Deny Morlino

Without a doubt I would say bags go to biohazard trash. Our housekeeping group are the watchdogs for our facility (they don't want any part of biohazard trash).

Welcome Nova! This group is very helpful on any topic. Opinions on forms are frequent here (most likely you will have a huge amount of information to choose from). I am not familiar with the WHO recommendations regarding transfusion vitals and time frames, but whatever the time frames given happen to be I would say that is your best practice to follow. Good luck in your pursuit of JCI certification.

Did you run the new positive control with the outdating kit? If the kit was Qc'd as working correctly using the Kit's positive control then the positive control from the new kit could be tested as an "unknown" if you will to see if it is showing as positive. If not, I would say you determined the issue by using two diferent lots of reagent with the "offending" control. As for the medical director, remember that purchasing a kit is not mandatory, just convienent. If you can show the proper response of the homemade control with the kit and explain the limitations of no other lot number available, perhaps the medical director would be in agreement. Let us know how this goes. Oh, and for the record the idea is not crazy. Being creative within the guidelines is expected when in a jam !

1.Biohazard 2. Tie tag removed before disposal and charted (paper system so signatures are on this tag).

Mabel, I just pulled Judd's Methods off the shelf and following is the information I was able to find: Positive control RBCs:0.6% RH+ RBCs in RH- RBCs, prepared by mixing 1 drop of 3% Rh+ RBCs with 16 drops 3% Rh- RBC's and diluting 1 drop of this mixture with a further 9 drops 3% Rh- RBCs. Hope this helps!!

I like this idea!! Can I retire there too???

Oh wow!! :eyepoppin Scary, scary, scary, but not an uncommon belief among the physicians. You know we can give O negative blood for every sort of emergency even when there is a positive antibody screen, right? Please don't let me be sick, oh please, plese, please!

Like AMcCord we use Ortho's diluent. I have validated Immucor's cells in the past and am in the process of doing the same with Biorad's red cell reagents as we speak.

Similar experience here.

We still make ours up daily from a 3-4% suspension. The pain in the .... is outweighed by the avoidance of the issues that started this thread. An added bonus is reduced contamination for our lab. If you are into your primary bottle frequently was when we experienced higher contamination frequency. You have to do what works for your situation. Sounds like you need to do some looking for light protection and keeping the bottles cooler. I think Wescott Lab Solutions offers a sort of sleeve to help with the light exposure issue (they advertise on the site here) Give them a call and see if they have some suggestions for you. The company owner is a past blood banker (is there such a thing??) and knows his products.

We just moved into our new space in August. As others have mentioned it is a large task that requires constant attention to the process. As others have stated maximize your power outlets (especially the backup powered ones), overestimate your network connection requirements (there is no such thing as too many network hookups regardless of what I.T. says), and make very sure the HVAC folks understand just how much heat the analyzers we operate generate. The hospital is gearing up for a central monitoring project for temperature and humidity. The thermostats just fitted into each area of the lab will need to be replaced with humidity controls as well (we told them!!). They are still working the bugs out of our HVAC system. We requested modular cabinetry and have "semi-moble" cabinets. The cabinets can be moved, but it will be a process to make any changes. Don't forget countertop colors either. The off-white countertop I specified for blood bank has received more than a few positive comments from the techs when reading gel results. Most immunology kits recomment natural light or incandescent light to read results. Our facility is going incandescent free from an energy standpoint. I compromised on fluorescent lights with a number higher in the K rating that is similar to daylight (it actually is very close to daylight). Consider foot pedal operated or motion detector sinks for hand washing (we love ours). Remember to step back and breathe frequently as it can (and will) be frustrating at times. It is well worth it in the long run as it improves the attitude of the techs when they have a little room to breathe. If you do not perform any PCR or testing requiring "special requirements" keep them tucked in the back of your mind as they may show up regularly in the next few years. Best of luck.

Do not hesitate to post information or questions here!! The only way to learn is to ask questions and try to help others. The best way to be sure you have a good grasp of something is to be required to try to teach it sometimes. There are many VERY sharp folks on this site that all have one thing in common... all started as a student at some point in their career (except for possibly Malcolm ).

Another common reason I have heard is to be sure there is not any sort of mix-up. Giving the 50 dose to a post partum by mistake could have huge fallout. We have always used the 300 dose on both antenatal and post partum situations.

Agreed. I often confer with a physician and our blood bank director on issues. I am in the department most frequently and usually in the best position to "put the pieces together". Getting reimbursed is another sore subject all together.

Malcolm I agree with your logic 100%. It makes much more sense to "spend a little up front" to minimize the cost in the long run. The sad thing is that the insurance system does not usually allow that sort of logic to prevail. An example: my daughter went to see the family physician. He requested an MRI of her head. After calling the insurance precertification group, I discover that an x-ray must be performed first. This did not show what the physician was looking for. Precertification again for an MRI and this time a CAT scan was what they insisted upon. The result still did not give a clear result to the physician. The third time of precertifying an MRI was approved and wouldn't you know the result was useful to the physician. Moral of the story I guess is even though we know what the better practice probably would be, we are at the mercy of the insurance precertification system.

Hang in there then and best of luck! It sounds like it may be a rocky ride, but I admire your ethics and determination.

Same as David, 30 days after primary container is opened saline in plastic squeeze bottle is discarded and bottle cleaned before refilling with new saline.

Thus the reason for my post earlier.

Microbiology here as well.

While I do not disagree with the points made by Liz, Auntie-D, and Malcolm, I do have another angle to look at this from. I am not sure what the employment opportunities are in your area, or how mobile you care to be. Ask yourself the question as to how difficult will it be for you to work with the guilty party and the supervisor? Only you can make that decision for yourself. Is the stress of the situation likely to cause you issues. If any of this is answered yes, you may want to consider employment at a different place if only for peace of mind.

The patient's physician. They have the option of refusing the responsibility of notification at our facility at which point the notification is made by the blood bank. Can say I have not ever had a physician refuse the duty.

Welcome to Pathlabtalk.

Liz, We do not test donors here except for the retypes required by AABB. For cord blood confirmation of Rh I use a product from ALBA Bioscience called Anti-D delta that is specifically designed to identify D VI. It is a tube method, but is an immediate spin method. For our lab the tech time saved pays for the reagent very quickly. It has a good outdate (the lot I received in mid-September outdates 4/15/2013). Not certain if you are set on column agglutination as the only method, but it is an option. Good luck!!

Thanks!!

Agreed. You need to pull out your educators hat and give a mini lesson in blood bank science so the client has the correct basis to make the decision. At the same time be open to their point of view so as not to stoke the fires of a disagreement further. Be ready to offer the information related to the different methods and their drawbacks as well since the client will suggest trying a different method than you currently use. Stick to your guns though as your goal is to provide the safest product and best results for the client's patients. Let us know how this progresses please.