BankerGirl

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Really Malcolm?

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I have a question about the "newborn card". I am not familiar with this card, so forgive me if this is the case. Does this card contain IgG, and is it incubated at 37 prior to centrifugation? And when you perform the testing in tube, do you incubate and carry it through AHG phase? This is how we detect weak D.

Yes, why would this be different than any other physician's lab order?

We do much the same, except we don't use the BBID numbers.

We did the same. Our Medical Director did send out a letter to all the physicians notifying them of the change, and we heard nothing from any of them about it.

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We do the same as cswickard.

When I started here we performed elutions on all positive DATs as well, but when I became supervisor we put an end to that. Busy work for no real benefit; like your Pediatrician, they treat the babies the same. Just this year, our Pediatric Subsection decided to start performing cord blood evaluations on all babies of O Pos moms. I know there are several facilities that do the same, but we never have. I asked our Mother/Baby nursing coordinator for the evidence they used to make this change and have had no response. I have never understood the long standing practice of performing the cord blood workups on jaundiced babies either. It seems to me this is all academic and of no real clinical value, but what do I know. Does anyone have any Best Practice guidelines with supporting evidence for any of these practices? The only thing I can come up with is that if the baby turns out to be O as well, that may steer them to investigate alternate explanations for the jaundice; but even then, unless the baby is having continued problems, is the information actually used to determine treatment?

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I forgot about the breaking glass sound! I have my volume muted most of the time because my computer is constantly making annoying noises. I get so (disturbingly?) excited when the Christmas lights appear, so thank you Cliff!

Logan 51: I don't understand why you are thinking about changing anything. You have the notice from your survey organization that the sample was contaminated, and I am assuming that your testing showed reactivity with Anti-IgG? I do understand you being troubled by the C3d control cells reacting with anti-IgG, but it seems that you got the result that you should have gotten.

That is what I always thought. We dropped it when we went to our new computer system in August UNLESS the fetal screen comes up positive. That hasn't happened yet.

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You don't say who "upper management" includes, but this might help. We struggled greatly when I first started doing the transfusion review several years ago. The Quality Review department (all nurses) used to do the reviews and we were always at 100%, partly because they didn't audit all transfusions but mostly because they only looked at blood pressure for vitals documentation. I couldn't believe that a nurse didn't know that temperature is part of vitals! When I started doing it they were shocked that our compliance was <50%. Fortunately for me, our Director of Nursing and Risk Manager were appalled and very adamant that we fix this. It wasn't easy, but we have been at >95% for several years now. I would enlist the help of your Risk Manager if you haven't already. I became a pro at completing incident reports in several systems over the years, but writing up every single instance was what finally turned the tide. The nursing managers were fed up with investigating incident reports very quickly!

I do not know the g-force. I found an online g-force calculator but since the model we have doesn't seem to be still available, it probably wouldn't help you much. I'm sure if you looked at the specs of the ones they have now, you could find out.

We use the Hettich and spin at 8000 rpm for 2 minutes. Works great but it does has a latch check that takes a about a second to complete, so if you are really fast at pressing the start button, it won't start immediatedly. I don't usually have a problem with it because I let it do it's thing, but occasionally I will be too fast and have to press start again.

We also order only pooled cryo from our supplier, but our previous pooling procedure stated that a small amount of sterile saline should be added to each bag after adding it's contents to the pool bag to remove additional cryo. At the facility where I trained, we did not do that. I don't know if the additional recovery is worth it or not.

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We perform Electronic Crossmatch at our facility, and the computer differentiates antibodies as clinically significant or not clinically significant. Even if the antibody is not considered significant, it is set to not allow EXM if the present antibody screen is positive. We don't consider anti-D from a documented, recent RhIG administration clinically significant so as not to brand the lady with an anti-D forever.

Very interested in this concept. What exactly does the electronic order state, other than the standard? Does it specify a quantity or a duration for the order? And how do you handle the requirement for the Blood Bank Director's review? I recently had a physician return a form 3.5 months after I first sent it to him with a signature but no date. This is the latest one by far, but they usually take a few days to come back.

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