BankerGirl

This subject came up recently at our facility and it was decided by our Patient Safety Committee, of which I am a member, that the co-signer would need to be qualified to administer blood. This means, RNs, Perfusionists and Anesthesiologists. The thought process was that if the co-signer is not qualified to administer blood, then they would not be knowledgeable enough to know exactly what they were verifying.

Are you planning to request antigen negative units for these patients, assuming that you have antigen typed the patient prior to the DARA treatment initiation? If so I think this would definitely be the way to go. If you are not requesting antigen negative units, then you have units already in your blood bank that would be just as compatible as the ones sent from your blood supplier. As for a true emergency situation, I would think that you would have to do the same as for any patient with incompatible crossmatches.

I hate these too. Not really difficult but tedious, so I farm that out to someone else whenever possible.

I'm not sure if it is elsewhere, but I know that there was an Echo Customer Communication notice entitled Guidance for Interpreting Galileo Echo Images that covers this. It is actually on my competency quiz this year since we had this happen.

This intrigues me. Does this calculation automatically fill in the previous history? I asked Meditech if this was possible and they told me it was not so we are manually resulting the history.

Sorry Malcolm, my statement was not clear. I meant that if the DAT was positive you may not need to give Rh Negative blood, not that you should do a Weak D. Poor sentence structure, inadequate proofreading. If the DAT is negative with a positive Weak D reaction, it may NOT be an autoantibody and the patient would need Rh Negative blood. I think this post makes sense, but I have been having issues with communication lately.

I don't see any reason to perform a weak D on a patient with an anti-D as you are going to give Rh negative blood anyway, unless like Malcolm said, the DAT came out positive. Why do additional testing with no clinical value? If the patient DOES type positive with Weak D, then I assume you would change the blood type to Rh positive and still need to give negative blood. Seems to me like that would just be confusing to most folks (clinicians and technologists) for no reason.

I doubt that they will respond. I asked and was told that they are not supposed to give out that information because they are not coders.

I used 85576 x 3 for the Platelet Mapping and 85347 x 2, 85576 x 2, and 85384 for the citrated assay. We just started doing these so I don't really have any feedback from the payers to say if that is correct, but I got them off google for another hospital that used them. I can't find the exact one now so can't tell you what hospital that was, sorry.

I just saw this post, and in the event that you do not know this, API now has an automated DAT survey available. Last I heard, it was not yet accepted by CAP, but they were to evaluate the results from 2016 and make their determination.

We have two hospitals for which we perform blood bank testing. Both send us a sample and we perform the type and screen, crossmatch, and any additional work necessary and then ship them the units, fully tagged with the reports. Neither of these hospitals stock any blood products. They have hospital volunteers act as couriers. Regs I don't know about, sorry.

We tried to do that but there was a problem so we gave up. I just stuck with the mnemonic. Sorry, but it has been a while, and I can't remember what the problem was.

We use a combination of the Temperature indicators and the Temp-Check thermometer. If issued in coolers, we use the place the temp indicator on the unit prior to issuing. If it has started to turn when returned, then we take the temp to determine whether to quarantine or not. If the unit is not issued in a cooler, we use the thermometer to check temp if returned in a reasonable time frame (less than 15-30 minutes or so) and again determine whether to quarantine. (We don't use the 30 minutes to determine acceptance, just if we will bother checking the temp.) This may be a bit of overkill, but I don't trust ED or OR to not remove units from the coolers. Like was mentioned previously, they could have repacked it in time for it to turn cold again.

Try leaving the units and the temp indicators in the refrigerator while you put them on. Be extremely careful not to touch any part of the indicator except the outside edges. Then prepare your coolers and be sure that the indicators are not touching any room temperature materials in the cooler. Good luck.

Hi Ann, I didn't phrase that too well so thought I should clarify. Anesthesia does do a two person check, just not in the computer. With TAR you have to have a second qualified person enter their user name and password into the module before you can start the transfusion. Anesthesia does all their documentation on paper and does not want to put anything in electronically, not just the transfusions. If that were the only thing, we could probably persuade them.

We have had ED on TAR since the beginning, but Anesthesia is our hold out. They claim that they don't have the staff to document real time or to do the 2 person verification. I have thought about eliminating the 2 person verification since the computer verification is acceptable, but I haven't done it yet. Maybe that would encourage them, but honestly, I doubt it.

We use the new Timestrip temp indicators. They store at room temp and you "pop the bubble" and have not encountered any issues. We used to use the Safe-T-Vue but several folks couldn't keep their sticky fingers off of the indicators and they turned pink while they were packing the units. The Timestrip indicators also stay active for several days so if the units come back unused you can put them in the 'fridge and issue them again if needed. They are a little more expensive than the Safe-T-Vues but I think they are worth it. They come in 6 and 10 degree indicators.

We use TAR. 1. Do you use an additional form of identification (Typenex bracelet)? NO 2. Our LIS tech is telling me it has to be used for all or none in TAR because of the way the parameters have to be answered. This is correct. 3. What form of identification or requisition do you require at the time of issue? We require the patient's full name or MR number. 4. What information from the unit and/or the patient do you require nurses to verify (scan barcode) at bedside? They scan the patient's wristband (account number) and all four quadrants of the blood unit. For RhIG they only scan the patient's wristband since the other info isn't applicable. 5. What other issues have you encountered? I can't think of anything specific right now.

This is my understanding as well.

Wow, I really didn't think I'd see the day. Congratulations Malcolm, and I'm glad you will still be around on here!

We have Meditech and our nurses also use TAR. We have our expiration time set to 2359 and the RNs have no problems with scanning the barcodes as such. How do you have your dictionary set up for the product? Do you have it in days or hours? We have ours set as days 5.

Does anyone printing ISBT labels from Meditech have any idea how to get the CMV status, volume etc to print automatically? I can select the Attribute code and manually enter the volume, but I would like that to print without my additional help since it is already entered for the components. I haven't figured out how to do the CMV status, so those I have to print out of Hematrax. We are on Meditech v5.67. Thank you in advance.

KDAVIS: You may have this figured out by now, but if you are converting to Thawed Plasma with a 5 day outdate, the outdate time is assumed to be midnight and then the Hematrax printer does not print a time on the label. This is how it should work. However, if you are only using a 24 hour expiration, then the time should print with the date. On the Hematrax stand alone program, you have to select either date or date/time for the expiration field.

This is what we did. I built a separate antibody called RHIG and made it not clinically significant. It translates to PRESUMED RH IMMUNE GLOBULIN and we report the date given.

Computype no longer has the on-demand printing system.