BankerGirl

I think you should invite members of that committee to remove a bag from its cube, try to label it sufficiently (substance, lot #, expiration, etc.), attach that label in such a way that it will stay attached when the bag 'collapses' as it's emptied, hoist the bag up to the level of a cell washer without the aid of the box (especially this part), and suggest ways to keep the collapsed bag at an angle that will ensure all the contents are used. 
I'm willing to bet they'll come around. 

I'm going to be blunt.  This is ridiculous!!  You have the potential of causing far more problems by removing the cubes from their protective container.  

John, I agree that reimbursement may not be always be realistic, but for documentation purposes it would be advisable to have even a basic registration and document the transfusions.  

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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 use Mobilab as our normal positive patient ID process.   Registration has a system where they can generate visit labels during downtime without the MR number, so during downtime we have prenumbered armbands and write that number on these demographic labels. 

Cliff - can't we keep the lightbulbs to bust up until this allocation is over?  It's very therapeutic.

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Something to consider.  If the charge drops at XM you might get paid for it.  If it drops at transfusion and the blood does not get transfused you will definitely not get paid for the XM.  Something to think about.  We dropped the charge when the XM was completed.  
Another little story from the past.  Us old guys like little stories from the past.   I was called to the billing office to "discuss" a billing issue with someone from the insurance company.  She wanted to know why we charged for the XM when no blood was issued or transfused.  I told her that the DR. had ordered the testing in the anticipation of needing the blood because the surgery routinely required transfusion.  We did the work and charged for it.  Her contention was that since the patient did not use any blood the testing was unnecessary!  At about this time I asked to see her license to practice medicine.  She became quite incensed when I told her that insurance companies had no business practicing medicine. That's when our conversation came to an abrupt end.

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I think we need to add an OMG emoji to our selections!

I've been searching for the powerpoint I made of the occurrence I wanted to share but I must have stored it on an external hard drive that crashed and was unrecoverable.  (That's my excuse anyway.)  Consequently it was long ago and my memory is fuzzy on the details but in this case the details is not the point I'm attempting to convey.  Bottom line was that 2 units of blood were sent via pneumatic tube to ICU for 2 different patients. No, the units were not in the same tube, they were sent 10-15 minutes apart.  The units went to the wrong patients and the proper patient identification protocol was not followed.  Both units were transfused and the paper work was sent back to the transfusion service.  I do remember a very white faced staff member coming to my door to tell me what they had discovered.  Luckily both patients were type O+ with no problems and recrossmatching showed that each was compatible with the unit they had received. We had dodged a bullet!  The ensuing investigation discovered that the patient identification protocol used by the ICU nursing staff had morphed into something I did not even recognize.  A couple of years earlier the nursing department had taken over all training of new nurses as well as annual reviews for current staff.  They basically told me my services were no longer needed in a training capacity.  When the details of the occurrence came out the assistant CNO (chief nursing officer) who was filling in for the CNO on sick leave wanted to severely punish the two nurses involved and then sweep everything under the rug.  Heaven forbid that word got out that a couple of HER nurses had made a mistake.  Much to my surprise and delight I was able to convince the ICU nurse supervisor that the problem was much deeper than just human error and the protocols the nurses were following were deeply flawed.  We did extensive retraining for the entire ICU staff.  When the CNO returned to duty I had a long talk with her. I had always had a very good relationship with her and she trusted me.  From that point on I was actively involved in the training a new nurses as well as the annual refresher courses for current staff.  During those training sessions I was not surprised that other areas had "adjusted" the pretransfusion patient identification protocols to be easier and quicker for them.  Using this occurrence as an example I was able to convince them of just how critical patient identification was.   
As a side note, I one time had a labor and delivery nurse tell me that it was impossible for her to transfuse the wrong blood to her patient and nothing I could say would convince her otherwise.  Some times I wonder how I ever got out with my sanity intact!  My wife (a nurse) reminds me that I didn't!
 

fortunately/unfortunately this scenariooccurred where I was working.  Patient w acute gi bleed at a hospital not close to us.  Transfused 20 group B plasmas and 16 group B rbcs.  Patient under control and transferred to our hospital.  On day 2 we  gave him 2 B plasmas.  On day 4 we had a request for 2 rbcs.  Patient still typed as B+ with a lot of unagglutinated cells in the front type.  Those cells typed as O=.  The patient's bili went from 2 to 31 in the next 16 hrs and they expired.  Turns out the patient was a known O=.  ER doc drew bloods and put in pocket; labelled later (obviously mislabelled).  BB tech fired as patient was in their file (sent to us because we would not know.   We turned the other hospital in to the FDA for the transfusion associated death (as we had not transfused any rbcs).
this is a scary story

Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units.  this was during a time when many people were donating autologous units and having them frozen (early 1990s).  There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS.  To further complicate the error, the patient didn't really need to be transfused, 30-something healthy guy in for jaw surgery, very minimal blood loss during surgery, but the unit was on the shelf and it was autologous, so they decided to transfuse it!  So, he got an entire BPOS unit and he was OPOS.  The patient spent about a week in ICU and his kidneys shut down for a while, but he survived with no long term consequences.   I will never forget that one!

That is a similar scenario to my most recent nightmare.  The nurse had given the patient multiple units of blood over two days so she "knew" he wouldn't have a reaction.  Then checked nothing and bypassed the computer transfusion program.  An aid came in the room when she was getting ready to transfuse unit #2 and noticed the blood type wasn't the same as the one she was discarding.  Fortunately the patient suffered no harm. 

That is a similar scenario to my most recent nightmare.  The nurse had given the patient multiple units of blood over two days so she "knew" he wouldn't have a reaction.  Then checked nothing and bypassed the computer transfusion program.  An aid came in the room when she was getting ready to transfuse unit #2 and noticed the blood type wasn't the same as the one she was discarding.  Fortunately the patient suffered no harm. 

When I was a very young tech, our supervisor had us carry every Rh negative result through "Du" as it was called then.  I also had an O Neg labeled unit test O "Du" positive.

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We require one blood type per registration for all of the reasons stated above.  We also have encountered a few patients with identical first and last names and similar dates of birth that kept getting merged together.  We caught it each time because of their different blood types.

We require one blood type per registration for all of the reasons stated above.  We also have encountered a few patients with identical first and last names and similar dates of birth that kept getting merged together.  We caught it each time because of their different blood types.

I agree with the above statements.  Our nurses usually get two units infused withing 4 hours so they don't have to use a second blood administration set.