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Posts posted by R1R2
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I have used both types of specimens - real and fake. I prefer the fake (expired unit of red cells and plasma). I can make up a lot of fake specimen and can use one for each associate. By using a fake specimen, the answers are known and will be the same for each tech (I don't have to remember what the results should be if using a different patient sample for each tech). All DOs are done with the fake specimen. Results are recorded in LIS and on any worksheets. Any instrument maintenance is included in the testing DO. A test is included for each test system. I am sure there are so many other ways to accomplish competency. I have attached a CMS document that I have found very helpful.
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Yes and we charge for autologous no used too.
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3 hours ago, Barb Thompson said:
We use gel for the antibody screen and ID. The DAT was done in tube. The reference lab uses PeG.
I would be curious if the reactions would go away if saline technique was used instead of gel?
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On 5/12/2016 at 8:39 PM, butlermom said:
We've started getting requests for LARGE volumes of plasma for therapeutic plasma exchanges on adults and we currently do not have the ability to pool this in our computer system. I've searched the ICCBBA database and cannot find an appropriate E code for the pooled product to build this in our computer system. Does anyone pool plasma and if so, what E code are you using for the pooled product code?
What a good excuse not to pool the plasma. Yes it is easy for the therapeutic operators but a pain for the blood bank. Also, if for some reason, the exchange was cancelled or cut short, you would have a useless pooled product on your hands. If the procedure was cut short, you have exposed your patient to many donors needlessly. My 2 cents
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What enhancement media are you using for your screen/antibody ID?
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Yes, you need to save the panel sheets, hard copy or scan.
You could develop a new policy for suspected RHIG workups to minimize paperwork. I don't know how many panel sheets you are saving now but you could probably reduce to one.
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I don't know of any regulation that would require this. I think your current process is sufficient. I would ignore the recommendation.
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On 4/29/2016 at 10:20 AM, woebegone1997 said:
To update this discussion with our experience since we implemented the second sample...
We are not using mechanical barriers, so for us, the important part of this process is that the second sample must be from a different phlebotomy from the initial ABO/Rh sample. To ensure this, we print a different colored label in the BB when we have get a sample from a patient with no history, and we send it ALREADY AFFIXED TO THE TUBE to the floor. (And yes, we have had to tell nurses that they cannot peel off that label and put it on a tube that they had drawn along with the first sample for convenience, because they knew that they would need a second tube!)
The only exception we made is for trauma. BB management met with Trauma staff, and even they agreed that this was a valuable process, and they wanted to stick with the second sample. To speed things up, as soon as we get the trauma alert and the patient has been registered as anonymous, we send the pre-labeled second sample tube (instead of waiting to receive the first sample). We have been assured that trauma staff WILL NOT take "shortcuts," having been educated that taking such "shortcuts" is a dismissible offense. The patient will get emergency-released blood (O +/- RBC, AB or A plasma according to policy) until we get the second type.
As for the small hospitals for whom we provide blood banking services (R1R2: it varies from a unit a week to no more than several units a week), since most of their patients are scheduled, we have decided to add a comment to their pre-admission testing, when necessary, to prompt them to send a second sample. They provide the courier, so a second sample will be sent to us with the courier on the day of the procedure. The courier will wait while we complete testing on the second sample, and then we will issue type specific products. Cumbersome, and a few minutes delay for the patient, but this is what we came up with to conserve precious universal products.
As with most new processes, there were MANY phone calls with the nursing staff, doctors yelling at my blood bankers, etc. It's been almost a month, and things are settling down. Most of the hospital has gotten onboard and understand that this process will add another measure of safety for the patients.
You may want to rethink sending prelabeled tubes to the patient care area. I can think of at least 3 regulatory agencies that require samples to be labeled in the presence of the patient.
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4 hours ago, goodchild said:
We wrote in our policy that we don't expect 100% concordance, cited several publications regarding the differences between the methods, and made a note that the blood bank supervisor and medical director will both review the results to determine the significance of any observed discrepancy.
You can use correlation samples with nice, strong reactions to get around this problem.
