currently working with our trauma coordinator on an order set for MTP. She asked me just today if the emergency release form could be electronic with an electronic physician signature. We have always included the emergency released unit numbers on the form that the physician signs. Of course, this info is easy to obtain from our patient and unit history. After reading through this thread it seems reasonable that we really could eliminate this piece of paper and go to an electronic physician signature. I apologize for this being so lengthy, but I do have a question or 2– do any of you have order sets in your LIS for MTP? Also, in the midst of an MTP, how do you keep track of which “cooler” you are on? We give a plateletpheresis with every 6 RBCs and FFPs. Cooler 1 is 3 RBC & 3 FFPs, cooler 2 Is 3rbc, 3ffp, & 1 plateletpheresis (obviously not IN the cooler), cooler 3 is 3rbc & 3 FFPs, cooler 4 will have RBCs, FFPs, and platelet. My trauma coordinator is proposing to have this be electronic too, so that as soon as we verify the first order, it will reflex an order for the next set of products and so on until we get an order to discontinue. Does anyone have anything like this set up? Thanks for bearing with me. We have Cerner Millennium if you were wondering. Kathryn
  2. The topic came up recently regarding specimen collections from patients while the patient is receiving a transfusion. In general the phlebotomists will not draw a patient for any lab test while they are being transfused, but is this an unnecessary practice? Does anyone have any information or a reference that addresses this? We have no policy on the subject, but it seems to be what is currently being practiced here.
  3. butlermom

    Vision Software Upgrade

    Is there anyone with a Vision and Cerner Millennium who has upgraded to the new Vision software version 5.10 that was released in August 2017? If so, would you be able to share your experience, specifically, how many Visions do you have and did the upload go smoothly? Did you experience any major issues during or after the upload? Did you perform the upload through e-connectivity? We have 2 Visions and are getting ready to upgrade one instrument at a time (different weeks) through e-connectivity. We had major LIS issues before we went Live a year ago that delayed our plans almost a month! Thanks for any insight! Kathryn
  4. butlermom

    XM for a newborn with mom's specimen

    We have Cerner and our test for neonates is called "Baby Type and Screen" and includes 2 orderables: "Baby ABORh," and "Mom ABSC" (mom antibody screen). Our workflow: Transfuse order for RBCs is received in blood bank We go find the pedi lavender from hemo and add-on a Baby Type and Screen and a Crossmatch. The Baby T&S consists of a blood type on the baby-"Baby ABORh" (just a forward type, of course) and the Mom's antibody screen-"Mom ABSC." Usually we have already performed cord blood testing so we have a blood bank comment which shows the mom's name and medical record number (our cords have both mom's and baby's label on the sample and we add the comment to the baby's profile while doing the cord blood workup) We look up the mom's record to see her antibody status If no antibodies, we result the "mom absc" as negative. We select a neonate crossmatch and it is "compatible" once we scan the unit number for the aliquot. No serological crossmatching is done. We only transfuse O pos and O neg to babies. If mom has an antibody, we use antigen negative blood for the baby. Again no serological crossmatch required. We use the "neonate protocol" to override the sample expiration so our neonate samples are good for 4 months (Cerner actually calculates it as 120 days from the date of birth.) I hope this is helpful.
  5. Occasionally we have neonates who are still in the NICU after they become 4 months of age. At that point we begin treating them like any other patient in that we must do an antibody screen on the baby's blood every 3 days if they are receiving RBCs. My practice has always been to use the pedi lavender in hematology or maybe a pedi red from chemistry to do the baby type and screen. One weekend the blood bank tech actually was able to have a phlebotomist collect a small sample on a 4-month old NICU baby and place a blood bank armband on the baby too---we have NEVER armbanded babies in the NICU. (Had the 4 month old baby been in our pediatrics center he would have been armbanded.) I'm just curious how others handle neonates who are still in NICU after 4 months. Do you go find their other lab samples to perform the screen or have the baby stuck again? Also, if you have a BB armband system, do you armband babies in the NICU? Thanks!
  6. butlermom

