tkakin

Who gives the order to transfuse? I believe the RN's on the hellicopter are in communication with the ER they intend to transport the patient to, and getting the order to transfuse. Good Question. I will investigare this more. Do you have trouble with wastage? No they are very good at taking care of the products. I like the idea of billing medflight if they are wasted or the patient is taken to another facility. What about competency of transfusing staff? Hmmm another good question that I am sure has been looked at by my previous supervisor, but I do not know how that is being tract.I believe CAP requires competency documentation of transfusing staff at least yearly.

We do the same as most everyone here and allow a verbal order followed up with documentation at eariliest convenience. We do however require proper patient ID written at request of the products. For MTP I require the initial request to have paper documentation then the following products are sent without the request form.

I have a question about how you guys handle requests for more products before a transfusion reaction work up is completed. We are wanting to make a firm written rule that they cannot receive additional products until a transfusion reaction workup is complete with the exception of life saving circumstances. Is this a rule that is unreasonable? Also we allow the attending physician to decide if they want to continue the transfusion. This rule is also being questioned. Do you guys allow the continuation of transfusion or do you stop the transfusion no matter what? I appreciate any and all advise on this subject Thanks in advance Teresa.

We provide 2 Oneg units to Lifeflight. They keep the units at home base until they get a call then they are packed in a cooler. We have Saf -T-Vue indicators 10C. on the units as well. If they patient is transfused in the field and the patient is taken to a different facility then we charge the units to lifeflight. If the patient is brought to our facility we have them drawn and worked up. We require that they change out the units within 10 days of expiration if they are not used. takin@pathregional.com if you have specific questions for me. Teresa

ditto

We have a procedure that states a massive transfusion is considered a transfusion of greater than 10 units of packed red blood cells in 24 hours. The ER is confusing GI bleeds with Massive transfusion. Has anyone found criteria that would be more specific for the Physicians to know when it is appropriate to call a massive transfusion? Thanks Teresa

I find that the resounding reason things do not get done in our facility in all depts., is that everyone is too busy. The reason is supported by managment, and yet it is not addressed. I find that I have become the BB nag. I would stop if I felt it was falling on deaf ears, but our staff does care and they don't want to be sloppy. If I can get away with it, I will leave the task for them to complete. Eventually they get it and we move on to another issue. It is interesting that we are increasing our safety by adding more testing, but we are decreasing our safety by decreasing our staffing. Our management has decided if they move their desk closer to the lab then staff will work harder. Hmmmmm, I guess we will see, but I am skeptical.

I wanted to also mention that we have it on the favorites bar for technical documents instruction for use, so it is easy to get to.

Hi Mabel, We go to the Ortho web site to check the package insert version on each new shipment. I put the latest version on thereagent list, so it can be compared.

What kind of hospital are you and what size? (Community, university, teaching, etc. Small, medium, large, or number of beds, etc) Any add'l info you'd be willing to provide to give an idea of the workload would be appreciated, approx. type and screens tested, rbc units transfused, etc.2 Community hospitals about 300 beds total. Transfuse about 3300 units/year with approximately 2900 T&S/year 2. What is the established turnaround time for your STAT type and screens? Do you have any location specific criteria? 60 minutes from collection to completion. No location criteria 3. What are the parameters for your turnaround time? (i.e. receipt to verify, collect to verify, is the specimen received by your department or a centralized specimen processing area? is the specimen received already spun or do you spin them upon receipt?) Specimen processing receives the specimen and it is spun in the Blood Bank 4. What is the primary method for your Type and Screen testing? Manual Gel 5. Do you monitor your turnaround time as a quality indicator and with what regularity? If so, do you think this is an appropriate quality indicator? How do you report this information? (e.g. do you report a time at a particular percentile, do you report the percentage of specimens that met a particular turnaround time?) No, but it is on my list.

