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We have Soft and Epic and are a level 1 Trauma Center with approximately 175 activations each year. We pre-label MTP cooler #1 for either Male or Female to a dummy patient (Patient, Massive T) and have a 3 part form to document units on (6 RBC, 6 plasma and 1 platelet) along with the Emergency Release attestation that requires a physician signature. The first cooler is almost always issued on paper but can be scanned into Epic using the MTP flowsheet (NOT part of BPAM). Additional units are set up using Emergency Issue with a one step Issue process that prints XM Labels and downtime transfusion records if needed. In order to streamline the issue of this cooler, it is protocol to only document actual patient trauma ID on the 3 part Emergency release form. Cooler contains 6 Group O RBC, 6 Group A plasma and one platelet of any type. Nursing or anesthesia can scan unit numbers into the MTP flowsheet or use an anesthesia workflow from Op-Time to capture scanned blood products in the operating room. It is not a perfect system and takes some education for the users and we still have problems with documentation and we are 3 1/2 years since conversion to Epic/Soft from Soarian/SunQuest. For straight emergency released units from one of 2 remote storage refrigerators, ER nursing can scan unit numbers into an Emergency Released flowsheet for either RBC or plasma. This actually works really well and is widely used by Trauma staff members before patient moves to OR. It is a simpler version of the MTP flowsheet.

I received the same notification yesterday and asked my Quotient rep as the IFU being shipped is the same January 2019 revision as is on the Quotient BD website. The answer was to call the Ortho Customer Service line to ask for the date of the future implementation. The original notification is dated May 2, 2019 for an August 2019 implementation. The timeline has obviously changed to some future date which is not being disclosed at this time.

We recently had baby with strongly positive DAT on cord blood, Mom and baby both Group O, mom had a negative antibody screen at delivery. So, per policy, did eluate and identified anti-Cw in eluate. Went back and tested mom - who had unidentified anti-Cw demonstrating at delivery. Our screening cells do not routinely have cell positive for Cw antigen. Textbook case. We routinely call baby's location when we have a positive DAT on a cord blood evaluation. This is at the request of the physicians so that they can order a Bilirubin sooner than the routine 24 hrs post-delivery. This was after many meetings with Risk Management, OB physicians, pathologist, nursing, etc..... This is NOT considered to be a critical value notification. We call it "abnormal result notification".

We keep RBC and plasma on our helicopter using the Pelican Credos and a datalogger. Units are changed out every 24 hours or replaced when transfused and they keep extra sets of credo panels in the ER freezer to follow manufacturer IFU. Dataloggers record temperatures every hour with an audible alarm to the user if the temperatures exceed 6C. Datalogger data is transferred to the Blood Bank for review and retention. We are looking into keeping units with supervisor units for ground transport in 3 counties but that is still in the works. If you can install an undercounter BB refrigerator at the airport with Wi-Fi temperature reporting and 7-day continuous chart recording, that may be another route to investigate. I have worked at a facility with remote storage at the heliport that was maintained by both ARC, hospital and air ambulance services. All have to work together to meet requirements to ensure that blood products are maintained properly.

I have had this conversation numerous times with Anesthesia manager - do we really have to have 2 people verify? Yes. Stop asking. As for scanning, we have Epic BPAM which does not function in the OR. OR has their own process that does allow scanning of units during massive transfusion but it isn't perfect. If they scan the units from the cooler and somehow the unit isn't transfused and is returned to the BB, there seems to be a glitch where unit status in Epic thinks the unit was transfused when it actually was not and did not update when returned to the BB. Later, when trying to scan for another patient, BPAM gives a warning "Unit not intended for this patient". This statement is an almost guaranteed nurse "freak-out."

I understand the logic of the Typenex as a 3rd or 4th identifier that links that specimen to the unit of blood. But, I am living with the issue of getting 10,000 nurses to be able to complete a Typenex specimen label and Typenex bracelet correctly. It just is a problem. Biggest issue with specimen labeling is forgetting to add the Typenex label that says "Place patient information below this line and attach to specimen" - it just doesn't happen. I don't know why it's so hard, we have powerpoint education, it's a class in Orientation where they hear it and see it then do it and the report back is that, even after just talking about it, 75% of orientees fail the test of labeling a specimen and bracelet correctly.

Not advertising but there was a good podcast from BB Guy this month on implementing use of low-titer WB at University of Cinncinnati and their experience from both trauma and blood center perspective.

If there is anyone who has implemented the use of Group O LTWB for trauma that would be willing to share SOP? How are you monitoring recipients for adverse reactions to incompatible plasma? What types of patients are approved to get stored WB transfusions? What happens to the unit if not used - do you manufacture RBC or waste the units? Do you use O+ or O Neg (or both)? Do you have a set limit on the number of units a patient can receive while the ABO/Rh type is unknown? My trauma surgeons are pushing hard to move forward with the plan to implement, blood supplier is willing to provide product but I have lots of questions and not a lot of resources and don't want to reinvent the wheel.

My interpretation is that containers used for transporting blood products must be validated to ensure that the blood products are maintained at appropriate temperatures including extreme ambient temperatures (winter and summer). This validation would need to be done by the blood supplier since it is their container that is used for the transport and would be verified by the FDA during their routine inspections of blood manufacturers. As a recipient of incoming critical supplies (blood products, reagents, etc...), I must have established criteria that are used to verify that the incoming products are acceptable. If my criteria include measuring the temperature of all or part of a blood shipment, then that needs to be performed at the time the shipment is received. My blood supplier must pack products to maintain the correct temperature for a reasonable time period so that, should I choose to measure it, the units would be at the appropriate temperature.

Agreed. We had a recent positive DAT on Group O baby born to Group O mom with negative antibody screen. Eluted anti-Cw. After we went back and tested Mom with Cw + cells, 3+ reactivity. Actual practice on testing babies varies from hospital to hospital - and I think most is dependent on the volume of deliveries at that hospital and the Blood Bank workload.

Our admit order set includes performing Newborn Evaluation when Mom is group O, no prenatal care history, or history of positive antibody screen. Almost 100% moms have an admission ABO/Rh type and antibody screen. If mom has a negative antibody screen, what are we expecting to find when performing a DAT on ABO identical mom and baby?

We have built several different "dummy" patients that allow us to quickly get emergency-release blood issued - we routinely keep pre-labeled Group O RBC in the ER, OR, helicopter, and a remote satellite lab at a smaller rehab facility as well as units labeled for Massive Transfusion Protocol in the Blood Bank. We currently use a paper form where the actual patient name or Trauma ID and MRN is documented for our record keeping and traceability. TJC seemed to have the most interest in how emergency-released units were labeled last year during multiple rounds of inspections - they were happy with our system since it does allow tracking of units from issue to transfusion. DHEC was also interested but not as focused.

Thanks!

Thank you all for your invaluable input - does anyone know of literature referencing a mL/Kg formula looking at safety in transfusing incompatible plasma?

If you are in a Massive Transfusion situation and the patient is bleeding so profusely that you run out of available (aka thawed or liquid) ABO compatible plasma - the only available plasma is Group O. You have a specimen and the patient is Group A. What would you do?