MAGNUM

I sincerely hope you are correct Scott.
I have the utmost respect for nurses and transfusion practitioners (many of whom started out as nurses, but neither they, nor many haematology doctors (let alone general doctors) should be allowed anywhere near a blood transfusion laboratory, without extensive training and education - something that we have been exposed to for many years.

Many years ago when I was a baby tech, I remarked to the BB supervisor about this. I asked her why I would want to use these units when I had units available that did not have antigen typings available. her response was "Why be concerned because what would you do if you had the same unit but you did not know the antigens on the units?" I have used that thought for approximately 30 years now, but not for my NICU babies.

Many years ago when I was a baby tech, I remarked to the BB supervisor about this. I asked her why I would want to use these units when I had units available that did not have antigen typings available. her response was "Why be concerned because what would you do if you had the same unit but you did not know the antigens on the units?" I have used that thought for approximately 30 years now, but not for my NICU babies.

I may be opening a can of worms but I would not have done any validation and left it up to biomed to do their function and temp checks according to manufacturer's specs.   Do you validate IV pumps or rapid infusers?  

We, in the UK (and I think in Europe) have the cards shown below (and similar cards are available from other suppliers, such as Ortho, and they are FANTASTIC!

Syringe aliquots are divided units.

I found a box of popsicles in the plasma freezer on the bottom shelf at the very back, whoever stored them there (no one fessed up) knew they were wrong.

Are you screening for M- units? is anti-M clinically significant or you always give M- units?
your cost per antigen is very good. If I am paying that much I may consider buying from my supplier. It all depends on antigen you are screening for.
eg. anti-S 1 drop of anti-S will cost you $15 (if you are paying $900 for 3ml vial), add controls, frequency of finding units, other supply cost plus tech time.
it would be a good exercise for you to take your Jkb example and add all costs to see what was your cost per unit and compare that to your supplier cost.
By the way your supplier is really giving you good pricing? east cost or west cost?

It depends upon the circumstances and the underlying pathology, but we usually do so at four months.

I found a box of popsicles in the plasma freezer on the bottom shelf at the very back, whoever stored them there (no one fessed up) knew they were wrong.

I'm afraid that may not work.
We used to keep all of our "in-date" antisera on the top shelf, and our out-dated teaching antisera on the bottom shelf.  This meant that, if any of our "in-date" antisera fell off the shelf into the out-dated teaching antisera, and we didn't notice, it didn't matter.  Sadly, what I had not taken into account was the fact that one of our inspectors (I can't remember whether it was CPA or MHRA) knew much more about physics than did I, and explained to me, in huge detail, that the out-dated antisera must be kept in a separate fridge, in case the out-dated teaching antisera defied the Law of Gravity and flew up to the top shelf and secreted themselves there.
So, everyone out there, be aware that the Physical Laws DO NOT APPLY to out-dated antisera, which is pretty dangerous when you think about it.  In fact, I now rarely open the door of the fridge that contains our out-dated teaching, for fear of flying bottles, and NEVER without holding a stout stick, just in case! 

We have an electronic time stamp when we issue the blood or blood products. Also, since we use BCTA we have a time and date stamp of when the transfusion was started as well as who started the transfusion. We also have a record of all the vitals performed during that transfusion.

We order our irradiated products from our blood supplier as needed. I don't relish the government running around here.
 

We had a problem with the clinics not sending their results then sometimes when they did send them they may be old results, so when we as the transfusion committee rewrote the transfusion criteria I included in the procedure that we require "X" testing for "X" products and that to insure that we had that testing performed, that testing would be ordered for each outpatient transfusion, such as if the patient was to receive packed cells we automatically order a H&H, for platelets we order a Platelet count, FFP a PT/PTT, cryo a fibrinogen.  We then took the policy to the Medical Executive Council and the hospital Policy and Procedure committee.  At both places I pointed out the requirement and they approved the policy and changes without question.  So we now have an unwritten written order for the pretransfusion testing that we need.

6ml
packed
yes
 

We order our irradiated products from our blood supplier as needed. I don't relish the government running around here.
 

We send them out to our Blood Center reference lab, where they are actually done by flow cytometry now instead of the actual KB staining.

I have been there. There is probably a template that your laboratory uses. Look at your current P/P book in your area or in other areas of the lab and see if there is a pattern to all the P/P. Some regulatory agencies require specific things in all the procedures so you don't want to have to rewrite it.
 
You want to write it so that a person could follow along and be able to do what is required but you don't want it to be so specific that you get dinged because the techs don't follow the steps as written. Do what you say, say what you do. Slightly vague, slightly specific. I tend to be specific and I have to pull myself back.
 
We are CAP inspected. I look at the standards and find anything that may relate to the P/P I am writing and try to include the points to hit. Don't forget about Commons and General standards.
 
Write it, then put it aside for a few days. when you come back to it, it may sound totally dumb. Give it to the people in your department and have them critique it. Can they follow the steps as written?
 
I copied and pasted my procedure for checking the blood storage temps. Hope this helps. Cutting and pasting caused it to lose it's format but you will get the gist of it.
 
PRINCIPLE AND CLINICAL SIGNIFICANCE:
All Temperature Dependent Equipment (TDE) in the Blood Bank are continually monitored to ensure that blood products are maintained within proper temperature ranges.
 
POLICY:
The Blood Bank equipment in which blood products are stored must maintain temperatures in the following ranges:  
                        Blood Bank Refrigerator        2-6° C                         
FFP Freezer                             -18° C or colder
                        Platelet Incubator                    20-24° C                                 
 
If the continuous automated monitoring chart system is not operational, temperatures must be taken and documented every 4 hours to ensure that products are maintaining the correct temperatures.  
 
