Ann Viernes

We have an extensive blood donor medication list and citalopram and risperidone are listed as "accept".

See Cliff's thread on the same issue. TJC states clearly that the SOP review task cannot be delegated. We will continue to delegate thorough review to sups and senior techs and subsequently have the medical director sign off as well. That reminds me...I need to revise the SOP for SOPs to include that. And have the medical director sign off!

Cliff I just read that TJC standard also and reviewed the CFR and came to the same conclusion. A few years ago we delegated sections of our SOPs to supervisors and senior techs to get a thorough review, rather than the medical director signing off every year without being able to read every SOP. Our SOP for SOPs explains the process clearly. If an SOP needs revision, it gets revised, then the medical director reviews it. So he is only reviewing changed SOPs. No inspector has had an issue with this, and they all ask for the SOP on SOPs. We discussed this and decided to continue what we are doing and also have the medical director sign every SOP. Who says you can't have your cake and eat it!

I'm reviewing the proposed revisions to the TJC Standards for Blood Transfusion Service and Donor Center. There is no current standard addressing Rh Immune Globulin Administration. The new proposed standard is QSA.05.13.01 "The laboratory has written policies and procedures that address Rh Immune globulin (RhIG) administration." "Elements of Performance for QSA.05.13.01: 1. The laboratory's written policies and procedures for the administration of Rh Immune globulin address: -Crieria to identify patients eligible for prophylaxis; -Procedure to determine dose of RhIG required; -Optimal timing of administration following exposure. 2. The laboratory follows its policies and procedures for RhIG administration." This is a proposed standard, still in the comments phase. There is no mention of pharmacy control.

Our pharmacy finally accepted the factors about 2 years ago when they upgraded their computer system. This has improved timely delivery of the products to the patients. Efforts to control off label use of FVII (NovoSeven) include gatekeepers, policy to prevent issue of a second dose without consultation with a gatekeeper, and improved restrictions and education in CPOE. Blood bank handles RHIG, we keep only one brand on hand for prevention of sensitisation to D antigen and for ITP treatment, the brand that can be used for both IM and IV administration. Pharmacy also handles albumin. When blood bank uses albumin for plasma exchanges, we keep track of lot numbers. I do not know whether Pharmacy tracks lot numbers when they issue to patient floors.

This is an amazing list of testimonials since 2007 regarding refrigerators in the OR! We are in the process of studying blood delivery options for our new ORs scheduled to open sometime next year, a block further away from our blood bank. We currently rely on a dedicated tube station, a satellite dispense station with a refrigerator staffed M-F 7AM to 7PM. The refrigerator is locked when our tech is not on duty. We also use coolers for large cases (liver transplants) and for cases where blood is needed when our dispense station is closed. This works for now, with all the ORs on one floor. The new ORs will be on 4 floors and we can't have a satellite on all 4 floors. We are debating strategically located tube stations, refrigerators, and coolers. Transport will be an issue. AABB News recently had an article on the use of robots to transport blood to the ORs. The person that mentioned a refrigerator with a magnetic lock operated from the blood bank is intriguing. More information on that would be appreciated! Thank you all for the information in this thread!

In the past, The Joint Commission (TJC) usually didn't visit the labs or blood bank if they were accredited by CAP or AABB. However with their new tracer methodology, the patient's service activity will usually lead one or more members of the TJC inspection team to the lab or blood bank. Three years ago (yes we are up for a visit any day now) the inspection traced a patient to the blood bank and we were asked if we allow work on only one patient at a time. Of course in a very active transfusion service with 100-200 type and screens a day and only 2-3 techs on the type and screen bench per shift, most techs work on more than one patient at a time. We were then asked to describe and show the SOP for patient identification and avoidance of mix ups. Techs were then observed by the inspectors on whether they followed these procedures. The inspectors were satisfied with our response. If you are going to work on more than one patient at a time, be advised to have well written and followed SOPs on patient ID and prevention of mixups, down to the detail of how you label your tubes, gel card, micro wells or whatever you use in testing. Bit of advice to the originator of this thread: if you have issues with your superiors you should address them, then getting nowhere, request a meeting with this person's superior or with an employee relations person in HR. Don't air them in a public forum. You can tactfully get the advice of your peers on this forum without bashing your superiors.

Joined in 2004 when it was Donor Forum. Don't remember how I found Donor Forum.

Several of you have asked for my inservice powerpoint for the blue smart shippers. Attached as a pdf since I can't seem to be able to attach ppt. Also to answer the validation question, we validated the coolers to 24 hours using the same ice, opening and closing the lids to simulate removal of product. If you write your validation to include changing the ice, then in practice you will have to be changing the ice. This may prove difficult if the cooler is in an OR suite at the time of the needed ice change. Cool Blue Change 11-8-06.pdf

My point was that the reference lab bills the hospital per antigen, but the hospital may only bill the patient per unit, no matter how many antigens. A money losing prospective.

Edwards Lifesciences LTD does indeed distribute the Aquarius instument. See attached. aquarius_ic_p4.pdf Edwards Lifesciences Ltd - Aquarius - FSN.pdf

Comparing the Aquarius instrument with the Spectra apheresis instrument is a stretch since Spectra separates by centrifugal force not by filtration. Most systems that use filtration by hollow fiber or flat membrane do use heparin as an anticoagulant. Column apheresis (eg. Prosorba) also uses heparin. In the "old days" (1970's) heparin was used in both centrifugation and filtration procedures. Post procedure, the heparin was often counteracted by an injection of protamine sulfate, even in donor collections. Protamine sulfate has its own adverse affects so should be considered carefully, under physician direction, if used. Since most filters tested can activate complement, using citrate along with heparin has been shown to decrease or eliminate the activation of complement. The anticoagulant function of citrate is accomplished by the binding of Calcium which is required for the coagulation cascade, Calcium is also required for the activation of the Complement cascade. Therefore using citrate in filtration apheresis serves a dual purpose. Surely this Aquarius instrument has an operators manual? If not, then its use cannot comply with the requirement to follow mfrs instructions. If so, and its use requires the use of heparin as the anticoagulant, then perhaps the responsible physician could prescribe the addition of NaCitrate or ACD along with the heparin, and consider using protamine sulfate post procedure if post procedure bleeding is a concern.

mhc is correct according to CMS rules. Why is it, then, that the reference labs charge per antigen?

Are you performing donor procedures only or are you also doing therapeutic apheresis, like plasmapheresis? If you are doing only donation procedures, the Hemonetics MCS+ should suit your needs. Baxter no longer markets their blood product/transfusion division. A new company, Fenwal, has taken over these products. They have an instrument for double red cell collections, ALYX and an instrument for plateletapheresis and plasma collection, AMICUS. AMICUS will also do stem cell collections, but not therapeutic plasmapheresis. Caridian BCT (formerly Gambro BCT, formerly COBE) has 2 instruments, Trima for component collection (plateletpheresis, red cell, plasma) and Optia for therapeutic procedures. Fresenius is another company, I believe they only have an instrument for therapeutic procedures (someone correct me if they also can collect products.)

CAP requires proficiency testing for waived testing even the donor HCT. You can purchase Survey "Waived Test Combination Series XL5" which includes Hematocrit. What you are describing is competency testing. Are you comparing the fingerstick to the venous EDTA specimen crit? They won't match. However if you are using the same specimen as Hematology on the spun crit (not calculated from the automated CBC) you should get the same results. If not, one of the centrifuges isn't maximally packing the cells.