slc7067

The blood banks at my site have encountered an interesting situation, and I'm hoping someone has some insight on how to handle it. Here's the scenario: one hospital in our system issues blood for air transport to take with them when they leave to pick up a patient, the blood is transfused during transport, but the patient isn't transported to the same site that issued the blood. So, assuming that the air transport was able to collect a sample, who is responsible for crossmatching the sample, the site that issued the blood, or the site that received the patient, and logistically, how do you get the sample and the segments to the same place? Do you even crossmatch the blood at all at that point? What if the patient is delivered to a hospital outside your system? In my heart, I really feel that even emergent transfusions should be crossmatched eventually, but I'm not sure how to make sure it happens. Thanks in advance for any opinions! Sandi

That is EXACTLY what I'm worried about! Your story sounds outrageous, but if I had a dollar for every time office staff or L&D staff have turned "A positive, antibody screen negative" into "A negative" I could take you to lunch! It doesn't appear that I can do anything to stop this, though.

I had a question today from our Epic team about physician office staff entering blood bank results from outside labs into the lab section in Epic chart review. I hadn't realized that this was happening, but apparently they can and do. My concern is that it this result appears with our other lab results and it isn't clear that the results didn't come out of one of our hospitals. Have others dealt with this? Am I wasting my energy worrying about it? Thanks for any thoughts or insight. Sandi

Our site has 2 printers with 2 kinds of label stock, however if I had it to do over again, I would probably just print the full label on the label stock that has the DIN area perforated for everything. We're printing product/date labels for units that we irradiate and for the parent unit when we make an aliquot, and we could easily have 2 people doing 2 types of modification at the same time. With no DIN on the half label, it has to be scrutinized so carefully to make sure we get the right label on the right product, it makes me a little nervous.

Thanks Malcom, unfortunately, our ISBT labeling requirements involve recreating the bottom half of the label with a new product code and expiration date, as well as the Rad-Sure.

Do you mean that your ARC is suggesting tie tags for additional antigen labeling? Or for all label changes? If you were labeling a syringe of antigen negative red cells, would you make a regular ISBT full face label, then attach a tie tag with the antigen negative information? If you had to irradiate a full unit of antigen negative red cells, would you cover up the ARC antigen info with your irradiated label, and add a tie tag? Thanks so much to everyone for the replies!

Our Red Cross region is just about to go live with ISBT labeling, and I have one last question about it. It's my understanding that ARC will print antigen negative information in the very bottom right-hand quadrant, instead of the tie-tags that we used to get. Except for the fact that it's almost microscopic print, I'm good with this, however, when we irradiate a unit, we print a "product/date and time" label that we place over the bottom half of the label--which will cover up the antigen info on the original. We've talked about using scissors to snip off the blank part of the label that would cover the antigen info, but at this point, I'm not confident that it wouldn't interfere with the "further processing" statement. We've also talked about creating an additional, separate sticker that we would place on the unit--something similar to the stickers we currently use to document when we do the antigen testing in-house, but no one likes the idea of covering up the original info on the label. At this point our Digitrax software doesn't have the ability to print antigen information on labels, so I'm really stumped. Has anyone out there solved this problem? Are there FDA considerations that I haven't thought of? Thanks in advance for any suggestions! Sandi

What did you do to cause improvement from 50% to 95%? We battle with that constantly, but never seem to make any real progress.