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On 4/1/2016 at 9:53 AM, woebegone1997 said:
We are about to implement the second sample requirement for ABO/Rh for patients without historical records. AABB hosted an audioconference on this topic some time last year, and again stressed this during its recent audioconference on changes to the 30th ed of the Standards. We have piloted a small subsection of our hospital for a few months, and are implementing the system hospital-system wide. Previously for a patient without a historical ABO/Rh, we just had a second tech repeat the ABO/Rh with different reagents. Now when we get a T/S sample from a patient without a historical ABO/Rh, we send back to the floor the request (and a tube!) for a second sample. The pilot was relatively pain-free; how well this works with the rest of the hospital, we will have to see. For instance, we had one nurse draw two samples at the same time to "facilitate the process," but unfortunately the process requires two separate phlebotomies. :-(
Our issue is this: our transfusion service also supplies blood to a couple of small hospitals that do not have their own blood banks; we receive PAT (preadmission testing) samples via courier and send crossmatched units on the day of surgery by courier. We do not accept "outside" records and our MISs are not integrated, so we will likely need second samples for most of these patients on the day of surgery. Is there anyone dealing with the same issue? What strategies have you implemented, or are you considering?
Can I ask how many RBC units are actually transfused at these small hospitals?
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we dropped C/T monitoring after we went to electronic crossmatch
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hemoglobin
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This is one technique that I would not want to validate in gel. Gel will enhance reactions and will pick up strong, direct agglutinins. A microscopic reaction (negative) in tube could be a 1-2+ (positive) in gel. I don't want to take the chance of enhancing unwanted reactions and would opt tube testing in this case. I am interested if others have done this and their success or failure.
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I have seen this numerous times and is most likely due to the A antigen not being completely developed on newborn RBCs. I have seen a fetomaternal hemorrhage do this once in my career but it was detected in the D tube test. Can you look up mom's HGB pre and post delivery?
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15 hours ago, Darren said:
I actually have the system validated for electronic crossmatch, but the path is a bit timid. I figure I can go to him in three to six months with immediate spin results and say, "Look, all of these would have electronically released and you'd have saved us tons of effort and time."
Having done both crossmatches for years, I can tell you that the IS crossmatch is more susceptible to human and technical error. IS crossmatch has its place in BB but not for routine everyday testing to get the blood out the door IMO. And like Malcolm said, tell him about the money.
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Just curious, do you have the option of implementing electronic crossmatch?
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I have seen some very serious patient safety events with cooler use too so they are no safer than fridges IMO. The JC sentinel report listed a single fridge holding multiple patients' blood products as one of the root causes identified. Perhaps you can have multiple refrigerators if you have a large trauma center so each Trauma bay has it's own fridge (this was identified as a possible solution in JC report). IF you want a fridge in the Trauma unit then make sure you have put into place policies/procedures that include receipt, storage and return. You should audit the process too.
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This would be horrible, if in fact, they were using the test in lieu of a rosette test. All I can think about is he possibility that some moms did not get the required amount of RhIG.
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Hi all,
Our respiratory department, that performs non waived testing, was cited by the state for not having the technical consultant assess competency. A respiratory therapist with an associate’s degree assessed competency. I have thought about modifying the lab director delegation form to include the respiratory therapist, however the respiratory therapist does not have the required educational background required by CLIA. I know our department is not the only one in this boat and was wondering how others have solved this problem.
Thanks in advance,
CAROL N
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Hi all,
Can you let me know what you do for lot to lot for Hemochron ACT PLUS and Avox 1000E. Thanks in advance
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Hi all,
I need ideas for pre, analytic, post monitors for POC. Also, whom do you report these monitors - lab, hospital or both?
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Although not data loggers, our system records temp about every 10 minutes.
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I have seen this and it was the pathologist that thought this was a good idea. I reminded him that there is no literature on double filtered products and no one in the whole world does this (I guess I was wrong about that second part). Anyway, perhaps the reason they think it works in reducing transfusion reactions is that they are premedicating everyone. You may want to look at the cost of those filters and how much you will save when you discontinue the practice. I would send out some education to the docs with your pathologist's approval and discontinue this practice. Do you have a Transfusion Committee?
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Competency Assessment
in Education / Quality
Posted · Edited by R1R2
No it doesn't. It also does not require you to test an example of each possible result, for example a positive weak D or positive fetal screen etc.