For a visual cue that the units need to be confirmed we will put the on the shelf with the ports facing to the right and the label facing the back of the drawer. When the units are confirmed we will place them with the ports facing the left and the label facing front. I have another question. In order to get meditech to interpret the blood type it has to have the D/Rh included in the test. In the case of Rh positive products we do not need to confirm the Rh. Do I need to have the computer people build me a new test that will interpret a blood type without the Rh or is there a short cut. Thanks Teresa

We do a second ABO on all T&S that are banded and non O. We give O if we cannot get a second draw in time. It is about 20% as well that need to have a draw. I do not use meditech to reflex a new specimen when needed. If a patient is non O and has no history we manually order the test and call the phleb as a verbal "attention". We color the band card with a highlighter if it is an outpatient waiting to come in for a surgery so there is a visual cue not to crossmatch type specific until the type is confirmed. It is also on our pending list, so we can easily see that it still needs to be done. We have been doing this for about 1yr and it has been going quite well. We do try to get a specimen from heme/coag before drawing the patient again.

Thanks Mary, can you clarify for me what a specimen desktop is? I don't recognize the prompts.

WHBB can you email me so I can ask you some more specific questions on setting up Meditech? takin@pathregional.com Thanks again to everyone for your input.

Thank you sooooo much this will help a lot!! Teresa

We had a company that confirmed the blood type on the products for us, and now we need to do it ourselves. I was hoping you might share some ideas on creating a procedure for doing this. Do you do the confirmation when the products arrive or before crossmatch? How do you flag the unit that it has been confirmed? How do you make sure units are not leaving your lab with out the confirmation? I use Meditech computer system. I appreciate any help. Thanks Teresa

We also had our cancer center do it for us, but they had trouble keeping up with the regulations for blood products and decided to stop providing that service.

John, Sorry I didn't reply sooner, Yes I do work in transfusion service. I do the audit that includes this question, because it is highly recommended by Blood Systems and because I attend the Transfusion Committee meeting. I would like to improve patient safety. I feel if the pateint's are more informed, then they can make a more informed choice about their medical needs. Maybe it would seem more like a choice in most cases then doing it because the Dr. told them to. I also hope that by improving the education of alternatives to transfusion it will trickle down into the blood usage. I have no intention of approaching this as a repremand, but more of an opportunity to provide information to improvme on what is in place. I do see your concern with the the hospitals reaction to being audited. They may kick me to the curb, but I am still going to try. Eoin, Thank you so much for sharing. I do like it, and I can include Mabels suggestions. AmcCord I will check out what ARC has.

I was asked by a nurse if it is ok to switch from the 20 gauge size needle, to transfuse red cells, to the 25 gauge size needle. She has an article to support this change: 2007 Acqullo “blood transfusion flow rate – J Assos Vasc Access 2007: 12(4) pages 225-226. Are any of your facilities using a 25 gauge needle? Thanks Teresa

Thanks Mabel, does anyone encorporate this info into the signed consent documentation?

I have a story related to this. I did the blood type on the OB patient, and noticed it was different from what the hospital had in there record for her. I repeated the blood type on a different specimen, and it matched my typing. I called the floor to ask where they got the typing record from and she told me, she just made it up. She would change it after she got the report from me. They don't get to put blood types in the computer anymore. I do not recommend taking blood types from other facilities. I have had discrepancies with other labs as well. Teresa

pharmacy is responsible.

I have been doing an audit that includes the question "Are alternatives to transfusion discussed with the patient?" The answer is no, they need blood. Their H&H is low. Do any of you have information that is given to the patients discussing the alternatives? I understand it is the physicians responsibility to give that info, because it is so dependant on patient diagnosis, but if there was a general pamphlet that would allow them to raise questions to the physician, it would be better than nothing. Any ideas suggestions? Thanks Teresa

a. MTP1 - 4 units PACKED RED BLOOD CELL’S 4 units of PLASMA and 1 apheresis PLATELET (upon initiation). b. MTP2 - 4 units PACKED RED BLOOD CELL’S and 4 units of PLASMA c. MTP3 - 4 units PACKED RED BLOOD CELL’S, 4 units of PLASMA, and 1 pre-pooled pack of CRYO d. MTP’s will be ordered cycling through 1-3 until the MTP is canceled. This is what we have chosen to do.

We do not report the screen until the panel is complete as well. If Panel neg and tube screen negative we report negtive. If strong inconclusive reactivity, we report Inconclusive. I do like the idea that the Dr.'s are questioning the results. I was thinking they didn't even read the reports . I don't have the resources to work up inconclusive reactivity, so I would give them the option of sending it out to a reference lab with the side note of cost.