DPruden

UNOS has guidelines on off-type kidney transplants.  We were using the UNOS protocol for DTT treated iso-titers, but have transitioned to running IgG and IgM iso-titers on our NEO Iris.
https://community.asn-online.org/blogs/mark-lerman/2018/07/09/weekly-rewind-abo-incompatible-kidney-transplant-r
https://optn.transplant.hrsa.gov/media/2347/mac_guidance_201712.pdf
 

The Bone Marrow Transplant unit orders them post transplant, not anything to do with newborn/fetus

Most of our MDs order the MTP in Epic fairly real time, and if they don't the Blood Bankers enter the order with a required co-sign.

UNOS has guidelines on off-type kidney transplants.  We were using the UNOS protocol for DTT treated iso-titers, but have transitioned to running IgG and IgM iso-titers on our NEO Iris.
https://community.asn-online.org/blogs/mark-lerman/2018/07/09/weekly-rewind-abo-incompatible-kidney-transplant-r
https://optn.transplant.hrsa.gov/media/2347/mac_guidance_201712.pdf
 

Our inpatient consents are good for the length of that admission and our outpatient consents are good for a year.  We've never had any issues, but you might check your specific state rules.

Our inpatient consents are good for the length of that admission and our outpatient consents are good for a year.  We've never had any issues, but you might check your specific state rules.

Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units.  this was during a time when many people were donating autologous units and having them frozen (early 1990s).  There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS.  To further complicate the error, the patient didn't really need to be transfused, 30-something healthy guy in for jaw surgery, very minimal blood loss during surgery, but the unit was on the shelf and it was autologous, so they decided to transfuse it!  So, he got an entire BPOS unit and he was OPOS.  The patient spent about a week in ICU and his kidneys shut down for a while, but he survived with no long term consequences.   I will never forget that one!

I would say have compassion and flexibility, but don't let people walk all over you.  Don't be afraid to ask for what you need, like 5 minutes to finish a task before addressing their issue.  If people are complaining, I will often ask them to come up with a solution.  I definitely agree that stepping into a leadership position internally is more difficult than starting as a leader in a new facility.   One of the most helpful things that I was told early in my career was to vent up, personnel management can be frustrating, but go vent to a supervisor or manager away from the lab, this can often help bring perspective to the situation. 
Good luck!

Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units.  this was during a time when many people were donating autologous units and having them frozen (early 1990s).  There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS.  To further complicate the error, the patient didn't really need to be transfused, 30-something healthy guy in for jaw surgery, very minimal blood loss during surgery, but the unit was on the shelf and it was autologous, so they decided to transfuse it!  So, he got an entire BPOS unit and he was OPOS.  The patient spent about a week in ICU and his kidneys shut down for a while, but he survived with no long term consequences.   I will never forget that one!

Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units.  this was during a time when many people were donating autologous units and having them frozen (early 1990s).  There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS.  To further complicate the error, the patient didn't really need to be transfused, 30-something healthy guy in for jaw surgery, very minimal blood loss during surgery, but the unit was on the shelf and it was autologous, so they decided to transfuse it!  So, he got an entire BPOS unit and he was OPOS.  The patient spent about a week in ICU and his kidneys shut down for a while, but he survived with no long term consequences.   I will never forget that one!

Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units.  this was during a time when many people were donating autologous units and having them frozen (early 1990s).  There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS.  To further complicate the error, the patient didn't really need to be transfused, 30-something healthy guy in for jaw surgery, very minimal blood loss during surgery, but the unit was on the shelf and it was autologous, so they decided to transfuse it!  So, he got an entire BPOS unit and he was OPOS.  The patient spent about a week in ICU and his kidneys shut down for a while, but he survived with no long term consequences.   I will never forget that one!

