crldehart

Do you have a consent signed specifically for RhIG administration?

We maintain a log for receipt, open dates with lot numbers and date of package insert. For the Ortho products, there is an "e" number (electronic) for the Instructions for use on line, or a "J" number. We record this number. If it changes, the material is quarantined until the electronic instructions can be printed from the Ortho web site. We sometimes have to open cases to get the number from the individual sleeves of Gel cards. Immucor package inserts also have an ID/bar code number which we handle the same way. A bright green card is taped or rubber-banded to each unit to be opened(set, kit, vial). Whenever the product is opened, the open date in written on the card and left for day shift to record on the log. works well.After the new instructions are reviewed, a notation is made in the log, stating whether any procedural changes were needed

We keep cells on 2 racks: 1 for day shift (6:30 am- 7 pm) & one for evening & nights. We alternate daily QC between the racks. 2nd rack is used less so is refrigerated more. Stored in refrigerator without internal lights.

We store the segments used for crossmatch in sealed tubes in a biohazard specimen transport bag (zip closure) kept at RT during the day. At the beginning of the next day shift, the dated bag is place in the specimen refrigerator on top of that day's patient specimen tubes. Tubes and segments are discarded after 10 days. It is a quick and easy way to save segments and also date the specimen racks.

We also do not wash the cord blood. We check all specimens for clots before putting them on the Provue, even with the new software. Negative anti-D tests on the cord blood are followed up with Tube Weak D tests (for mom's RhIG candidate evaluation).

We have seen this happen in the days of tube testing and "dirty" cord blood collection (stripping the cord vein into a tube). There was so much wharton's jelly in the sample that 4-6 washes were required prior to DAT testing. If the DAT was weakly positive, the additional washes after incubation in the weak D test seemed to remove the cause of the positive DAT and left us with a negative weak D test. This is not a problem now, cleaner collected samples and Gel technology.:)

We are on 5.64 without TAR and units are auto-transfused at 8 hours. Only problem is a rare unit not "released from issue" in the system that goes to transfused, but this is fairly easy to fix.

We have been using this filter/syringe set for some time. It makes preparing the aliquot so easy we keep thinking we have forgotten a step.

I found this discussion while searching for a reference to cite requiring that optimum spin times be performed semiannually. I could not locate a requirement in the CAP Transfusion Medicine Checklist. (Speed & timers are required, but functional calibration is not mentioned). I also could not locate the requirement in the standards. Does anyone have a source/reference for the specific requirement of performing functional calibration, "spin times" for serological centrifuges? Thanks.

All this 2nd BT talk is from CAP transfusion med. check list. Transfusion Medicine Checklist 06.17.2010 The previous version also included a comment that a 2nd band did not exactly meet the standard, but this has been removed. TRM.30575 Misidentification Risk Phase I The facility has a plan to implement a system to reduce the risk of mistransfusion for non-emergent red cell transfusions. NOTE: Mistransfusion occurs from misidentification of the intended recipient at the time of collection of the pretransfusion testing sample, during laboratory testing and preparation of units to be issued, and at the time of transfusion. Misidentification at sample collection occurs approximately once in every 1,000 samples, and in one in every 12,000 transfusions the recipient receives a unit not intended for or not properly selected for him/her. The laboratory is expected to participate in the development of a plan to reduce these risks through implementation of a risk-reduction system. Among options that might be considered are: (1) Documenting the ABO group of the intended recipient on a second sample collected at a separate phlebotomy (including documentation in the institution's historical record); (2) Utilizing a mechanical barrier system or an electronic identification verification system that ensures that the patient from whom the pretransfusion specimen was collected is the same patient who is about to be transfused. Other approaches capable of reducing the risk of mistransfusion may be used. The laboratory should participate in monitoring the effectiveness of the system that it implements. The laboratory should also consider improvements in procedures and/or educational efforts as part of its program to reduce the risk of mistransfusion.

