BankerGirl

Ours are transported this way as well, however we have still had rare instances where they were not within the 20-24 degree range when they arrived during extreme weather conditions. When this happens we call the supplier and they decide if they are acceptable or will be replaced. I believe that the original question was for units issued for transfusion but returned unused. For this scenario we take the temps, examine the product, and decide from there.

The only option our nursing service has is RhIG if indicated. We order the appropriate testing to determine the answer to the question. If RhIG is indicated, then the RhIG order profile includes a fetal screen and an Rh type (or Type and Screen if one hasn't been done). The BB techs must cancel the Fetal Screen if it is for antenatal purposes.

What version Meditech are you implementing? We are on v5.67 and our TAR is set up differently for RHIG where only the patient armband is required to be scanned. If you are changing to v6.x this might have changed, but it might be worth investigating.

Mabel, Just curious in your scenario above, if you don't draw a fresh specimen and perform the screen on mom at the time of the exchange transfusion, how would you know if mom DID develop an antibody after delivery? I would think you would remain blissfully ignorant of any new developments in mom.

We do just as Goodchild states. Our computer system (Meditech) reflexes the pool charge each time one is issued and bills for each unit in the pool.

My cellphone number is on speed dial in the blood bank. I wish they would call me more often than they do, but some folks just won't do it--even in the afternoon. I have told them I wouldn't have put my number on speed dial if I didn't want them to use it. I was working late in my office one day (across the hall from the department) when a tech didn't know what to do about a problem with the computer system. Our lab director heard the discussion and convinced her to call me. They were both surprised when I walked in and solved her problem.

I agree with you about the practice Brenda, but the additional benefits of smaller size and (mostly) no refrigeration were the deciding factors. We don't use them very often so I was constantly having to rotate the monitors in and out of the refrigerator. Plus when they are stressed in a MTP situation, it is easy to be careless and mishandle the Safe-T-Vues. Those are the units most likely to be returned to us.

We switched from the Safe-T-Vue to the BloodTemp indicators recently. We had issues with the staff touching the indicators while applying them and so we were wasting a lot of them. I like the BloodTemp ones because they don't have to be refrigeratred prior to use, so touching them is not a problem. Also, they are smaller than the Safe-T-Vue. They are a little more expensive, but I think with the decreased waste we will probably about break even. We only apply them to units in coolers.

We would not honor the special blood protocols because we couldn't honor them. We don't irradiate blood and have very limitted (if any) supply of irradiated units. I don't know what BB IS system you use, but our Meditech has an emergency issue function that basically allows us to give anything to anyone. It will still pop up alarms if incompatible blood is issued, but it will allow it. This can be done with crossmatched blood as well as uncrossmatched.

I set this up a few years ago. We are on v5.67 at the moment so I don't know if calculations are done the same, but if you want to see my calculation I can send it to you. We stopped performing them inhouse a few years ago, so I haven't actually used it for a while, but I recollect that it worked.

Well, in this case the mom came into the ED several weeks previous with suspected threatened abortion and received RhIg so I was surprised that any fetal cells would survive in mom's circulation. I guess anything is possible, especially since the infant was stillborn. Time to move on.

David, I too have given moms of full term newborns many more vials but my concern is that the fetus was only 22 weeks. It would seem that is a lot of blood to come from such a small one. That is my only question.

We just had a mom with an incompetent cervix who had been bleeding for several days (4 days that we know of) deliver a stillborn at 22 weeks gestation. Our second shift tech performed a KB and the result was 0.9% with recommendation of 3 vials RhIg. I wasn't here to look at the slides but a second tech verified with the performing tech. We didn't get any cord blood so don't know the fetus' Rh status, but from what I'm reading, that seems an unlikely percentage for 22 weeks. We did give the poor lady all three vials, but it seems like a lot.

We have custom label designs for our non-mobilab labels, but I believe that the dimensions are close to 1.25 x 2 inches.

I doubt that these additional items will be on the mobilab label. You can still print the labels out of Meditech for you information if that is something you need. The MRI will be printed on the labels. I didn't set up the labels for Mobilab. All of our Mobilab labels look identical to each other but we don't have anything fancy like that on our regular BB labels.

Same as mollyredone.

Mobilab uses a Mobilab format. It has items in different places than the ones we have set up in Meditech, but all the information is there.

We are a different reagion from AMcCord but have had the same experience as her. I would definitely recommend you talk with them and see what they can do for you. We don't have the luxury of a closer community blood center. If we did we might shop around just to see what they could do for us, but I have no real complaints about Red Cross.

We use stickers for our assignment/crossmatch info and total Electronic documentaiton with the exception of Surgery, Trauma, MTP and Code Blue transfusions. OR has a different format of electronic documentation where vitals are still only on the anesthesia record. When I started monitoring transfusions, our compliance with vitals was <50% but now it averages >95% but it took several years and relentless incident reports to get there so keep trying. The computer makes it easier for the nurses to document but they can still circumvent the process. I do not do much real time monitoring because that would be way too much time out of each day.

This is how we do it (as bill only tests). If it got done, then it gets billed. Occasionally reimbursement will call me and question charges but I have the charge sheets from our IRL to show that the charges are appropriate. The insurance company pays us whatever they want to, but I submit the charges regardless of reimbursement.

How did you find out about it in the first place? And how did they document the transfusion electronically if the unit was never in your system? Is it in nursing notes or something similar to that? If that is the case, I would think that as long as they followed your transfusion procedure then it should be fine. That is the way we have handled it in the past.

I added tests to result QC results, Lot # and Expiration date to our FHB battery, as well as our KB. They are free text fields. This way these are all documented at result entry and are filed with the specimen results.

We just had a baby come up weak-D pos and I had to decide how to report this. I chose to go with Rh Neg and add a comment that the weak D was pos so mom needed RhIG. It was easier to answer the RN's question once than to worry about changing the baby's blood type after dismissal or having questions later in life.

We order an AGID on the unit which allows us to document the results of the unit and controls, as well as the lot number and expiration date of antisera used. There isn't a place to document the actual control used but you could enter that in comments. We chose to also maintain a paper log for that information, mainly so that it is easy for other shifts to see if QC has been done for that antisera for that date. I keep that for way more than 10 years, due mainly to procrastination and lack of time/motivation to clean out our storeroom.

Hi Amy, We are the transfusion service for three hospitals in our area that don't have blood banks. They follow our blood draw and patient identification requirements, send us the specimen and we perform the type and crossmatch and transfer the blood. We have contracts spelling out exactly what is required of them, as well as us. It is their responsibility to arrange for transport of both specimens and RC units. Two hospitals send the specimen with couriers and someone from their facility will pick up the blood later, while another sends the sample with a hospital employee who then waits "in the Big City" for an hour (usually they shop!) while we get everything ready. I have never been to any of their hospitals but they are required to send the transfusion paperwork back so I can review and make sure they are following policy for transfusion. They also have protocol for how to what is needed for a transfusion reaction and we would work it up here. We have been doing this for many years and no inspectors have questioned the process. They just want to see the contracts and transfusion documentation. We are a non-profit hospital.