butlermom

As for the signed Emergency Release form, we have always sent the original to the chart and kept a copy in the blood bank. CAP says that "records" of the emergency release must include the authorization of the physician; AABB says the "records" must contain a signed statement from the requesting physician, etc....... . Does this form actually need to be placed in the patient's chart or is our blood bank file a sufficient "record?" We are exploring the possibility of obtaining an electronic authorization and signature for emergency release. Thanks

I am currently trying to implement this at my hospital. I do have a question for all of you at trauma centers: do you use the same form that the physician signs for emergency release as you do for an MTP? At our hospital many MTP's start out as emergency release, but we do have MTP's on patients in surgery sometimes and there's already a type and screen so no need to sign a form there. We are also trying to have the form in an electronic format that the physician will electronically sign. How do others handle Emergency Release vs. MTP? Thanks in advance!

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

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.

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

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.

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!

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.

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?

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.

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!

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?

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.

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.

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.

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.

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?

12-year old patient who had never been transfused had a type and screen in December, and was group A positive with a negative screen by gel (ProVue). She returned in early April, still showing a negative antibody screen and received one packed cell, after which we learned she had thalassemia and needed Rh and Kell phenotypically matched blood. The unit she received was c negative and K negative, but was E positive (she is c neg., E neg., and K neg.). She returned approximately one month later, antibody screen still negative, and received two units that were c, E, and K negative. She left the hospital with a hemoglobin of 10.6. Exactly 6 days later she returned to the hospital with a 4.9 hemoglobin, positive antibody screen, all panel cells positive of varying strength (all 2+ and 3+), a positive auto control, DAT weakly positive for both IgG and complement. The eluate was reactive with all cells tested. We sent samples to our reference lab and they identified a cold autoantibody that is IgM in nature plus 4 other antibodies: Anti-E, Anti-K, Anti-Jkb, and Anti-S. We were thinking this was a delayed transfusion reaction from blood received elsewhere, but the physician questioned the family again and they insisted that she has never received a blood transfusion anywhere else. 6 days just seems like too short a time-frame for this to be a primary immune response with this much reactivity, and we have only transfused K negative blood and yet she exhibits an anti-K! Our reference lab indicated that autoantibodies can demonstrate specificiy to antigens that the patient does not possess. I have heard of this as well, but am only familiar with it as far as Rh antigens. Two of her previous transfusions were with units that were Jkb positive and one was S positive so I think she has so much circulating anti-Jkb, that it is destroying the transfused cells. Her hemoglobin dropped to 4.0 by the time we were able to find antigen negative units for her 4 antibodies and have given her 2 units in the past 3 days. She appears to be improving, although still clearing some of the transfused cells. Urine is dark yellow. Her plasma has always been icteric, even prior to transfusions, and has never looked hemolyzed. So, back to my original query: is it possible we are truly seeing a primary immune response here? (Sorry this is so lengthy, but I've lost a good bit of sleep over this one!) Thanks!

Does anyone know of a company that produces a plasma thawing microwave other than the Canadian company with the distributor in Florida? I've been waiting 5 months for new bag holders and the company seems to have trouble getting the materials to make the parts. We have a new microwave in the budget, but at this point I'm interested in shopping around.

How do you report a titer result when it is all negative, even the 1:1 shows no reaction? The antibody screen was 1+ with anti-D identified, but it did not titer out. Is it correct to report: Titer <1?

Goodchild, I'm afraid I'm not familiar with the term "RVUs." Could you please explain?

Does anyone have a "formula" or "metric" to determine how many FTE's are needed for "X" amount of workload? I guess the first question should be, "How do you measure workload in your blood bank?" I know we can use transfusions as one indicator, but that doesn't begin to cover all the other activities we do such as preparing syringe aliquots, panels, QC, etc., etc. Our facility is planning to expand significantly in the near future and in order to justify additional staffing, administration wants to see some sort of measurement rather than us just saying we need more staff. Is there something measurable that says when we reach this number we need another tech? There are days when we can barely keep our heads above water and the projection is that our facility is going to double in size. Thanks for any ideas or suggestions!

We have the Helmer Ultra CW and have had no problems with it in over 5 years. We do QC on it every day and BioMed checks the rpms when they check our serofuges biannually. I am wondering, do others also check the timer on the cell washer?

Amelia, We moved in late October into our new building and the field engineer was on site. It was expensive but everything went smoothly. What I did was to write a re-validation plan which included just a couple of items from each section of the original validation from when the instrument was installed. I wrote the plan, another tech performed the testing, then I reviewed the data. We also ran previously tested specimens after the move -- I used samples of every blood type for this as well as about 8 cord blood samples. The move involved the ProVue being lifted and placed in a truck then transported about half a block away and off-loaded. I was nervous the whole time but the field engineer was great and made sure it was handled carefully. We moved 4 years ago about the same as what you are about to do and we did not have the field engineer at that time. The ProVue stayed on its rolling cart and we simply rolled it down the hallway and into an elevator then down another hallway into the lab. At that time my FE did advise me to take some packing material--I used bubble wrap from our FFP--to immobilize the robotic handler so it wouldn't move around. I kind of "wedged" the bubble wrap under it and placed some on the right side so it would not bang against the inside wall there. Also, you will want to perform a back-up prior to moving. At that time, we only ran some previously tested samples and QC and we were good to go. For fifty feet this should work for you. Good luck! Kathryn

We've been live with Cerner since February 2013 and our process is the same. We get a unit of the patient's blood type from the fridge, go into Result Entry, scan the sample accession label, scan the barcoded BBID (blood bank i.d. from the armband) on the sample, and then scan the unit (however many are ordered). As soon as you scan a unit, the computer makes the decision that the unit is ABO compatible with the recipient and automatically fills in the interpretation field with Computer XM OK. Don' forget to pull a segment from the unit as well as a number sticker--we affix the sticker on a 12X75 tube and place the segment inside folded so it won't fall out. Often we will wait until a nurse comes to pick up blood and just perform a Computer Crossmatch Dispense at that time. The only thing is you have to manually enter the BBID in the field in the save dialog box when you are dispensing so that it will print on the donor tag. Since we do not have the sample in hand at that time, I had to figure out a way to be able to quickly find the blood bank armband i.d. What I did was to build a BBID result field in the ABORh test so that we can quickly look in Order Result Viewer at the most recent type and screen results and see the BBID. We can then verify it against the blood request form that the nurse brings which MUST have the BBID on it. We type this into the BBID field during dispense, pull a segment and sticker and we're done. We never have to handle the patient's sample again. It took us awhile to get used to this as we went live with electronic crossmatching the same time we went live with Cerner. Everyone loves it now and we've never looked back, including this "old timer" blood banker!