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As a facility that uses Care Everywhere for previous blood bank history (ABO/Rh type and clinically significant alloantibodies), it is a very useful tool but must be reviewed carefully. As the CAP brought up, Epic does allow a "historical provider" to manually enter blood types - and we have seen many examples - so made it part of our policy to not use that information as an example of a historical blood type - we must see where the result was reported by a clinical laboratory. With the December 2024 Changes, we may be moving toward historical information within our LIS only (we are currently a 13 hospital system that shares SoftBank) as we standardize policies and procedures across all facilities. We previously used Sunquest - and would use information shared within Hospital ID (HID) -as part of our history check. Don't know if that is a viable option.

(Slightly paraphrased from the Guidance to the 34th Edition of AABB Standards for Blood Banks and Transfusion Services) AABB Standard 5.14.8 requires that there be 2 determinations of a recipients ABO group..... the first determination must be on a current sample and the second determination may be determined by one of the following methods: 1) comparison with previous records 2) testing a second sample collected at a time different from the first sample 3) retesting the same sample if the patient identification was verified at the time of sample collection using an electronic identification system. CAP standards (12/2024) Changes to Standards clarifies the requirement even further: "In the transfusion medicine checklist, TRM.40300 Historical Record Check says ABO, Rh, and antibody screen test results must be compared with results of the same tests recorded previously to detect discrepancies and identify patients requiring specially selected units. “New language was added to this existing requirement to clarify what is acceptable ABO and Rh historical records,” says Matthew Karafin, MD, MS, chair of the CAP Transfusion, Apheresis, and Cellular Therapy Committee and clinical professor of transfusion medicine services at the University of North Carolina at Chapel Hill. The revised requirement now says the acceptable ABO and Rh historical records for transfusion purposes are only those generated or entered by laboratory personnel into the health system’s laboratory information system and performed by an accredited lab or certified by the relevant government agency in its jurisdiction. “We learned that assessors have encountered facilities that were using blood types from other institutions, such as from Epic Care Everywhere,” Dr. Karafin says. “Moreover, we were made aware that blood typing information from these other institutions was sometimes being added by non-blood bank personnel, so we had concerns about the reliability of this information.” For patient safety, the CAP wants to ensure that the ABO and Rh used for transfusion are the ones that laboratory personnel have entered into an LIS. This “implies that a transfusion service reviewed the information and was responsible for its data entry,” Dr. Karafin says."

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Can you convert the tube panel cells from 3% to 0.8% and test in gel? We primarily do that to run selected cells that are not already diluted to 0/8%

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Our Visions won't read our outpatient cancer center labels which have a blue border. If the label is crooked or the sample isn't positioned correctly, it won't read. Other than those, ours are pretty good at reading. More than 50% sounds like too many. Sorry you haven't been able to fix it. We run about 3000 specimens per month on our 2 Vision Maxes which were installed about 1 year ago.

We operate with the same workflow. It is up to the tech reviewing testing in Soft to expire the "old" specimen or cancel additional TS orders in Epic to prevent the collection of new specimens. If the provider orders RBC, it will fall into Soft under the existing TS and you will need to develop a workaround for that as well or will generate exceptions when trying to select products.

The problem with retesting the same sample is that you don't have a second sample drawn with a different venipuncture to confirm the patient's ABO and can potentially issue ABO incompatible blood no matter how the compatibility testing is performed.

1910.1030(g)(1)(i)(F) Containers of blood, blood components, or blood products that are labeled as to their contents and have been released for transfusion or other clinical use are exempted from the labeling requirements of paragraph (g). 1910.1030(g)(1)(i)(G) Individual containers of blood or other potentially infectious materials that are placed in a labeled container during storage, transport, shipment or disposal are exempted from the labeling requirement.

I had a unit come from the OR with LR attached. The filter and tubing was full of clotted RBC. This fit with my theory that adding calcium back into the unit didn't play nicely with the citrate anticoagulant.

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Our system uses Epic as HIS and rates are defined within the Transfuse orders. The documentation is in Epic where you can see the starting rate and any rate changes. We also have had TJC examine transfusion rates to ensure that nursing is following the ordered rates.

Correct me if I'm wrong but this version 4.0.0 update only applies to licensed manufacturers. It would apply if your Blood Bank lab is licensed and manufactures blood and blood products.

I went back to your original post and it clearly said "Trigger" for some posters. My lab only uses the microscope for FMH screening tests and rarely (like once in a blue moon) looking for mixed field during post-transfusion reaction investigations. I would consider it to be looking for Zebras, as Malcom said, to want to see rouleaux or a cold-reactive antibody by letting tubes "sit before looking under the microscope" (slightly adulterated version, my apologies). I didn't see any mention of "only for ABO discrepancies" or even "reverse type". I've seen cold reactive antibodies look like rouleaux and rouleaux that gave the same appearance as cold reactive antibodies. Some are helped to be clearer with saline replacement, some not. That's probably where I stopped looking at these things under a microscope. We predominantly test using automated gel method with tube usually being the "come to the rescue" method to not see just those things you were talking about. Do I saline replace or pre-warm the test components for those things? If I need to, but I try not to wake the sleeping beasts so I don't see them in the first place.

I'm still wondering why you want to look under the microscope and why you want to see cold-reactive antibodies and rouleaux. Are these things written into your SOP and following the manufacturer's instructions?