[**revised** trm.50000 cap]

I inspected a small hospital that had an MLT running the Blood Bank with an MT close by. They had 6 pages of violations mostly because the well intended MLT didn't have the expertise to know what she didn't know and didn't know who to ask. The lone MT of this lab was overwhelmed with the entire running of the lab and didn't realize there were holes in their operation. But she technically ( ha ha ) met the CAP requirements.

I am seeing a lot of bench techs given managerial responsibilities, no matter there qualifications if you give too much work you will have employees who cannot perform their best, fail, and burn out. So sad.

[Cooler Question]

What do you use as a "Product" when validating your coolers? I wouldn't want to experiment with a unit of packed cells.

We also use expired units, or units the floor has requested and returned out of temp to validate the cooler.

[Cooler Question]

We found that the PLAYMATE coolers just did not keep the temperature within acceptable range. (That is, unless there is a special cooler model for donor blood units that I am not familiar with.)

We purchased several "Credo Series 4-OR" coolers from Minnesota Thermal Science ( www.credothermal.com ) The model that we bought is rather small and holds only 2 or 3 units of Packed Red Cells, but they can maintain temperature of 1-6 C for over 12 hours. Expensive little dudes (around $250 or so), but they do a good job.

Donna

I am interested in the Minnesota Thermal Science coolers. Has anyone validated them in colder than room temp evironments? If yes what temp was the environment? OR is often colder than room temp. I cannot get my Playmate coolers to keep products from going below 1C when in the OR.

Thanks

Teresa

[D neg to D pos]

Is it possible for a pregnant patient to type D negative (no weak D testing performed), then at delivery type as 2+. I recognize this is likely either a tech error or a phleb error, but I was wondering if anyone knew of this happening?

Thanks

Teresa

[How do you issue?]

How do you all issue blood to the nurses?

Do you call every time you complete a crossmatch or do your nurses take the responsiblity to look in the computer to see if the units are ready?

We are in the same boat as LCorondo's response to this

Do you have pneumatic tube stations? Yes Is that the primary method of transporting units? Yes

Do you make the nurses or an approved courier come to blood bank to pick up units? Approved courier, does not have to be a nurse. Definately have to have a "request slip" with patient ID.

How do you track the blood administrations? Faxed paper with patient ID, form with the courier for window pick ups? Blood administration orders in the computer?

Request slip, and the computer

I'm trying to see if what we do could be improved or not.

Thank you all in advance for your replies

For one facility we enter transfusion data in the computer, for the other facility it is automatically transfused after a period of time from issue.

[Lookback?]

The patient's physician. They have the option of refusing the responsibility of notification at our facility at which point the notification is made by the blood bank. Can say I have not ever had a physician refuse the duty.

I have, what a mess.

[Aabb standard 5.13.5]

I noticed the standard has been condensed and the Minimum Retention time is 10 years instead of 5years. If I have files in storage that expire in 2013, do I need to exted that date to 2018?

Thanks

Teresa

[Cooler for storage - how to define acceptance for reissue?]

I did challenge the deficiency, so hopefully all goes well.

We had trouble with the Safe-T-Vue 10 indicators turning pink or red during the issue process, so now we place the units on refrigerated gel packs when we have them out on the counter. I can only imagine how bad the Safe-T-Vue 6 would be.

I do have a datalogger that I use for cooler and refrigerator validation. I really like it, but the program is only on my office computer, so the techs can't use it.

I use the data loggers as well for validation and I am loving them. I have a question about the validation of coolers though. Surgery rooms can get down to 14C. Are you validating your coolers for that low or just at room temp?

[Observation of Transfusion]

I have found that the nurses make sure everything is running ok then they leave and come back after 15 min..even with me observing. I feel I need to define sufficient observation. And put out some education

Thanks

Teresa

[100% irradiated red cells and platelets]

we irradiate all our plts. RBCs upon request.

The irradiation is charged separately.

ditto

[Daily QC QSA.02.09.01 #3]

We perform daily QC each morning on first shift. This standard contains a note that all staff are to be included in daily QC over a period of time. We have 1 tech in BB on 1st shift, 3 techs covering the lab on 2nd and 2 techs for the entire lab on 3rd shift. There are 5 techs who do not perform QC due to their work schedules. How are other facilites with minimal staff handling this?