    Ortho Vision and MTS gel method

    We have had our two Visions for about 6 weeks now and love them! We routinely run Panel A on them. Each shift has two panels. We take the panels out of the fridge and let them come to room temp. The Visions are configured to reflex the panel when an antibody screen is positive. (Note: if you have to manually review a positive screen, it will not reflex) When the instrument reflexes a panel, it will beep and the bubble will turn red if the panel is not on board. That is our cue to load the panel. We will put Panel B on if we want to run it, but it is not routinely taken out of the fridge until needed. If we don't get clear-cut results with Panel A, we will use Panel B, or maybe selected cells to help confirm an antibody. As for the second question, I have never heard of extending the incubation for weak to 1+ reactions on antibody screens and panels in gel. I don't think this is necessary at all. Gel is very sensitive already and the instructions are for a 15 minute incubation. I seem to remember reading that gel cards should not go past a 30-minute incubation due to dissociation of antigen-antibody complexes if formed.
  7. butlermom

    Ortho Vision

    We are validating our two Visions currently. It was suggested that we perform roughly 20% of our monthly volume for correlations with our ProVue. This would be a LOT! I'm just curious what are others using?
  8. butlermom

    Pooled Plasma

    As an update we now have 1,000ml and 2,000ml transfer bags for pooling plasma and we have built several pools based on anticoagulant in our computer system. The FDA does not recommend pooling plasma with different anticoagulants, therefore, we are only pooling plasmas that are the same anticoagulant. The process is going smoothly except for the billing. I have to e-mail my billing person with the patient's information and the number of plasma units we used so she can manually post the charges. The only CPT code I can find is for solvent and detergent treated pooled plasma. I'm thinking of just creating another orderable (we have Cerner Millineum) that we could use to submit the charges--something like "pooled plasma X 4" that has a specific charge since this would usually be the minimum number of plasmas pooled into the 1,000ml transfer bag. We could then just order it however many times needed for larger quantities.
  9. butlermom

    Helmer paper recordings

    I've just ordered a Helmer BB fridge and even though it comes standard with a chart recorder, I don't plan to use charts. I am told I can download the temperature data to a USB and print the report. Would that also be an option for you amym1586? I'm curious if others still change charts every 7 days or are most of you using the download option? I read on another thread where alarm checks may be done electronically rather than using the ice/warm water bath. I really like that idea too!
  10. We've started getting requests for LARGE volumes of plasma for therapeutic plasma exchanges on adults and we currently do not have the ability to pool this in our computer system. I've searched the ICCBBA database and cannot find an appropriate E code for the pooled product to build this in our computer system. Does anyone pool plasma and if so, what E code are you using for the pooled product code?
  11. butlermom

    Anyone using the Vision (new Ortho analyzer)?

    LKSchroed, we are getting ready to order 2 Visions and we also have Cerner. I'm guessing it will be mid to late summer by the time we are up and running. Let's keep in touch as we both go through this process.
  12. butlermom

    Ortho Vision

    We are on track to get 2 Visions very soon. After the incubation rack is full, if there are remaining available wells in the cards, are you able to manually place them back into service to be used by the instrument? I'm assuming it keeps track of the gel card barcodes just like the ProVue.
  13. Does anyone perform Continuous Renal Replacement Therapy at your institution? We have done this for two pediatric patients, one earlier this year and another very recently. The order is for a certain amount of blood reconstituted to a specified hematocrit with FFP. It's just like preparing a unit for an exchange transfusion. What I didn't know until recently is that this blood is only used for priming the machine and does not enter the patient at all. We've been preparing labels and issuing the units as if they are being transfused to the patient. Does anyone have any experience with this and how do you document the reconstituted unit if it is not really transfused to the patient? I suppose I could attach a note with the product in the computer indicating its purpose was for priming only.
  14. butlermom

    Haemonetics and the Blood Dispensing Refrigerators

    I know this thread is a few years old, but I am currently validating the Haemonetics "HemoSafe" Blood Dispensing Refrigerator. We have Cerner Millineum as our LIS. I would love to engage in a discussion with others.
  15. Occasionally our supplier gives us pheresis platelets for our neonates in two attached bags. SInce we use the sterile docking device to prepare syringe aliquots, we pool the platelets into one bag, mix well and take out the aliquot, and then re-connect the bags and divide the contents evenly between the two and store them as before. Is there any reason this would not be an acceptable practice?
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