Deny Morlino

Our LIS team created "tests" for the extra tubes collected with any frequency. At times we have a nurse or physician request that we collect an extra specimen. Our phlebotomists are seasoned enough to make an accurate determination as to when an extra is warranted. ED draws their own "rainbow" so extras are frequent from them. An extra lavender tube has a test possibility of XLAV, blue top has XBLU, extra green top gets XGRE, and extra SSTs get XSST. This makes things easier when phlebotomy is looking at a previous order to see if a previous sample is available for use when testing is added.

We use a blood band ID system. Patient identified as John or Jan Doe and cross match performed. Band remains on patient until ID is corrected. As soon as there is a period of time allowing redraw and reband for blood bank, that is completed as well as repeat of blood bank testing with a new specimen with correct ID. The BB band is the source of truth in an unknown ID situation for blood bank and ED until identity can be properly established.

Same as Scott, 50 and 100x oil. Techs count with whatever is most comfortable. Deny

ID required at point of admission here as well.

That was my thought Scott. Oxygenation levels vary from one person to another.

Welcome

Same as the others

We use a 2 part temperature guideline based on ARC's reaction forms. If the temp is greater than or equal to 102.9 F a reaction is called. If there is a 2 degree C rise in temp a reaction is called.

Agree with Scott. We have been using gel for more than 10 years and have not used an auto control. When we use tube method, yes.

Are you referring to paper logs, electronic logs, or both? For paper logs, an overlay template with the areas to be filled in cut out of the template is a handy tool (nursing loves the one the have here for checking completeness of transfusion record). If you are talking electronic records, most software systems have reports available that can be custom defined and saved so that minimal changes (i.e. date ranges) are necessary. As far as training goes, buy in by the people reviewing is paramount to success. If the reviewers are just going through the motions, failure to catch all the omissions is likely.

Kathy, I can sympathize. Add to the headaches the fact that we do not utilize a blood bank module, so everything is paper! My experience having generalists is that they are apt to forget details as they do not work exclusively in one department and remembering all the details is practically impossible. Things that are common across other departments (like the lot number changes) I would be more irritated by since this is an integral part of the job. Examine your processes to see if there is any way to streamline things for the generalists (it has helped me at times). Sometimes you can spend more time "catching" the inconsistent errors than taking the issue as a whole and handling it (day shift reviews all charges here for this reason). Encourage people to leave detailed notes attached to paperwork they leave out, or put the paperwork away. Yes, it is like herding cats at times! Hang in there and find a rhythm that allows you to be productive and not spin your wheels feeling as if you are chasing details all day.

Welcome! I do not have a state specific anwer for your question. As you have stated, there are not any specifications per AABB, Best bet would be to look to the agency that used to be NCCLS (drawing a blank this morning as to the new name) for suggestions. Looking at workload from a patient safety standpoint should give you a good balance in staffing.

I am with goodchild on this one. One place to start is the "why" some physicians insist upon pooled vs. apheresis products. It seems to me there is approximately 6 times the risk of exposure utilizing pooled vs apheresis products in terms of exposure to something causing current or future issues since the recipient is exposed to multiple donor products. You do not indicate if the sampling from the pheresis units is a closed system process or open. This changes the time of expiration potentially for all of the pheresis units entered to create the pool. These are the issues I see immediately.

Welcome to the site

I seem to remember discussion regarding the thawing of frozen plasma as a necessary part of the process to allow transfusion of the product (can't very well transfuse a frozen unit after all). I think that splitting of a unit is considered "manufacturing" and would require registration (we just dropped our splitting policy and no longer provide split units due to low request rate).

Lbiggs, You do not mention your reference lab for blood bank. The reference lab is often a good resource for best practice references as they have contact with many other labs, and are normally the "experts" we refer to. Ours is ARC, and I will call on their pathologist to clarify or discuss with my own pathologist as ARC's pathologist is focused on blood and transfusion whereas my pathologist must be more of a "generalist". The two have a very good working relationship. Something to consider.

Our policy is the same as yours. Infused within 4 hours of issue. If there was something that magically occurred to a unit at the 30 minute mark, all transfusions would be required to be completed within 30 minutes. My suspicion is that the nurse remembered the old rule that units had to be back into the refrigerator if not started within 30 minutes to be eligible for reissue. If the unit is started and completed within the 4 hour time frame, then the regulations as they stand are met.

We have been 100% leukoreduced for at least 10 years here as well. For many years prior to that we had a hematologist / oncologist that had all of his units transfused with a filter prior to universal leukoreduction. He was ahead of his time.

bldbnkr, At our last inspection the inspector indicated that we should be calibrating our centrifuge for immediate spin use for saline active antibodies, high protein antibodies, for cell washing, and for antiglobulin testing. In the AABB technical manual appendices the procedure is defined. We settled on performing this twice per year after discussion with the inspector. There is indication that a modification to the procedure reducing the number of time periods tested could be performed after the initial determination has been made for optimal time for each of the procedures. Hope this helps.

I seem to recall a discussion here that the UK performs a more complete Rh typing of all(?) patients and honors the the patient's Rh results as well as K when cross matching. Malcolm or some others from the UK can clarify that (and let me know how poor my memory actually is this morning) as well as the reasons why.

Guessing AAF is African American Female.

Couple of questions: Have you validated that units are ALWAYS within the accaptable temperature range and can thus use the 30 minute rule. When we checked this the best we could come up with was about 18 minutes out of the refrigerator before the temperature was exceeding 10 degrees. I understand the frustration of units wasted because they are slightly over temp. Is there any other possible means to retrieve the units from OR? The first thing that comes to mind is a transport cooler to move the units to for return to the blood bank. I realize this is probably not convienent, but to save a unit from discard in the scenario you describe it may be worth the effort. Let us know what you decide.

Welcome back!!

We use exclusively polystyrene tubes. I do not know of any polypropylene tubes cleared for use in blood bank.

When our MTS pipette died we went with a Biohit e-line e 300. It is programmable (6 positions) so tailoring for your specific uses is possible. Check out Wescott Laboratory Solutions. They advertise here and customer service and recommendations have been great (The owner is a past blood banker, so he understands our needs).