tricore

Then the supervisor was WRONG!
 
Thanks Mosaics.

I have used all of these techniques. It must be time to retire!
"And do you remember Folin-Wu tubes, colloidal golds, protein-free filtrates, changing dialyzer membranes on 2 channel autoanalyzers, leukocyte reduced cells by inverted centrifugation,"
 
Fortunately I wasn't around for these.
the fall of Rome, the discovery of fire and the other items that may mark us as ancient and should be retired like that guy's cell washer in another thread?"
 

I have used all of these techniques. It must be time to retire!
"And do you remember Folin-Wu tubes, colloidal golds, protein-free filtrates, changing dialyzer membranes on 2 channel autoanalyzers, leukocyte reduced cells by inverted centrifugation,"
 
Fortunately I wasn't around for these.
the fall of Rome, the discovery of fire and the other items that may mark us as ancient and should be retired like that guy's cell washer in another thread?"
 

I have used all of these techniques. It must be time to retire!
"And do you remember Folin-Wu tubes, colloidal golds, protein-free filtrates, changing dialyzer membranes on 2 channel autoanalyzers, leukocyte reduced cells by inverted centrifugation,"
 
Fortunately I wasn't around for these.
the fall of Rome, the discovery of fire and the other items that may mark us as ancient and should be retired like that guy's cell washer in another thread?"
 

I used to use glass slides (like the ones used for hematology slides) with a light box in the 1960's. We used a wax marker to make the lines. Do they still made wax markers, the ones where you had unwrap?? I haven"t seen one in years. We also used them to mark tubes.

I am an IT analyst, primarily Blood Bank. If you have a change control procedure and the company is not following it you have serious problems. If you do not have a change control SOP you have serious problems. This is CMPs and regulatory.
Was the BB SOP changed and made to accommodate the new column?
IT should NEVER make changes as was done in your system without consultation with all of the users who will be affected by the change.
We never make requested changes without receiving a System Change Request which must be signed by a manager or director. We have a ticketing system where all changes are recorded.The request is built and validated in the TEST system. If it is something that will affect all sites it is discussed in the Transfusion Management Workgroup before the change is requested. The exception is adding new bone/tissue codes or comment codes. These are usually built at the resquest of one site. If the other sites do not want or need to use it, it is not a problem.
Sometimes I validate and sometimes the requestor validates. Not until then is it moved to the production system. If it affects all sites a notice goes out to all sites.
If procedure changes are needed the item is not moved into production unitl the SOPs have been changed.
There is nothing worse than to log in, perform a test and find out the rules have been changed.

I used to use glass slides (like the ones used for hematology slides) with a light box in the 1960's. We used a wax marker to make the lines. Do they still made wax markers, the ones where you had unwrap?? I haven"t seen one in years. We also used them to mark tubes.

I used to use glass slides (like the ones used for hematology slides) with a light box in the 1960's. We used a wax marker to make the lines. Do they still made wax markers, the ones where you had unwrap?? I haven"t seen one in years. We also used them to mark tubes.

I wrote a look back and adverse reaction policy for tissues and bones years ago. I used the standards from the American Association of Tissue Banks. At that time it was an infection control procedure. It was before AABB got involved with tissues. Sorry I don't remember the CFR sections. http://www.aatb.org/aatb-standards-for-tissue-banking

We have a policy for what our indications for giving irradiated products are.  It is a joint policy with the Medical Staff and is approved at the Medical Executive Committee, so the physicians are agreeing that this is our policy.  That way we are not placing an order, we are following policy as a standard of care.  This works the same as our reflex policy, which is also approved at Med Exec so that we can automatically order an ABID for every positive antibody screen without having to get a doctor's order each time.
 
So if a physician orders irradiated for a new patient or if we see a new patient that qualifies, we look at their diagnosis and if indicated, we add irradiated as a requirement.  If the physician's specific order for it seems unwarranted (non-cancer patient, sickle cell, etc) we will call and question.

