BankerGirl

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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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We have Meditech instead of Epic, but we also do all of our MTP documentation on paper. We have a designated recorder that is responsible for documenting transfusions, vitals and lab results. We have a few more MTPs than you from what you said, but there is no way they could do this in the computer. We never know where the MTP will occur and getting the recorder access to a mobile PC that she can move along with the patient (they almost always end up in OR at some point) would be a nightmare. The documentation is usually not ideal, but the situations themselves rarely go as they are "supposed to go" so we analyze every MTP after the fact and try to do better the next time.

This is how we have it set up. Works just fine.

It was documented as a safety event, and no, I didn't get the unit back so I can't say how bloody. The nurse called me after she transfused the unit and had discarded the bag. I didn't think about her spiking the unit prior to laying it down. I have had leaking segments before, but I pulled the segs just prior to issue and would think that I would have noticed blood on my hands or the checkout counter if that had been the case. I do handle and mix them while inspecting them at issue. She put in the incident that the labels were bloody when she got the unit from the courier, but that it looked dried and she just thought it was odd. Later when she picked it up to transfuse it she had blood on her gloves. If it leaked in transit, I would think the courier would have had blood on her hands, and she did not.

We recently had a nurse call to say that the unit of blood she received was visibly bloody on both sides of the unit. Blood was smeared on both the unit label and the crossmatch compatibility label. The courier brought it to her and she laid it down in the patient's room while she went to attend to another patient, and when she returned and picked up the unit, it was bloody. She checked it for leaks and, finding none, started the transfusion "because the patient needed the blood." (She is Type A Neg with an anti-Fya and a 6 gram hgb.) She then called the courier who brought her the blood and the courier said she didn't have any blood on her and didn't see any blood on the unit when she picked it up. The nurse then contacted our Employee Health nurse who told her to call the blood bank. I was the individual who checked out the blood and told the nurse that it did not leave the blood bank in that condition. Any thoughts on this situation? I want to scream NO! NO! NO! but need some ammo for our risk manager. By the way, each manager concluded that their employee did nothing wrong and "Standard of Care" was met.

Malcolm, I'm shocked!

We do the same as above.

We also use their Medical Record number for our patient wristband, and we manually result the second Type and Screen. I don't know of a way to copy the results, although that would be really nice. Most of the time the blood bank orders are on their own requisition, so we can use the Move To Another Account without any issues.

We move the account number if there are no other tests on the requisition. If there are, we simply copy the results into the Inpatient order and credit the charges on the outpatient one. This assumes that the outpatient was armbanded when the type and screen was done and meets our requirements for pre-transfusion testing.

We have an NPR writer on contract with the hospital. I hope we never lose her!

I have found most of the standard blood bank reports useless for transfusion review. I don't specifically remember data mashed up and becoming unreadable, but it is difficult to do a proper review with the multi-line reports that they give you. I had my NPR writer develop a transfusion review report for me which pulls all of the data I need in a semi-colon delimited format. I download this report, export it into Excel, and then each transfusion is on its own line with headings that I can sort any way I need. This has been a lifesaver!

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We keep our cord blood samples until we run out of storage space. This usually works out to between 20-30 days. We have done testing on them up to a week after delivery if the baby is jaundiced at their 1 week doctor's appointment, but that is exceedingly rare. They almost always get ordered the day after delivery.

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No, it is all or nothing. You are required to retype all units, not just Type O.