I would say have compassion and flexibility, but don't let people walk all over you.  Don't be afraid to ask for what you need, like 5 minutes to finish a task before addressing their issue.  If people are complaining, I will often ask them to come up with a solution.  I definitely agree that stepping into a leadership position internally is more difficult than starting as a leader in a new facility.   One of the most helpful things that I was told early in my career was to vent up, personnel management can be frustrating, but go vent to a supervisor or manager away from the lab, this can often help bring perspective to the situation. 
Good luck!

Beyond any shadow of a doubt - personnel will always be the greatest challenge.  Not enough, not well enough trained, will they follow the SOPs (in spite of the continuous Competency - truly a pain!), will they show up, will they get along with each other...........
Be prepared for that challenge and take advice from a good manager, if you are blessed with one.  Always consider that mistakes may stem from a misunderstanding of what is written in the procedure or the procedure might need a tweak to eliminate a "process" problem.. Approach mistakes from the point of view - "Is it a process problem?  Can someone else make the same mistake?" before you go after the person who made the mistake.
As someone said earlier - get familiar with the standards of whatever inspection organizations you will be responsible for.  Read all of your procedures with those standards in mind and line them up.  That will make inspections so much easier and always gives you a "reason" if you have to change something.
Keep your sense of humor and be adaptable.  Nothing will stay the same forever - change comes along frequently and you have to roll with it.  Make friends (with distance - not "buddies") with your techs - stay friendly with other techs in the Lab and make friends with other administrative personnel - you will be on the front lines with other personnel in the hospital more than other Lab supervisors - think ER and OR.
Best of luck.
 
 

Ok, here we go.  First is from a personnel stand point.  When promoted from with in you are no longer "one of the guys".  This means that some of the staff will try to leverage your close friendship which in turn will cause problems with others.  Both you and the rest of the staff need to recognize that things have changed on a personal level, at least in the work place.  This does not have to be dramatic and should not be, but it is real.  Some can do this and some find it very difficult.  Now, when coming from outside your are exactly that, an outsider.  Now the level of this can vary immensely depending on the situation.  One time when I changed facilities it was just across town and I new many of the staff at the new facility so a lot of the unknowns were minimized.  On the other hand, I also moved to another facility out of state and pretty much walked into an unknown from a staffing standpoint except for what little I could glean from the interview.   As I noted in my previous post, be very judicious when using the phrase, "this is how we did it."  I've had new employees who would say this at every opportunity and then go into detail about how we were either doing it wrong and that their way was just much better.  This became very trying to everyone else on the staff and we finally just tuned them out.  Because of that we probably did miss out on some good ideas.  One last point, in either case be aware of any others staff who may have either applied  for the position or simply been over looked.  Depending on their personality they can either be a great help or a significant hinderance.  Do everything you can to get them involved and engaged.  They can be your greatest asset but it may take a little extra work on your part.  For me, the personnel issues were always the most difficult. 
I'm assuming that you are new to the lead position and not knowing your previous experience here a couple of generalizations.  Unless something is an obvious hazard to either patients, staff or the ability to pass an impending inspection/assessment don't be in a big hurry to make changes.  As they say in the military, you need to understand the lay of the land.  Become familiar with the blood bank/transfusion service medical director and let them have the chance to become familiar with and confident in you.  They can and should be your greatest allies.  Ultimately most of what you want to change will have to be approved by them.  You need to understand the current processes before trying to change them.   At one of the facilities I moved to I noticed that many of the staff were not following their procedures "to the letter".  The way I dealt with this was at the monthly staff meeting we would go through a procedure as a group, line by line and I would ask the questions, "Is this how you are really doing it?  If not, why not and how are you actually doing it?"  This is when I would make suggestions for changes and generally a lively discussion would ensue.  It took quite awhile to go through the procedure manual but by picking, what I considered the most important  one first it was time well spent.  
This is getting a little long so I'll end with how I described my position as Transfusion Service Supervisor at a 350 bed level ll trauma center.  My job was to provide the staff with the tools (equipment, knowledge, material and support) for them to do their jobs at the highest level possible.  All this while keeping the dragons (administration) away from the door.  Good luck and if I can think and anything else that others may miss I share a few more golden nuggets of wisdom with you.  Above all else have faith in your self.  
     Wow I think that's the longest post I've ever made. 