We do essentially what you have described.  We complete the "paperwork" when the emergency is over.  We document the release time/date on the emergency release form.  If we get a specimen, we will begin wokring on it starting with a stick type for ABORh.  Once we have this we will attempt to issue type specific.  Fortunately we rarely have to go this route . . . it would become a problem if there was more than one pt receiving unxm rbcs (in either ED or OR).  We would have to delay and place a pt name label on the units beside the unxm sticker. 
 
It was like pulling teeth to get my staff to release the blood without having labels and completing all the release documentation.  When someone is in danger of exsanguination the few minutes delay becomes a critical issue.  You know the staff dealing with the emergency is only interested in getting the blood into the pt - their documentation will be sparse too.  We passed our Trauma Designation inspection with flying colors and I quote one of the inspectors "I wish I could get my emergency department to provide service like this - they don't understand." 
 
If you haven't worked in a trauma center it may seem unconscionable to release unlabeled blood.  In the past I have grabbed 20u and run to the emergent areas because that was the fastest way.  In these situations the pt needs the blood more than you need the completed paperwork.

Here is my twopenny worth.  We have evolved into a culture where everything has to be done 'by the book'.  There's an SOP for everything and if the instrument says a reaction is + because it's interpreted a dust fibre as a positive reaction you can't change the result.  Well, it's not a bad thing to be standardised, but the problem is that when this becomes extreme, people stop using common sense.  In fact, they stop thinking altogether - sometimes thinking is just too dangerous.  Look back at some of the posts we've had where technicians have gone on to do further tests (because they were obviously needed) but were reprimanded because the doctor hadn't requested it and who's going to pay for it.  Also, we ask our 'qualified' people to have excessively high qualifications and get 'unqualified people' to do the majority of the work because it's cheaper that way.  But they're only allowed to do so much, and even if you've got someone who shows really a lot of aptitide they can't go any further unless they're prepared to opt into a long course of studies, for which they may well have good reasons for not being able to do.  Result - frustration and a lot of 'it's not my job' attitude.  I personally don't think that this is very good practise, and I can see why most of the problems listed above can be the result of these two factors

I don't mind a microbiologist who doesn't know much about blood bank. I certainly don't know much about micro. I worry when the people who are working in blood bank don't have basic BB knowledge.

So much for quality!

I don't mind a microbiologist who doesn't know much about blood bank. I certainly don't know much about micro. I worry when the people who are working in blood bank don't have basic BB knowledge.

I don't mind a microbiologist who doesn't know much about blood bank. I certainly don't know much about micro. I worry when the people who are working in blood bank don't have basic BB knowledge.

I don't mind a microbiologist who doesn't know much about blood bank. I certainly don't know much about micro. I worry when the people who are working in blood bank don't have basic BB knowledge.

An increasing number of organizations are making flu shots mandatory with termination if the employee doe not receive one. There is a law suit out there By a pregnant employee because they fired her for not getting a flu shot.
That said, imagine the liability to the healthcare organization if the employees give the flu to the patients. I can see the lawyers circling now.

I would like to provide some clarification about the Donation Identification Number (DIN) and the printing of the check character.
 
Whenever the DIN is printed, it must be accompanied by a check character.  The check character is not part of the DIN itself and it is not encoded into the DIN bar code.  The check character should be enclosed in a box when printed to distinguish it from the DIN.   
 
The flag characters are separate from the check character, and neither are part of the Donation Identification Number itself.  To help distinguish them from the actual DIN, the flag characters should be rotated 90° clockwise and the check character enclosed in a box.
 
