Deny Morlino
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Posts posted by Deny Morlino
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Welcome to Pathlabtalk
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OB's policy is a DAT on every newborn (regardless of the ABO of mom). I have attempted to redirect the physicians to appropriate ordering, but to no avail.
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Terri, Thanks for the article.
Scott, Thanks for the update
Mabel, I certainly agree.
I am struggling with a couple of physicians that, in my opinion, over transfuse regularly. If I could get these few stragglers into line, we would be on track with the <7.0 g/dL target for the non-acute cardiac involvement recommendations from ARC. The acute cardiac involvement set is a bit trickier.
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Malcolm,
Valid question. I am not certain how this is to be interpreted even after reading the CMS regulations regarding readmissions. The purpose is to reduce the number of readmissions for the same billing code/DRG. I am not certain how a readmission for such disease processes would be viewed in terms of reimbursement. My supposition is that attempts to transfuse would occur on an outpatient basis as much as possible, thus reducing the costs associated with a hospital admission. If readmission becomes inevitable, I am not sure how chronic transfusion disease processes would be reimbursed.
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With the latest reimbursement guidelines from CMS indicating non-payment for readmissions within 30 days for the same issue, the transfusion committee decided to pursue post transfusion H&H's to help determine if transfusion of LRBC's was effective as expected, or if there was a reduced increase indicating some as yet addressed condition that should be resolved. The committee also recommended an H&H the date of discharge for all LRBC transfused patients to be certain the patient was not decreasing Hgb, and that the patient has adequate Hgb as well (all of this is in conjunction with signs and symptoms). The Med Exec committee did not agree. I am looking for references and other facilities' practices to support the Transfusion Committee's stance. Help?
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Waiting on Bio-Rad as well
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We were inspected by HFAP this year and one of the STRONG suggestions made by the inspector was to issue units in a plastic bag with a biohazard sticker. The reason given was the possibility of a ruptured unit if dropped during handling. This was easier to "just do it" than to argue the lack of regulation especially since it makes practical sense to me.
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Mabel,
Maintaining the same number throughout the "stay" is our historic practice. Our phlebotomy team is VERY good about checking with blood bank to be certain that the BB number is still valid, adding the BB number to any EDTA tube drawn from the patient in case a new specimen is needed for testing, etc.
The BB band is a lifeline during trauma/"Doe" situations. We are a smaller hospital in a rural area so large number traumas are rare. Using the BB number as our source of consistancy throughout the name change/confusion possibilities has proven to be invaluable on multiple occassions.
We are not part of a multiple hospital system (very surprising today I know), so I have no information on that part.
Our Pre-op is 14 days ahead of time with the exception of maternity. The band remains on the patient the entire time. This would be helpful in avoiding the "insurance card sharing" that has been mentioned on this site many times.
Hope this makes sense and helps.
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Same here as AMcCord with the exception of the card system for PAT patients. Ours wear the bands. I do like the card system and will give that consideration!!
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Cliff,
I tried the setting change suggested. The three items that appeared when I first logged on were the only items showing. When I switched back to the "Items I have not read" setting more items appeared one at a time. I did not wait for the 15 minutes, but will give that a shot later today.
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I will give this a try and see how it works. Thanks Cliff
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Cliff,
I really like the new format of this site. I do have a question/problem I have not been able to figure out. When I sign into the site after being away for a bit (several hours to days) I select View New Content. When this selection is made initially I see 4 posts with "new" replies. After I have worked my way through those posts, if I hit View New Content again I see a single thread with "new" posts. After viewing this new set of replies, if I select View New Content again I will see a single thread. This continues until I have finally proceeded through all of the threads with new posts. I thought perhaps I was just seeing threads appear that had been updated since my previous selection of View New Content, but the time stamps of the posts the show up anew are not from within that time frame (i.e. they are older sometimes several hours to days old that did not show up originally). I hope this makes sense. Help please??
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Malcolm,
The incident in Waco was a fertilizer plant fire that progressed to tragedy. I have not heard any report of malicious activity related to this incident, but a full investigation will ensue I am sure.
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The phone number the hospital has listed is my cell phone. My cell phone is with me at all times short of bathing. I receive calls at any and all hours gratefully. I have enough confidence in the folks I work with that if they feel the need to call me it is a legitimate question. It is always quicker to answer their question now, than it is to repair the damage and domino effect fallout later!!
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Not sure if Cliff is from Boston or elsewhere. I know Lisa M is from very near that area as some of her treatment took place at Mass. General I think I remember.
Hang in there folks and keep doing the awesome jobs I am sure you are doing. -
To our colleagues in the midst of handling the fallout from this crisis, we are with you in spirit. Stay strong.
To the cowards who produced these circumstances, this is unacceptable!!!!!
To those this tragedy has affected, thoughts and prayers are with you.
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As long as the transfusion is completed, or the remainder of the unit discarded within the 4 hour mark the unit may be used according to our processes.
When a unit is returned the temperature of the unit is determined to decide if a unit is acceptable for restock. The time out of lab has no bearing on this process.
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Document the comparison specifically twice yearly so their is not a question as to whether it is performed or not. Remember the old addage, "If it was not documented, then you did not do it".
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Welcome and enjoy!
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The titer of 2 at 12 weeks and 1 at 16 weeks could (probably) indicate a decreasing titer. A decrease in the titer after a RhIg (Rhogam) injection over time is what we normally see. When testing with the method we use here (gel) it is not unusual to have a pisitive antibody screen detecting the RhIg as long as 6 months after the injection. It sounds like things are progressing well (?) for you? Hope this helps a bit.
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Same here as Mabel
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This is the way we function and have been inspected by Joint in the past with no mention of this practice.
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What I was going for is that the crossmatch may be compatible, but antigen typing or complete rule-outs of other possible antibodies may not have been completed yet.
In this situation we still classify this as incompatible since the identification is incomplete. The physician signs a release of the unit indicating that counseling of the risks involved have been explained and the responsibility and liability now lies with them.
Happy Birthday Cliff!
in Off Topic
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Sorry I missed the date. Happy belated!!