BankerGirl

If you follow AABB guidelines, you have to keep them on O until the second type has been performed. However, if the first sample is drawn using an electronic positive identification system, it can also be used to perform the retype. We try our best to get the initial blood sample drawn using our Mobilab system to positively ID the patient. We perform the Type and Screen on our Echo and the second type by tube. The rare times a patient goes bad in the OR and we need that second sample, we require them to draw it.

I don't understand this. Not only are they being selfish with the blood products, but also with all of the PPE and other supplies that are in critically short supply nationwide. I guess I should feel better about at least cutting the number of elective procedures that we are doing, although we are still doing way too many. The blood shortage is forcing our physicians to abide by the guidelines that we instituted 7 years ago, and it's forcing our Pathologist's to enforce them. My optimist self hopes that once this emergency passes, the will understand the reasons why we shouldn't over-transfuse and will change their habits. The pessimist in me thinks that won't happen, though. I guess we'll see which one comes out on top.

Actually, I believe that the daily QC takes care of that, as the saline is used the same in patient specimens and QC material.

When we were using gel, for the antibody screening negative controls we ran one with each diluent and the third with saline. Now that we are automated, we use saline as the negative control for the Check Cells in tube.

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We just did a history conversion from Meditech 5.67 to Meditech Expanse. I chose 10% as my target and used a random number generator to blindly select the records to validate. I also made sure to add a few patients that I knew had antibodies and special requirements, but found several just using the generated numbers. Have fun!

We also use the electronic alarm functions on our equipment, and at our last assessment the inspector brought up the chart pen moving. She told me the purpose of the alarm checks is to make sure the pen moves. I disagreed with her, said the purpose of the alarm checks is to ensure that the alarm is activated, and we check the movement of the pen each day when we do our temperature checks. She thought about it for a while and ended up not citing us for this. I know there are facilities who have abandoned their graphs for centralized electronic monitoring, so I don't see how they can require that a pen move when these sites do not even have pens or graphs.

We had a patient that seemingly converted from A Positive to A Negative. We sent the patient to our reference lab and through whatever voodoo they do, discovered that she had proteins masking her D antigens. I don't remember her specific disease process, and I don't think it was anti-D, but they reported that the patient was indeed A Positive.

What version of Meditech do you have? Finding vitals can be very challenging because yes, they may very well be documenting in the vitals section outside of TAR, especially if the aids are performing this task because I don't think they can access the TAR. What kind of daily transfusion record report are you looking for? There are a few standard report options depending on what you are looking for, but I also had an NPR report created so that I could export it to a spreadsheet and sort the data using various criteria.

I have to say that the demands on blood bank will depend GREATLY on who your facility selects as a surgeon. When we first started CVOR cases, we packed 2-4 units in a cooler and were required to have 4 platelets on hand. Our blood supplier thought that was ridiculous, because none of their other hospitals performing CVOR procedures kept that many platelets. That was 20 years ago, and the surgeons did not wait for Plavix to decrease in the patient's systems prior to operating. We later stopped packing blood for the surgeries because the surgeon thought it was ridiculous, since he never used it. I had never heard of TEG or Rotem until we became Trauma certified, and then we were not asked to get one. Our last surgeon barely used any products at all, but insisted that we get a TEG because that was "state of the art" care. I don't think he ever looked at the results. Since his retirement two months ago, we have had locum tenens physicians who don't know what to do with TEG results, so don't order them, and we are back to using multiple platelets, as well as other blood products. Best of luck to you.

We are AABB accredited but not CAP. Our hospital is accredited by HFAP, as is our lab. Our HFAP inspection falls 3 to 6 months prior to our AABB inspection, and the AABB one is the same quarter as the new Standards become effective. This makes it rather challenging to prepare for both.

bevydawn1, Here is the rule I had in 5.67. Hopefully it helps. The Data Flds From is BSP. (([f bsp ctime]-2400)/100)^X, (72-X)^Y, [f bsp exp hrs set](Y);

This should be true, but then it brings up the question I have asked before, which is why do they order the tests if it doesn't affect patient care? I have asked our Peds physician group and received no answer. Before this year we never did a cord blood workup unless it was to determine RhIG eligibility for mom or the baby was jaundiced. This year, however they are insisting on all O Pos moms as well. Of course they didn't tell us this, so we were caught off guard and short of supplies for DATs. When I asked for the evidence on which this decision was based, I was flatly ignored.

What version of Meditech are you on? I did this with a rule in v5.x and also in Expanse 6.x. I found it on the KB section of their website. I don't see it anymore, but I can email you my rule if you are interested. I also found KB article 43874 that addresses extending specimen expiration date to 72 hours after surgery date rather than specimen collection date. It is based on location, and may or may not be applicable to you.

Same here. We have Meditech set to expire as close to 3rd day at midnight as we can get it, but we cannot make exact. It is always within an hour so it is rarely a problem, but I wish they would allow days instead of hours!

We stopped performing Eluates on cord blood years ago. We initially said only if mom had a positive antibody screen, and then went to if Dr. orders. They never do, even when mom has a known antibody and the baby is severely affected. They know the source of the problem and treat the baby accordingly.

We dropped the poly for the same reasons you are considering. We have an Echo and perform ours on there and have tube reagents for backup or in case the sample is too small to run on the Echo. We are AABB accredited, but not CAP (we use HFAP) and our processes have not been questioned by either agency.

Meditech is not flexible and will not allow you to make exceptions for a specific patient population, but you can extend the outdate of individual specimens up to 999 hours. It still flags that the blood type and antibody screen are not current, but these can be overridden to allow you to use the specimen for crossmatching. It will, however. fail on the EXM, so you will have to perform an actual crossmatch.

We perform a type and screen on all of our labor patients at admission, so we do not repeat an antibody screen after delivery; but if the patient is in our facility and they want to give her antenatal RhIG, we do one before we issue it. We have identified a few patients who had already developed an immune anti-D so the treating physician had been able to monitor their pregnancy more closely.

We set our blood product orders to reflex off of the transfuse order. This accomplishes two things for us: the physician only has to enter one order, and we don't have staff calling us and asking if they need to order irradiated, cmvn, leuko-reduced, etc. We perform electronic crossmatch (sorry Malcolm, that's the term) so we do not set units up unless they have a transfuse order unless they have a clinically significant antibody (or history of one) or the patient is in OR and the physician requests units be packed in a cooler for quick access.

True, Scott, but I learned a long time ago the difference between talking to my coworkers/director and communicating with those outside the lab. My director still freaks out when I tell her that, but I try to remember to mention that those weren't the "official" words I used. I still take offense to the physicians who want to blame lab for their failure to order tests and the nurses failing to follow instructions, though. I have learned never to respond in the heat of the moment if it isn't absolutely necessary.

Thank you for your comment, John. My statement is also not popular with my Laboratory Director, but it is true none the less.

This is how we treat it. I have no way of verifying that there wasn't a verbal order from the physician to transfuse. We do have the physician order to transfuse on their checklist as well, and there have been nurses who just checked it and went about their transfusion without an order. I have to explain several times a year that it is the Dr.'s responsibility to order what he wants, Lab's job is to prepare what the Dr. orders, and the RN's responsibility to carry out the physician's orders. Not always popular, but we can't babysit everyone.

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One thing I would add to Dansket's post is that the standard says group O, it does not say O Neg. If your specimen types Rh Positive, you may, according to the standard, switch to O Pos and save your O Neg inventory for actual Rh Negative patients.