Deny Morlino

Was looking at the weather during lunch and noticed a severe weather prediction for just south of our area for tomorrow with a higher possibility of tornadic activity associated with the system. Going to contact my blood supplier directly to find out an alternate means of communicating just in case.

Was looking at the weather during lunch and noticed a severe weather prediction for just south of our area for tomorrow with a higher possibility of tornadic activity associated with the system. Going to contact my blood supplier directly to find out an alternate means of communicating just in case.

We use the IgG cards for neonates. We use poly cards for the reaction workups, but due to our small size if differentiation is necessary the specimen is referred to reference lab.

I interpret the "diligent" statement as the reason I am so anal with regard to the details here. No wonder I lose sleep when I am thinking about blood bank! Occupational hazard I guess.

Mabel, I would be inclined to consider it 4 occurrances. The process you have in place had 3 opportunities to catch the error. Your description indicates 4 separate people performing a part of the crossmatch and issue. At each of these "interactions" something failed allowing an error to pass through unnoticed. Here we would be performing an analysis on each part of the process to determine if there is a process failure with the potential to repeat, and/or if some sort of process change is needed at any given step. It is much easier to perform root cause analysis on each part rather than to analyze the process as a whole and attempt to capture all of the possible interaction scenarios. It might be a good idea to consider the process as a whole as well to capture the "It never gets to this step and is still wrong thought process". Just my .02.

24 hours here as well

Pat, I have read a couple of your blog posts and have thoroughly enjoyed them. Hope you continue to have time for the blog. Your topics seem well chosen and presented. Thanks for the time you spend with the blog.

Cliff, I have had discussions with more than one vendor of products for my lab. Many seem to be "watching" Pathlabtalk for informal feedback. A comment I have heard more than once about the site is the fact that the people posting here are pleasant and "flaming" of others does not occur (unlike many other sites where unnecessary comments are common). The group here is a good representation of things worldwide (and getting better all of the time) in the immunohematology field. The advice here is usually right on the mark, and suggestions save the time of reinventing the wheel. If AABB chooses to limit the participation on their site it is a sad loss for the field. Every student I have had I suggest PLT to as a learning tool and a wonderful resource tool. Keep up the great work on this site. The other sections will grow with time.

I like the sound of this process!! A goal to work toward. Our average over 2011 was 1.23 so there is room for improvement.

Terri, I looked into sending the RhIg through the tube system but cjose not to for a couple of reasons. 1) Transport can cause bubbles in the RhIg solution (obviously not something you want to inject into the patient) 2) The syringe for the RhIg is glass and this is one of the major "Don'ts" associated with our pneumatic tube system. I did contact the manufacturer for their stance on PTS transport and was told that they do not have a stance on this practice. Decided to err on the caution side with our practice. Just my .02.

Sounds like we are of a similar size and demographic so the 93% might not be too far fetched for us. A primary goal this year for us is to push for more evidence based transfusions and alternatives to transfusion. AABB has a series of webinars this year related to this thought process. It will ultimately come down to our pathologist educating the physicians on changes to produce the desired effect. I agree with the patient size and unit necessary relationship you expressed as well. Still have a handful of older physicians that over transfuse a bit that will need some coaching.

That is an impressive change and encouraging at the same time. Thanks for the information.

Sorry I forgot that part of the post. I keep the schedule until the next calendar day. Any issues seem to materialize rapidly from surgery here. I have not had a need for the schedules past this point.

We do not at this point. It would take a bit of time, but may be worth the effort if a particular subgroup of physicians tend to over order on a regular basis. It would be "evidence" of the need to utilize evidence based decisions instead of a knee-jerk reflex order. I think I will add it to my list to consider as a trial to see where different specialities are falling in comparison to each other.

We too receive a schedule from surgery for the next day. A comparison is made with the list generated by our PAT (presurgical) orders to see if any names expected are missing from the schedule or if any are present for surgeries "expected" to use blood that blood bank is not prepared to handle. If any of the above occurs, a call is made to surgical scheduling to make sure blood bank and surgery are on the same page. If a patient is due for surgery the next day blood bank is not prepared for, phlebotomy is flagged to expect the patient in the AM and to draw and band the patient appropriately for blood bank. The above keep the phlebotomists out of the surgery theaters 99% of the time, and allow us to provide better service to the patients having surgery.

Amen to that comment!!

Like a med here. The entire process is pharmacy based and pharmacy's responsibility.

Agree with both David and AMcCord. The fact that you use a blood bank band is benificial in that it keeps another consistant identifier throughout the process. AMcCord's suggestion sounds like a good one with regard to the MRN additions. Are you billing using a different billing number for each location? We run into that here as the patient may be drawn and the work in blood bank performed on one day with one billing number and return the next day with a separate billing number. We just bill what occurs on each calendar date under the appropriate billing number. Sounds similar to your 2 MRN's.

Sorry for the delay in reply ( first vacation in almost 2 years and was avoiding anything "work" related). At present we perform an antibody screen at the point of prenatal workup (usually 16-20 weeks). If the patient is Rh negative, we also perform an antibody screen when the patient presents with an order for RhIg (28 weeks). The question I was lookin for an answer to was the frequency we see a change from a negative antibody screen during the course of the pregnancy to a positive at term. From the replies there appears to be a very low occurrance of a change to positive, but the change appears to have a higher frequency of being a c antibody than anything else. Peter, thanks for the reference and the discussion on the article in Transfusion. As has been stated, this is an interesting topic!!

I will take a stab at an explanation. Laboratory analyzers have a range of measurement within which the results are considered accurate and repeatable. This is checked at intervals using quality control with a "known" result and comparing the result reported from the analyzer with the "known" value. Once a result moves outside of the analyzer's range of measurement (linearity is the term used in the laboratory), the accuracy of the result is not guaranteed. When a result is determined to be beyond an instrument's linearity the result is often reported as either > a given value (in your experience >5000) or > a value. Most instrumentation is designed to dilute the sample automatically to extend the reportable range to a degree. If the result is still beyond this extended range, manual dilution prior to placing the sample on the analyzer is often possible. Any time a dilution is performed there is some degree of inaccuracy (usually very small) added to the result. It sounds like this is what you are experiencing. If your physician wants a more numeric result, they will need to discuss what is possible with the performing laboratory. Hope this helps a bit.

Same process here

I have spent some time trying to find the regulations related to blood warming infusion equipment. My biomed department has factory calibration guidelines indicating the blood warmers used at our facility be set to operate at 41.9 degrees C. The warmers are the sort that have the infusion line surrounded by a heated solution to maintain even temperature to the patient infusion connection. My question is the limitations we use when thawing frozen units limit the temperature to 37 C. Allowing the warmer to operate at a higher temperature seems inconsistant with the handling in blood bank. Are their regs detailing temperature limits applied to blood components during infusion? If so someone help me with a reference. Thanks in advance.

Good points Auntie-D. Thanks

Our policy lists the turn around for a routine as 8 hours. Rarely is this the length of time it takes to handle routines. Our policy lab wide is 8 hours for routine, 4 hours for urgent, and 1 hour for STAT.

I have another thread started on this very topic. Can you help me to understand why this is the practice at your facility?