Technically, it is only indicated for treatment of patients who are undergoing massive transfusion. because of life-threatening trauma/hemorrhages.  We use it for MTPs in our OR as well as trauma patients coming into the ER.

Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units.  this was during a time when many people were donating autologous units and having them frozen (early 1990s).  There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS.  To further complicate the error, the patient didn't really need to be transfused, 30-something healthy guy in for jaw surgery, very minimal blood loss during surgery, but the unit was on the shelf and it was autologous, so they decided to transfuse it!  So, he got an entire BPOS unit and he was OPOS.  The patient spent about a week in ICU and his kidneys shut down for a while, but he survived with no long term consequences.   I will never forget that one!

Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units.  this was during a time when many people were donating autologous units and having them frozen (early 1990s).  There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS.  To further complicate the error, the patient didn't really need to be transfused, 30-something healthy guy in for jaw surgery, very minimal blood loss during surgery, but the unit was on the shelf and it was autologous, so they decided to transfuse it!  So, he got an entire BPOS unit and he was OPOS.  The patient spent about a week in ICU and his kidneys shut down for a while, but he survived with no long term consequences.   I will never forget that one!

Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units.  this was during a time when many people were donating autologous units and having them frozen (early 1990s).  There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS.  To further complicate the error, the patient didn't really need to be transfused, 30-something healthy guy in for jaw surgery, very minimal blood loss during surgery, but the unit was on the shelf and it was autologous, so they decided to transfuse it!  So, he got an entire BPOS unit and he was OPOS.  The patient spent about a week in ICU and his kidneys shut down for a while, but he survived with no long term consequences.   I will never forget that one!

I would expect the blood center to put an expiration date on that product.  You should not have to alter that as it would be a licensed/registered product in compliance with regulations.

Decades ago, one of the night shift techs thought that doing a type confirmation on autologous units was stupid, so she would routinely "sink test" the ABO confirmations on autologous units.  this was during a time when many people were donating autologous units and having them frozen (early 1990s).  There were 2 auto units being deglyced at the same time at the blood center, and through an honest mistake by the donor center staff, the units were switched during labeling, one was OPOS and one was BPOS.  To further complicate the error, the patient didn't really need to be transfused, 30-something healthy guy in for jaw surgery, very minimal blood loss during surgery, but the unit was on the shelf and it was autologous, so they decided to transfuse it!  So, he got an entire BPOS unit and he was OPOS.  The patient spent about a week in ICU and his kidneys shut down for a while, but he survived with no long term consequences.   I will never forget that one!

Only thing read Microscopically is the fetal screen which is the procedure for that test. According to the literature out there (see Issett) no other tests should be read microscopically 

I have never understood this obsession with looking at reactions down a microscope in blood bank, except looking at things like a Kleihauer or when teaching, to show mixed-field reactions.
The great Peter Issitt, not a bad roll model to have, wrote, many years ago now, a passage that I attach from page 69 of his "Applied Blood Group Serology" book, 3rd edition, 1985, Montgomery Scientific Press.
That having been said, all reactions seen MUST be recorded, it is just that macroscopic reading is almost all that is ever required.

I used to use a 10mL tigertop tube, it was an excellent brake!

21CFR606.151(e) states "Standard operating procedures for compatibility testing shall include the following: Procedures to expedite transfusion in life-threatening emergencies. Records of all such incidents shall be maintained, including complete documentation justifying the emergency action, which shall be signed by a physician."
We keep them regardless of whether or not the units are transfused.

21CFR606.151(e) states "Standard operating procedures for compatibility testing shall include the following: Procedures to expedite transfusion in life-threatening emergencies. Records of all such incidents shall be maintained, including complete documentation justifying the emergency action, which shall be signed by a physician."
We keep them regardless of whether or not the units are transfused.