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I am the manager of a blood bank in a large city hospital which has a level one trauma center,a children's hospital, and performs open heart transplants and adult and pediatric bone marrow transplants. Our blood bank is moving across the street, with the rest of the lab, from the main hospital. We are planning on keeping a blood distribution site in the current hospital close to the OR and ED. Blood will either be tubed or walked in coolers from the blood bank to the distribution site. Nurses or other hospital staff will pick up the blood from this distribution site. The question is, "What should be the qualifications of the staff person who will be at the distribution site?" Should that person be a blood bank med tech who is familiar with all the aspects and special needs of our patients who need any different types of blood components or a "non-med tech" who can be trained in the actual process of distributing blood but has no formal training or experience?

Our hospital system, with two large hospital blood banks started using the ECHO's about a year ago. One hospital blood bank was previously performing manual gel and the other tube testing. The installation and training went very smoothly at both blood banks. We have had no major problems in the first year of operation. The techs at both blood banks love it, even the "die hard" 35 year tube testing techs! We do not think that we are missing any clinically significant antibodies and we are not picking up as many room temp anti-M's and other room temp antibodies, which we were picking up with tube and manual gel. We also are not picking up as many "non specific IgG" reactions. I would highly recommend that you seriously consider the ECHO.

Four years ago we switched our hospital policy to having two people being present at the drawing of a blood bank type&screen specimen. One of those people had to be a lab phlebotomist. One person would draw the specimen and the other would be a witness to the draw to make sure that the specimen label info on the tube matched the patient's wristband. Both people would sign on the specimen label. Two exceptions were for specimens drawn in the OR and in labor and delivery. In those areas, two people had to draw and witness the draw, but a phlebotomist does not need to be present. We went to this policy because in a period of three months we had four T&S specimens, all nurse draws, which were either drawn on the wrong patient or mislabeled. Fortunately, in each case, we had the patient's blood type "on file" so we knew that something was wrong and patient care was not compromised. Since we went to this policy, we have not had any mislabeled or misdrawn specimens that we are aware of. We are a large hospital with a level 1 trauma service, OH service and bone marrow transplant service. There was a concern when we first went to this policy, that the drawing of the specimen would be delayed because of the phleb witness requirement, but that hasn't been the case. We did say that O uncrossmatched red cells would be available in a life threatening situation, where the draw was delayed. This has only happened once or twice in the four years we have used this policy.

About six months ago we switched from manual gel testing to the Immucor ECHO automated solid phase testing. We are a large reference medical center and we get a lot of warm auto patients. In every case, so far, if the ECHO results showed a warm auto pattern, we would get the same reactions if we tested with tube reagents. We also used to see the same "false positive" reactions with the manual gel testing, that are described in the above postings. We have only seen a couple of "false positives" with the solid phase testing, where the tube testing would be negative.

We have a policy that all blood bank Type&Screen specimens need to be drawn and witnessed by another person. One of those people need to be a lab phlebotomist. The exception would be specimens drawn in the OR. There one nurse or physician can draw and another witness the draw. Both parties in either case need to inital or sign the specimen. If the specimen does not have both ID's on the label, it is considered mislabeled and not used. My facility is a large medical center with a level I trauma center and a pediatric hospital.

The loss in revenue is an issue for all of us. I do not expect that a new CPT code will be given for a non-serologic test. I also do not think that you can charge the patient for a second ABO&Rh typing. This is considered a QC test and you could run into compliance issues with a double charge to the patient. Good idea, but we looked into this charge and we were told by CMS that we could not charge for this.

Are you sure you want to become involved with tissue storage? This opens your blood bank into many more questions both from the FDA and the AABB. Be prepared.

We had a somewhat similiar situation with thermometers. We were cited in a recent AABB inspection because we had not recertified our NIST certified thermometer, that we used to do our yearly checks of all our other thermometers. The assessors said that these NIST thermometers, just because they were certified in the past, does not guarantee that they are still accurate. My point was that we checked 30 thermometers against the NIST thermometer and they all read the same as the certified thermometer! Could all the thermometers be wrong?? Needless to say, we were still cited for this. Sometimes we major in the minors. The assessors did tell us that if we purchased an inexpensive regular certified thermometer yearly, and checked that thermometer against the NIST certified thermometer, we in essence did our own recertification. This sounded fairly reasonable, however in my opinion, unnecessary.

I have been a CAP inspector and AABB assessor for 25 years and I highly recommend having references for SOP's and other documentation with the checklist that you can show the inspector when he/she comes to your facility. First impressions are always important and if I see that the BB supervisor is well prepared for the inspection, I usually find that the inspection goes very well. In preparation for the inspection, you might ask your chemistry or hematology supervisor to "play" inspector and ask you all the questions on the checklist. Sometimes, they may see something that you don't because you are so familiar with the questions that you might assume something that isn't actually there. Their perspective can be helpful.

We purchase a liquid plasma from our blood center that contains weak (1+ to 2+) alloantibodies. We aliquot this plasma into 25 ml aliquots and freeze them. We thaw as needed. One unit of plasma is good for at least two months of QC. This works for both gel QC and tube QC, no dilution needed. Rare antisera, even the outdated sera, is too expensive to use for QC!

For our screening cell QC, we purchase a liquid plasma from our blood center that has a known weak (1+ or 2+) anti-D antibody. We divide the plasma into 25 ml aliquots and freeze the aliquots, thawing each aliquot as needed. This meets our QC needs for at least two months. The price of rare antisera is just too high to use these reagents for QC, even if it is outdated. We just use a two cell screen, so anti-D works. If you use a three cell screen, I'll bet your blood center may have a donor, on file, who has the right combination of antibodies to give you positive reactions in all three cells. The blood centers don't have much use for this plasma, that contain allo-antibodies, so they will be happy to sell it to you.

Both Ortho and Immucor are pushing their automated testing, Provue and Galileo. By drastically increasing their tube testing reagent price, it makes it more cost effective to drop tube testing and go to automation. Like it or not, I predict that ,within five years, most hospital blood banks will not be doing tube testing.

We use pH paper to check the pH of all units. Any units with a pH of 7.0 or lower are checked with a hand held pH meter before the platelet unit is returned to our blood center for cultering.