My hospital system is trying to standardize the process of auditing across several very different hospitals. Our current practices range from sending a form up for nursing to complete on each patient (not each unit) in the bigger hospitals, to following one unit to the floor each month in a smaller hospital, to following a unit whenever they can in the small hospital that only does about one transfusion a month. I would love to hear how others are handling this. How do you document? How many audits is "enough"? What can you do about it if you note deficiencies on the nursing side? Is a blood banker really qualified to document the transfusion process on the floor? Thanks in advance for any thoughts you can share. Sandi

My site is getting ready to go live with the Galileo Echo. We are thinking to cut costs by using the Echo reagents for our tube typing. Has anyone out there had any experience with this idea? Do you do your tube types using only anti-D1, or do you routinely use both anti-D1 and anti-D2? Or do you add anti-D2 only when the D1 is negative? TIA for any thoughts you can share. Sandi

Malcolm, that was wonderful! In 15 years of being a tech I never reallyunderstood why the procedure you described is an adsorption rather than an absorption! Thank you for the time and thoughtful answers you post on this site.

We currently use the Digi-trax Standalone label system to make ISBT labels for our autologous units (our supplier is ARC, so that's all we use it for right now). Our hospital is in the process of converting all of our applications to be on the network, rather than on each individual PC. The blood bank supervisor is concerned about Digitrax being unavailable in the event of a network downtime. It's not a big concern at the moment, but eventually when all of our units are ISBT and we need to make new labels for every split, syringe, irradiation, etc, that will be a bigger problem. Does anyone have a downtime plan that addresses this? Anyone have any thoughts you'd like to share? Thanks, Sandi

I think you should stick to your guns. The possible consequences are just too dire. We also have the truncating problem, and our phlebotomists and nurses fill in the missing letters on the label. We have the same specimen criteria across all of the lab departments (full name spelled correctly, med rec number, DOB, date, time and initials) however blood bank is the only department that routinely checks for completeness.

Thanks everyone, for your answers. You've set my mind at ease considerably. I asked them to fax me the antigram for their screening cells, and it does show good "homozygosity" so I think I can go back to sleeping well at night.

Hi Malcom, Good questions. They do tube method with Immucor's Panascreen screening cells. They are a small community hospital, with relatively little blood banking workload. They don't do any antibody identification or antigen testing. If they get a patient with a positive screen they have to send out the patient specimen and segments from the units they want crossmatched for antibody ID and unit antigen testing. Alternatively, they send the whole patient out for transfusion at another facility.

I work for a hospital that is part of a small group of hospitals and clinics. Our blood bank does antibody screens by gel, and immediate spin crossmatches when there is a negative gel screen and negative history. When we implemented this policy, we justified it to our very concervative medical director with the increased sensitivity of gel over tube antibody testing. I recently realized that one of our newer, more remote hospitals also started doing immediate spin crossmatches when they became part of our system. I'm all for consistency across the system, but this hospital doesn't have gel. I'm concerned that immediate spin crossmatching isn't adequate without a more sensitive antibody detection technique. Anyone have any thoughts? TIA, Sandi

My facility has used Lean and Six Sigma in several departments of the lab, including Blood Bank. The projects have had varying degrees of success. I might be able to share some of our experiences--or at least sympathize with some of yours.

I have another "I saw it on TV" story. Our NICU nurses had just recently started drawing blood from babies themselves, and we were still having lots of issues with improper tubes and insufficient volumes. I called one nurse to explain that we didn't have enough blood to perform the ordered testing on her patient. She was very irritated and informed me that she knew there was plenty of blood because she watches CSI. In fact, we should be able to "perform all the testing and more on nothing but the bandage from the baby's foot!" I explained that if she wanted to set it up with the state forensics lab, that was fine, and she would likely get her results in a couple of months!

My facility collects autologous units for in-house transfusion only. Our current practice is to create the ISBT label before the collection without the blood type quadrant on a stand-alone ISBT label printer. The phlebotomist places this label on the unit at the time of collection, and later in the blood bank when the unit has been typed, we create a new full-face label, now including the blood type and place it over the original label (we leave the original unit number exposed). Some of the blood bankers are uncomfortable covering up any part of the original label and feel that creating a new label is an opportunity to make an error. They would prefer that we place a blood type sticker on the blank quandrant. Does anyone have any thoughts on this? Any experience with the FDA or AABB concerning a situation like this? Thanks, Sandi