We have it included on our list of annual comptetency. It is up to each individual to notify the BB tech if they need to be observed doing the QC. Then they can make arrangements do it. If it is 2nd or 3rd shift then I have to come in and observe them doing QC. It is done in duplicate on 2nd and 3rd. We always do it in the morning on first shift.

Sorry so late posting this

[Ortho Red Cell Reagents & Hurricane]

I received my full shipment yesterday

[units spiked not transfused returned to the blood bank]

We do not accept a unit back if it was spiked. I encourage the RN to try to complete the transfusion within 4 hours of entry or discard the unit. I will update the BB records if unit was not transfused and discarded in the patient care area.

ditto

[Observation of Transfusion]

I was wondering what other people use to define, sufficient observation to detect onset of acute reactions, in regards to nursing observing the patient during the first 15 minutes of the transfusion.

Thanks

Teresa

[Blood bank testing for OB admit patients]

This is similar to our protocol. All L&D admits are drawn and banded for blood bank "Just In Case" (called JIC in the LIS). This allows us to be prepared for the bleeds and emergency c-sections and does not force OB to "wait on lab to draw the patient" as they prep them for surgery. Has been about a year now for this process and it seems to work well.

This is what we have done for several years as well.

[Do you require a second specimen from a different draw when you have no history for a pre-transfusion candidate?]

Dansket, Thank you so much your email, helped my IT work through the LIS. Can you please tell me how you are able to reflex the CONFIRM order? Is it attached to the B-type test or the anti-A,B test?

Thank your

Teresa

[Do you require a second specimen from a different draw when you have no history for a pre-transfusion candidate?]

We created a test in our LIS called ABOCONFIRM which is a forward type and Rh only. We can order and run it on a hematology sample from a different draw time or if we answer YES to NEEDCONF? the system will order it and a label will print on the nursing unit. We are using Meditech so I don't know if that is an option for you. We use Cerner Classic.

Is your ABOCONFIRM test completely separate from you original type? We created a forward type test, but it is having conflict with the original type. I don't know how to explain this very well I am not computer savey.

[Helmer UltraCW cell washer ???]

We do not use the cell washer frequently either, and we do flush the system weekly. If you are using is less is it less dirty?

Teresa

[Do you require a second specimen from a different draw when you have no history for a pre-transfusion candidate?]

Are you performing or are you going to perform an electronic crossmatch? If so you must perform ABO typing cells and serum and Rh. AABB STDs 5.15.2, 5.15.2.2, 5.13.1, 5.11.

No we are not currently doing electonic xms.

[Do you require a second specimen from a different draw when you have no history for a pre-transfusion candidate?]

We are currently doing the ABO retype on all non O's with no current history. However, I have had a lot of trouble trying to get our LIS to allow us to perform only the forward ABO and not the back type nor the RH. We are using a log book currently. It seems everyone else is doing a full type. Are any facilities only doing the forward ABO using Meditech? Pathologists' Regional Laboratory Lewiston, Idaho

Thanks

Teresa

[Neutropenic Fevers and Transfusion reactions]

We recently had a patient that is as you described. Everything we gave him he had a fever and we worked it up for every product he received, 5 so far

Teresa

[30 minutes for return blood and blood products]

Both AABB and CAP until now we are thinking how to resolve this problem they gave us one month to solve this problem.when they read the procedures they found the 30 min . for RETURN Blodd and Blood Products.

I was wondering how they feel about blood products that are sent in a validated cooler to say OR or ER. Would you have to take the temp of the products if you are recording the temp of the cooler on return?

[New Specimen after transfusion of 10 or more PRBC]

It's my understanding that once you go into the massive transfusion scenario, the standard allows you to do "abbreviated" compatibility testing. In our facility, once we are past the first ten RBC units, we go to handing out type compatible blood that is not serologically crossmatched. The IS crossmatch on the original sample is pretty much meaningless at that point. We get a new sample after three days.

I don't understand what you mean by abbreviated compatibility testing. I thought it is the type and screen with an IS crossmatch. Do you do electronic xms?

[Maintaining patient identity in traumas]

We also received friction when asking that trauma patient not be merged until they are out of surgery. What we do if they merge is give them oneg uncrossmatched until we receive a new specimen. They have been pretty good about waiting since we did that.

[working up pos DAT not associated with transfusion]

Hi Mabel,

I looked at the TM 17ed and it says "Clinical considerations together with laboratory data should dictate the extent to which a positive DAT is evaluated."