Here are some references on the ICCBBA website for the check character:
 
ISBT 128 Standard Technical Specification Version 4.5.0Section 2.4.1 – Donation Identification Number [Data Structure 001] Section 7.6.2 – Keyboard Entry Check Character K  
United States Consensus Standard Version 3.0.0 Draft YSection 4.1 – Donation Identification Number [001] Section 4.1.1.4 – Keyboard Entry Check  
Implementation Guide: Use of the Donation Identification Number Version 1.0.0 (You will need to have password access to the ICCBBA website to view this document)
Section 3 – Check Character Section 4 – Text Associated with the DIN  
 
Erwin Cabana
ICCBBA

We use only a computer system and there is no check by somebody else. Our automated system exports results to the LIS, but our manual tube results are entered as they're performed and nobody double checks it. The LIS contains truth tables that will not allow incorrect entry of results. For example, if the reverse type doesn't match the front type an error box will come up saying there's an ABO mismatch. The tech then has to re-enter the results if they were entered incorrectly or if there is an ABO discrepancy to result an  Indeterminate for blood type. That ABO discrepancy result will appear on an exception report. As long as the techs are looking at the results before hitting verify (not just blindly hitting verify) and there are truth tables set up in the LIS, then you're in compliance with regulations.

TRM.40690 Data Entry Verification Phase II
If a serologic crossmatch is not performed, there is a method to verify correct computer data entry before issuing blood or blood components, and the computer alerts the user of any discrepancies.
NOTE: When a serologic crossmatch is not performed, patient safety must be ensured by requiring verification of proper data entry before issuing blood or blood components. The computer system must alert the user of any discrepancies of donor unit labeling, blood group confirmatory test interpretation, and to the existence of any ABO incompatibility.
Evidence of Compliance:
✓ Written policy requiring verification of correct data entry prior to release of blood/blood components AND
✓ Records for verification of correct data entry AND
✓ Documentation of computer system alerts used to prevent issuance of blood components when discrepancies exist

CAP LAB GENERAL 7/29/2013
GEN.43825 Result Verification Phase II
Manual and automated result entries are verified before final acceptance and reporting by the computer.
NOTE: Data entered into the computer system either manually or by automated methods must be reviewed by an authorized individual who verifies the accuracy of the input data before final acceptance and reporting by the computer. An example of best practices for this step is checking the result against the reportable range and critical results for the test. Depending on the local environment, this may or may not require a second person. Verification procedures must generate an audit trail.
This checklist requirement does not apply to autoverification procedures (see below).
TRANS MED
TRM.40100 Test Result Recording Phase II
Observations of all test results are recorded properly at the time the test is performed.
NOTE: Test results must be recorded at the time the test is performed in order to reduce the risk of transcription errors from delayed recording.
REFERENCES
1) Department of Health and Human Services, Centers for Medicare & Medicaid Services. Clinical laboratory improvement amendments of 1988; final rule. Fed Register. 2003(Jan 24): [42CFR493.1291(a)]

Your current system is only comparing paper results. Why have you not just entered data directly into the BBIS? I have never understood copying paper results into the BBIS after the fact/at the end of shift/etc. I have seen major errors during inspections when this has been policy.
Your BBIS has truth tables and you should get an exception report and also be able to print out a copy of all work performed (not just the interps). Nothing will prevent someone from incorrect data entry, but your system will alert them (and you) if the truth tables are violated - should evoke some investigation before results are validated. Your system is your safeguard, that is why you validate its functionality before you go live.

Soooooo... If everyone in the department make the highest evaluation level will they all get the highest possible raise?  The reason I ask this is when I was supervising at my previous life we were told that we could give anywhere from a 0% pay increase to a 6% pay increase based on the evaluations, BUT the department must average 3% pay increase.  So if I gave a 6% I needed to balance that with a 0%.  I don't know about most of your blood banks /transfusion services but mine not only did not have any poor performers, I had damn few average performers with most rated at the top, so guess what happened.....     

Actually, I copied the explaination from the ICCBBA documents.
When we first started using ISBT the two sideway zeroes (flag characters) would bring down our transaction processor (entire lab system) if we tried to return to inventory a unit that had already been given a final status in the computer. Sunquest fixed that pretty quickly since we had to call them everytime we had to return a unit in final status (i.e., transfused, discarded) to inventory.