jnadeau

A gentleman and a scholar (and a natural comedian). Thanks for sharing your knowledge in such an understandable way through the years - and now with this pic I can point to my reference! Congrats again

Will you please post a picture receiving the medal - then when I quote you I can show them my reference! Congrats Malcolm!

After being cited by a NYS inspector a few years ago for vital signs not being documented as described in the blood administration policy (some pre- and post vitals were documented with the same time as the start and end times) I searched through numerous P&P's and regulations from around the world (English speaking anyway) to find a fix. The citing was legitimate (pre=BEFORE START, post....) and I wanted the corrective action to reflect the most up-to-date best practice I could find. There was an almost universal policy/regulation for pre-, 15 min and post vital signs. The variations in the timing of vital signs (other than the 15 min ) was all over the map. The multitude of situations patients are in make it difficult to be cut and dry in a P&P. Decided to go with pre- and post within 30 min of start and stop; must stay with patient first 15 min so that was easy. More frequent vitals if provider indicated (almost never) or transfusionist deems patient requires - or if I recommend with my knowledge of the patient history / lab results. You know though, that as soon as there's an incident they'll "fix" it by requiring more frequent vitals and the loop continues...keep your old policy handy.

I have noticed this too, more recently in the past couple of years - they're coming up in gel which we know enhances the "M"s but...why enough times to take notice now? We report them as a cold autoantibody mimicking anti-M. The providers never call to question this ...aren't you surprised?

I've taken an outpatient sample (so I know it won't be needed again), added 3 drops of anti-s (BioRad - IAT), mixed and put it in the water bath agitating for about an hour. Works like a charm. I've also used Coombs control (labeled as a patient sample) - they elute anti-D as expected-much less of an eluate volume but we use gel so there's enough.

Thank you very much Malcolm. I'm going to read this over again at home - maybe with a cold beverage in hand - and let it sink in. I appreciate the time you take to answer these questions and my student will be very pleased with your compliments.

My student asked about the original natural antibodies in the plasma - I assume they're "wiped out" with patient's B cells in the chemo/radiation and the transplanted B cells in the donor's marrow makes the appropriate antibody(ies) for the patient's new blood type. What about the tissue/organs that express ABO antigens though? Please help Malcolm.

Sorry but the "Help" content at the Emergency Issue for Products prompt says that the system references this prompt only if the patient has no current blood type - if the patient has a blood type history that would normally be considered incompatible with group A FFP the system puts a hard stop on it.

Does anyone know of a dictionary setting in Meditech 5.67 that will allow emergency release of group A FFP/FP? I've looked in Meditech's "knowledge based" articles but...nothing found. I don't want to change the blood group settings dictionary - just want to be able to override the pop-up for this blood type and product. Paper (as in downtime) is the only option I can think of with this old mind - and in an emergency setting that is not ideal.

We're moving to eliminating the saline bag and using a 50cc saline flush (syringe) at the end of the transfusion. A bag of saline will be at the bedside in case of a transfusion reaction. This has been prompted by the saline shortage - the pharmacy is very happy with the move. The saline flush was suggested because the nurses said patients notice if they don't get all of the blood they're paying for...not worth the argument.

Clear bags - blood products are not considered a biohazard (I thought - if my memory serves me correctly on this "Friday where have you been?!!)

We started doing this every 6 months for CAP years back. I now just assign 2 pos and 2 neg samples from our proficiency samples (AFTER the due date of course) and techs will perform in gel, PeG and albumin. Reaction strengths vary of course but it keeps techs comfortable with the tube methods which we rarely use.

Thank you BankerGirl- it worked! What do I owe you?

We can't enter these units into inventory without differentiating the DIN somehow - even with scanning the product barcode (which is obviously different) first. Meditech is not that smart or I missed a setting in the product dictionary (and am not that smart either). Is there a TAR consultant for hire out there?

How are you handling the labeling of two units with the same DIN when nursing is using TAR in Meditech? We now manually add an "A" to one of the units but nursing doesn't want to have to override the scanning of labels at the patient's bedside when TAR goes into use.