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Townsend

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About Townsend

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  • Birthday 04/19/1976

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  1. The extra spin is not recommended by Ortho. We definitely see some lots/shipments that have more rejections than others. It was requested by Ortho that we contact technical support when this happens so it can be reported and they will replace those effected cards. We actually had a problem around a year or so ago that led to a lot of troubleshooting with the card manufacturers by Ortho. Reporting to them is really the only way to find out what the root cause is - problems during shipping or manufacturing could all play a role.
  2. The standard in 5.14 quoted above states that pre-transfusion requirement for any allogeneic component is an ABO group and Rh type. It does not state that this has to be done within 3 days or on the current admission. As we can see by the responses, some facilities are requiring confirmation on the current admission and others will go with historical ABO/Rh for a plasma/plt/cryo transfusion, and I can definitely see arguments for either side; bottom line is, this is not a regulatory requirement and must be defined by your facility. There is a standard that requires the pre-transfusion testing within 3 days if transfused or pregnant (5.14.3.2) - but the entire section for 5.14.3 is regarding the antibody screen for WB/RBC/Gran transfusions, not the ABO/Rh only.
  3. Agree - also, what blood type is the mother? From an operational stand-point you have a couple of options: Call the blood type "indeterminate" or "unable to determine" or call the baby AB. Either way, we would suggest repeat testing at 4-6 months and include A1 lectin typing if discrepancy still exists. In the meantime we would give group O red cells and AB plasma/platelets until resolved.
  4. We also use a communication log that others are referencing here. Each tech is required to read the communication log since the last shift they worked EVERY DAY as one of the first things they do as they enter the Transfusion Service. We have been doing it for years, and it has now become second-nature. Anything that has to be handed off must be recorded by the outgoing staff, and anything else to speak of (patient using frequent products or an OR or MTP that used a lot) is also helpful. We also instituted a huddle board (dry-erase board at the end of the room) and do a standing huddle around 3pm everyday when we have the most staff and are usually the busiest. Even the Transfusion Service MD on-call participates in the huddle and it has helped out with our team communication!
  5. You should be able to check with your blood supplier to see what codes they will be using. We use the Red Cross and have only built E8340, E8341, E8342, E8343, and E8344 thus far.
  6. We perform neonatal exchange transfusions on only one to two patients per year. We are a large free-standing pediatric facility in Ohio with about 525 beds (includes about 130 inpatient neonatal and 150 offsite neonatal beds). We provide reconstituted whole blood since we are already FDA registered (see related thread on RWB for exchange txns). A baby who needs an exchange who is at our offsite neonatal units at our partner adult hospitals should be transferred in-house on main campus for the exchange procedure. It is a manual push-pull process, usually performed by the NNP in the NICU. The RWB is not required but does make the process easier for the clinician as opposed to alternating prbcs and plasma. Stephanie
  7. We also used to do electronic checks quarterly, but now that there is specific guidance to standard 3.7, we have reverted back to the old water/ice alarm check. This is from the AABB portal on the guidance for standard 3.7 in the 31st edition - "An electronic alarm test that merely increases or decreases the electronic digital readout to determine if the audio alarm sounds, would not meet the intent of the Standards." The full checklist item and guidance are attached. AABB Standards 3.7 and guidance (31st edition April 2018).docx
  8. I don't have any good reference material for you, but I can say that we use adsol units for all of our MTPs, regardless of age/size. We do have different MTP packs based on the patient's weight ranging from 1 rbc: 1plasma :1 plt to 4 rbc : 2 plasma : 1 plt pheresis. We are a free-standing pediatric Level 1 trauma center with about 30 MTPs per year.
  9. Sounds like an amazing program - Congrats to your team!
  10. We use both pre-pooled cryo from our blood supplier and in-house pooled cryo. We are a pediatric hospital, so we may pool only one or two units depending on patient weight. We do not add saline to the pooling process, and there is very little cryo left in each bag. I am curious - what diagnosis or indication requires 36 units of cryo? I would like to learn a bit about that.
  11. 1. How many beds in your facility? About 450 with additional offsite NICUs, level 1 pediatric trauma center  2. What is your TAT? We only monitor T&S from the Emergency dept- 45 minutes or less (goal is 95% resulted within 45 min. We are usually 97-99% and perform around 120-150 samples from ED per month) 3. Is the TAT calculated from order to result or receipt to result? From receipt to result only  4. Who collects your specimens? RNs, phlebotomists, others? RNs or IV team 5. Do you have any automation in your Blood Bank? Yes- one Vision; it has not impacted our TAT for these ED samples. We set a timer when a STAT is placed on the Vision so that it can be resulted as soon as results are available.
  12. You may want to check with the FDA on this, or you may be able to find the answer in previous "Ask the FDA" sessions from AABB - I am fairly certain that this does not require FDA registration.
  13. We do our titers in gel (ABO titers only as we are not a delivering hospital; pediatric only). Any positive reaction seen in gel should be interpreted as 1+ since there is no w+ interp in the MTS gel interp. guide - there is also no w+ on the Vision. So, our end-point is the dilution with the last 1+ positive. Our results have correlated well with the CAP samples done in tube when looking at all of the methods reported, but we have only done these for about a year now (only about 3 CAP survey's so far). We haven't looked at bringing this onto the Vision yet..... all though I am aware that it is now able to do the dilutions for both the buffered card and IgG titer reactions; so maybe with the next software upgrade??? Would love to hear back if you successfully implement the titers on the Vision! Stephanie
  14. We currently do as you described - the techs add a credit irradiation charge if the patient doesn't need it, but then we have to go into the account and manually credit the irrad RBC and bill for the correct non-irradiated RBC instead. You could set up a charge edit rule in Sunquest to do this automatically (I have been thinking about this as well). Sunquest should be able to help you with charge edit rules if you've never done them before. Basically you create a rule so that anytime Sunquest sees the credit irradiation code AND the irrad RBC charge together, then the resulting charge would be the regular LR RBC charge code instead. We haven't set this up for crediting the irradiation, but we bill this way for some of our manipulations like aliquots so we can charge for the split P9011 product instead of a whole product. You might even be able to do this without the charge edit rule. Set up a new charge (we'll call it CRIR for credit irradiation). In the billing maintenance for CRIR, define a CREDIT for the IRRAD RBC charge code and a CHARGE for the LR RBC. The techs would still have to add the CRIR charge at the time of issue (when an irradiated RBC is issued to a pt who doesn't need irradiation), but it would adjust the charges automatically. We have gotten pretty creative learning how to bill for manipulated/divided products at our pediatric transfusion service - feel free to send me a message:) Stephanie
  15. We use the 24 hours regardless of how the red cell was entered (sterile connection device or spiking unit). I hadn't really considered the possibility of extending to 5 days with the use of thawed plasma. I will also be interested to hear if anyone else is doing this. Stephanie
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