Equipment and Materials:  Refrigerator, freezer or platelet incubator to be checked Refrigerator, freezer or platelet incubator temperature chart.  
 
Safety Precautions:  All blood products should be treated as potentially infectious. Use universal precautions.
 
 
PROCEDURE: Daily Checking of Continuous Monitored Chart System:
Temperatures of TDE are documented daily at about the same general time of day. Document the temperature of each TDE on Blood Bank Temperature Check form. Assess that the chart is turning properly, is within the temperature guidelines, and is currently at the appropriate day and time on the chart. The person taking the daily temps should initial the chart each day when it is checked.  This verifies the proper day/time setting was checked  
Weekly Chart Change –
Temperature charts are changed weekly at about the same general time.  Information listed on the back of each chart should include the equipment identification number and the date, time the chart is placed on the equipment and initials of the person replacing the chart. Completed charts should have the date and time removed and should be initialed. Weekly charts are paper-clipped together and placed in the file for review.  
Procedure for Abnormal Results: Audible Alarm Sounds – The audible alarm for the refrigerators and platelet incubator is set to sound before the upper and lower temperature range is reached.  If refrigerator or freezer temperature reaches unacceptable limits at any time, an alarm sounds in the blood bank and the power plant. When this situation occurs, the following steps should be taken:
Compare Chart and Thermometer Readings- If these are within range, the probable cause is prolonged door opening. Limit entrance into the refrigerator or freezer and monitor the temperature which should begin to return to normal range shortly. The tech noting the alarm and deviation of temperature should initial and make a note on paper chart to reflect the cause of the alarm. Temperature of Equipment Does Not Return to Normal Range- Carefully monitor temperature of equipment so that products will remain within acceptable range. Call Maintenance Department for STAT assessment of equipment. If equipment temperature stays the same or continues to increase, blood products must be removed to prevent loss. It is not necessary to seek Lead Technologist approval before removing blood products to safer conditions.  RBC units and reagents should be moved to another monitored refrigerator in the Blood Bank. The blood center should be called to provide insulated boxes and dry ice for frozen products before the freezer temperature reaches unacceptable temperatures. Frozen products should be placed in blood center insulated boxes with dry ice placed on top of the units. Platelets may be placed in RT platelet shipping boxes for up to 24 hours without agitation.      
Remove products when temperatures of equipment approach the following sustained temperatures:
            Refrigerator    ≥6.0° C            FFP                 above -18° C         
            Platelets           ≥24° C             Surgery           above -65° C
           
Actions if System is Inoperable             Power Failure- In the event of a power failure, make sure that auxiliary power is functioning.  If this cannot be ascertained, call Maintenance.  In the event of a complete power equipment failure, our current blood supplier or other area hospital facilities may be called to provide help with red cells.  With an area power failure, red cells would be maintained in boxes with bags of wet ice placed on top.  FFP would be maintained in boxes with dry ice placed on top of units.  Platelets can be maintained in platelet shipping boxes for up to 24 hours without agitation. Reagents should be placed in insulated boxes with bags of wet ice placed on top.
 
Refrigerator/Freezer/Platelet Alarm Inoperable – If blood products must be stored under unmonitored conditions, the temperature will be checked every four hours and documented on Manual Temperature Recording Log form. This will document that proper storage temperature has been maintained.
 
            If the Ultra-low Freezer in Surgery is Not Functional- The Surgery department is responsible for maintaining the temperature of the tissues stored in the ultra-low freezer. Blood Bank may help by obtaining insulated blood boxes from the local blood supplier and Surgery may obtain dry ice to pack around the tissues. Space may be available in the laboratory ultra-low that is located in Chemistry, however, this freezer generally does not have free space.  
 
When the Refrigerator /Freezer/Incubator is Back in Service- Before blood products and/or reagents are placed back into the TDE once it is repaired, the equipment must be temperature stable for at least 4 to 24 hours. Temperature and alarm checks on the TDE must be satisfactorily performed and recorded. Reagents and antisera should be inspected for quality concerns and must pass QC before patient testing is performed. Reagents and/or antisera that does not pass quality inspection must be discarded.  
 
SOURCES:
AABB Technical Manual, Current Edition
 
RELATED DOCUMENTS:
Blood Bank Temperature Check form (QC002)
Manual Temperature Recording Log (QC005)

But we sooooooooooooo rely on your infinite wealth of knowledge.

But we sooooooooooooo rely on your infinite wealth of knowledge.

But we sooooooooooooo rely on your infinite wealth of knowledge.

But we sooooooooooooo rely on your infinite wealth of knowledge.

But we sooooooooooooo rely on your infinite wealth of knowledge.

Nope, therapeutic phlebotomy is considered a clinical procedure.

The intent of the CAP question is to compare testing methods between your platforms. If you do Gel testing with tube as a backup, you must test both. But if you are only using tubes there is no comparitive testing to be done. I actually called CAP to inquire that since I use the same QC for both gel and tubes why cant that suffice, but because the QC specimens are "manufactured" you cannot use them, the CAP wants true specimens including CAP survey specimens. I developed a policy that states that every quarter I will retest samples on both methods and the samples include both Rh+ and Rh= for A,B,O, and at least 1 postive Ab screen and 1 negative Ab screen. I got popped on my last inspection on this and this method that I developed satisfied the CAP as a correction.
To think that because you use a cell washer you must wash manually is overzealousness. As I stated before it is your testing platforms that you are comparing.