My hospital Medical Director has asked how our blood component usage compares to other hospitals of similar size and patient population. Does anyone know of utilization stats tied to discharges, average patient days, admissions, or similar hospital size/activity data? Any info will be appreciated.

At my facility, every Blood bank tech is required to perform at least one CAP specimen per year. Each tech is assigned a calendar quarter in which to perform the testing. Whatever CAP survey arrives during that quarter, the techs assigned get to select which sample to test (on a first come, first served basis). This includes all techs all shifts. Only one tech per sample. If the tech has done a simple CAP (like the DAT), I will require another survey when everyone has had a chance to perform once during the year. After reporting, we usually retest the samples using a different method (manual tube vs Provue or manual Gel). This way we demonstrate tech competency and method correlation.

---------------------------- I would refer you to the CAP accreditation requirements in the lab general section: GEN.20377 Phase II N/A YES NO Are laboratory records and materials retained for an appropriate time? NOTE: The following records must be retained for at least 2 years: specimen requisitions (including the patient chart or medical record only if used as the requisition), patient test results and reports, instrument printouts, accession records, quality control records, instrument maintenance records, proficiency testing records, and quality management records. Specimens of serum, heparinized plasma, EDTA plasma, CSF, and body fluids (except urine) should be retained for 48 hours. (The 48 hour retention requirement does not apply to whole blood samples; for example, samples collected for blood gas testing.) Urine specimens should be retained for 24 hours; exceptions may be made at the discretion of the laboratory director. Blood films, permanently stained body fluid slides, and permanently stained microbiology slides prepared from clinical specimens (including blood culture bottles) should be retained for 7 days. Specimens must be kept under appropriate storage conditions. Laboratories may wish to retain instrument maintenance records for longer than the 2-year requirement (e.g., for the life of the instrument), to facilitate trouble-shooting. Records of method performance specifications must be retained while the method is in use, and for at least two years afterwards. For requirements on retaining records of changes to software, the test library, and major functions of laboratory information systems, please refer to the Hardware and Software section of the Laboratory Computer Services section of this checklist. More stringent requirements for certain laboratory records (e.g., in anatomic pathology, cytopathology, transfusion medicine) may be found in the discipline-specific checklists. For data directly transmitted from instruments to the laboratory computer system via an interface (on-line system), it is not necessary to retain paper worksheets, printouts, etc., so long as the computer retains the data for at least two years. Manual computer entry of patient result data from worksheets, print-outs, etc. requires retention of all worksheets, printouts, etc. for at least two years. For results that are manually entered into the computer from 1) observation of an electronic display, with no paper print-out available, or 2) manually performed test methods without worksheets, the two-year retention requirement applies to the data within the computer. In establishing retention requirements, care should be taken to comply with state and federal regulations. REFERENCES 1) College of American Pathologists. Guidelines for the retention of laboratory records and materials. Northfield, IL: CAP, current edition 2) Department of Health and Human Services, Centers for Medicare and Medicaid Services. Clinical laboratory improvement amendments of 1988; final rule. Fed Register. 2003(Jan 24): [42CFR493.1105]

We are on 5.5 Meditech, Client Server. I've just seen an on-line demo of 5.6 that we are due to start implementing in Sept. It looks like the EMR. There seem to be a lot of improvements. Transfusions are captured, including start, end times, cosigners, vitals, reactions. and all can flow into BBK. A check list of steps, including bar code scanning of patient wristband, unit no, unit type, exp, product. We will have to wait and see if this materializes in the release.

We have been live on Meditech corporate-wide (about 15 hospitals) for all hospital areas, including BBK, purchasing, nursing, pharmacy, lab, etc., for 2 years. TAR still does not work for nursing. Nursing returned to paper documentation of pre- & post-vitals used prior to the system retired 2 yr ago (HBOC) when Meditech went live. Nursing can record vitals in what is called PCS, but they would have to re-record the vitials in TAR to be associated with the transfusion.