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There is a simpler method for keeping temperatures over a longer time frame. You can find a temperature logger that records the temperature for up to 48 hours or longer on the internet. It looks like a USB device or a circle and will sit inside the cooler of your choice. It has a computer program that you load into your computer and it can then be uploaded and reviewed. You can print out the report of the temperature and keep it for any agencies that may require it or for your own records.
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It is not that the diagnosis code is incorrect. The diagnosis code should be the same Type II or I diabetes. The best way to resolve the issue of when testing is to be performed would be to call the doctors office and see when he wanted the test to be performed. We had a outreach Manager and staff that would handle those issues. They would call and see when the next testing was to be performed and educate the office staff to include a date when future orders were to be performed. We had some office that would write scripts for testing to be performed on specific date and fax it over to our facility. Educating the doctors office would be the first place to start.
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I understand that an ABN form needs to be filled out for a Medicare patient. Your computer system should notify you that one is required. There is not a mandate that you notify any patient other than Medicare that their insurance is not going to cover tests that a physician orders. In my pervious employments we had the largest reference lab in the state of Mississippi. Do you think that a patient with a severly elevated A1c should take medications that are not correcting the pateints blood sugar. There are severe complication that occur if a patient's A1c is elevated over 7.0 . Complication of the eye lower extremities and coronary artery blockages. As I know that you are well aware an elevated blood sugar causes placking of all intra vascular material to the artery and venious walls. I think that a 30- or 40 dollar test charged to a patient would offset the knowledge that the patients medication and or change in diet is working to lower his A1c.
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There are many reasons that one might test the Hgb A1c before the three month time frame. New medication may make it necessary to retest. A patient A1c may be so high that the risk factors associated with a high A1c might require a retest to be performed before the three month time frame. As far as coverage by insurance some policies may pay for it before the three month time frame and other may not. I would go ahead and charge for the test and keep physician order on file. It is not the laboratory responsibility to see that insurance will cover the tests but that there is a vaild order and perfrom test that are needed in the care of the patient. Did the order say repeat testing every two month X _ .
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We are a large trauma center. We currenlty transfuse about 28,000 units of blood a year. We keep a 10 day supply of blood of our shelves at any given time. We track our inventory daily to keep it at the same level. We order more blood when our inventory get low and cancel orders when it gets too high. We have not had to be in triage for the past two years. We only waste about 18-24 units of PRBC's a month. We stopped getting AB positive PRBC's and our expired units have decreased even more. We feel comfortable having this amount so if there is a shortage of blood or we get into a major diaster we will have enough blood to meet our patients need. We have not had issue with upper managment and the amount we spend on blood.
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UPDATE: Pre-Pooled Cryo. Expiration
Gumby replied to Brenda K Hutson's topic in Transfusion Services
We have two supplier for our pooled cryo. We have been using pooled cryo almost exclusively for the past ten months. We use between 35-50 units of pooled cryo per week. We only keep 20 units of single donor cryo for babies. Prior to the release of pooled cryo the Hospital hired a pathologist from the ARC in South Carolina and even with her connections we were not able to get an answer from the ARC. Our two providers for pooled cryo are LifeSouth and the American Red Cross. We have found out over the first few months that if they do not give it in the first 4 hours 98% of the time it was not given during the next two hours while we had the 6 hour expiration time. So have the additional two hours will not cause a decrease in the amount of cryo that we expire. -
UPDATE: Pre-Pooled Cryo. Expiration
Gumby replied to Brenda K Hutson's topic in Transfusion Services
Listed in the CIRCULAR OF INFORMATION for the use of Human Blood and Blood Components states that pooled Cryo is only good for 4 hours after thawing. We ran into this issue when we first started using pooled Cryo. We first used the 6 hour rule and changed all of our procedures and debated this over a two month period. We had called our two suppliers and neither would give a definate answer on this issue. Since we could not get the information from our suppliers we decided to then switch to the 4 hours of expiration. Unless we receive documentation from our suppliers we will continue the 4 hour rule. After making this decision we went back and reported to the FDA that we administered 2 units of pooled cryo after the 4 hour expiration time. -
What are your thoughts on this question? Thank you
Gumby replied to trisram's topic in Transfusion Services
At our facility we would give O positive CMV negative ( if patient was CMV negative prior to transplant or if unknown) irradiated units of blood. -
We are currenly located next to a childrens hospital and as their patients age they are coming over to our facility for treatment. We perform single or double exchanges on a weekly basis, but currently have three patient who need exchanges on a frequent basis. These sickle cell patient have had strokes in the past and have been placed on this protocol for the rest of their lives. Our goal is to provide the best quality of care for our patients. I guess since we are a large facility that we see more of these patients with the added benefit of having a childrens hospital right next to us. The problem that we see with the iron chelation therapy is that the medication tastes horrible and most sickle patients do not take it on a regular basis.
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This has been in place prior to me being employed at this facility. We have more time in our ER to decide which type to give, when the nursing staff come to our staellite blood bank which is located right out or surgery we give them a cooler of blood that is only O negative. We do not want to delay treatment in any fashion.
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In the emergency room we issue O positive to male patients and O negatvie to female patients. If the need arises during surgery we give only O negative no matter what the patient sex is. We do not require the OR staff to let us know when they are comiing just to bring the patient's two identifiers and we give them pre-set up coolers of blood. This is our protocol.
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As far as I know this will continue for the rest of the patients life. RBC exchange transfusion are only done after the patient's level of Hgb S reaches a level above 30%. For most patients that is once a quarter but we currently have a patient that this is done once a month. Between the monthly exchages, each week the patient has 1 or 2 unit of blood removed and replaced. By performing these procedures we are providing a better quality of life for them and meeting the needs of our customers.
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One of the reasons for RBC exchange transfusion in sickle cell patients is to prevent repeat strokes. It has been shown that once the level of Hgb S is over 35% that there is a significant increase in probability of strokes. By decreasing the level of Hgb S to 12% or less this will prevent the chance for the patient to have a stroke and loss of brain function. We have recently started this protocol at our facility. It takes between 10-15 units of blood to decrease the amount of Hgb S from levels in the 30's to lower teens. The procedure at our facility is done with apheresis machine and takes about 4-5 hours. We are currently seeing patients in the age range of 20-35.