lalamb
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Posts posted by lalamb
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We are also manual. We write so much we run pens out of ink! Logs, forms and paper everywhere. We are working to go live on Cerner Millenium in May 2011. Can't happen fast enough.
WE have been live on Cerner Millenium for about 2 years. We were on Mysis - yuck phth @@#%$^*(^^. Course the move to Cerner was so new to me I had a miney break down. Having said that, now I'm pretty swift w/it. The key to success is to put stuff in , 1 step at a time, in the proper order. !!!
It has a really nice BB pt history file - shows past comments, Ag typing, ab hx, transfused and crossed compnonets. Our sister hospital is also on the system (our patients often go to both places) so we can see their testing.
We still keep all of our old logs/forms for computer down time..cuz downtime for a 2 hour upgrade often translates to 6 hour or 2 days of unexpected computer glitches...That's when I realllly miss paper system.
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The only problem with that (much as I admire your thinking; and I do) is that you are not testing like with like.
The grouping reagent you are using on your out-dated red cells is going to be very strong and specific, whereas your sample plasma may well have a very weak, "polyspecific" antibody.
In the example you quote, it might be better to use an old, stored example of anti-K from another patient.
:confused::confused:We are a small hospital and don't freeze old positive samples (often there is nothng left). I'm pretty sure we got the idea of qc'ing old panel cells w/ag typing sera from our former and current BB ref labs. I will check with them next week.
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Ok, so here's my question: when doing rule-outs, where I work, we have a pile of gel and tube panel cell sets that we use for this purpose, most of which are past their outdates. They still "work", as in, the reactions will still show up, but that's always not made a lot of sense to me--what's the purpose of having an outdate on reagents if they're to be used beyond the expiration? I know you can't always rule out everything on the first shot, with an in-date panel, so what does everyone else here do? I always thought that using outdated reagents was a no-no with CAP, AABB and other regulatory agencies, in any section of the lab? Thoughts?
We do use outdated panels to help w/rule outs. When we Ag type the patient for what we've ID'ed (or can't ID), we also test the outdated cells w/the typing antisera in question.
ie If I was trying to r/o K and found a K homozygous cell on an outdated panel, I would test those cells, along w/my patient, and an appropriate pos and neg screening cell. If my outdated cell still had a strong rxn, I would feel comfortalbe in using it.
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Do other hospital require "ordering physician" signatures on your informed consent for blood products,ect...?
As a result of our inspection a year ago, nursing now has to bring down the signed (by pt and dr) consent form, along w/ a hospital sticker, that has the pt's name, med rec number and DOB. Before, it was only the sticker.
So now, nursing puts the sticker on the consent form, it stays in the chart, and they bring it down for every unit. The signed form is considered good for the "admitted event". If the patient is discharged and comes back 2 days later, there is a new form and a new billing # and a new sticker.
We (lab) have refused to issue blood if the RN didn't bring it down. We apologize profuseley and send them back to floor to get it, or to track down a Dr to sign it! (Exceptions are ER, OR and emergencies). It's more of a habit now for the RN;s so we aren't dealing w/refuseles so much.
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I would never just do a front type for any reason. Front and reverse go together kind of like peas and carrots.
As far as ordering tests that the physician didn't order, we have a list of reflex tests (things that our Medical Director has agreed are necessary). The Medical Staff (Med Executive Committee) agree on the list, and then we are covered. For example anyone getting blood products gets a type and screen because we've been caught too many times with just doing the ABO/Rh and getting in trouble when the screaming starts when blood isn't ready.
Thanks , that's a good idea - I'll ask my pathologist and medical staff to OK doing a type and hold on all patients getting blood and FFP. We use to stock only AB FFP so banding the pt wasn't an issue. Now we stock A,B O, and AB. so we had to come up w/a new plan.
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Our current policy is to aliquote off the plasma from a banded specimen into a pour- off tube,( that is properly labeled, per our policy).
As we have recently switched from serum to 10ml EDTA plasma tubes, is aliquoting still necessary?
Found no reference/requirement for this in AABB, I called AABB and they said there is no regulation for this and that~ 1/2 of hospital do aliquote off and 1/2 don't.
The rgt manufacturer (Immucor) insert talks about "run as soon as possible, ..several days...prolonged periods". Those time intervals are not defined. They suggested, if I don't want to pour off the plasma, I do validation studies to see how long rxn's are still good over a period of time. Don't really want to go there...
Any thoughts / concrete evidnce / reasons for choosing one way or the other?
We do tube method w/PEG. thanks lal
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We band patients for FFP. The lab orders an ABORh. (If it's a STAT we give AB FFP untill a banded specimen is collected, then type the pt and give type compatible). If the FFP order turns in to a crossmatch, we add the orders for antibody screen and crossmatch to that originally banded tube. The patient still has that armband on, so we don't need to redraw the patient.
It's cumbersome- we have to be really vigilent to make sure a xm isn't done on a FFP patient w/out an antibody screen
I would prefer to just do an aborh and absc and have it done, but then we're doing tests the Dr didn't order...
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Our cords are usually less than 10 hours old, depending on when OB sends them to the lab. Ave is ?6-8 hours old
We have no time/ age specification
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Our cord bloods come to the lab labeled w/ mom's name and type, gender, date and time of delivery and Dr's name. OB orders an ABO/DAT panel for the baby.
We check the mom's type in the LIS (sometimes the clinincs send over records that don't match our record for aborh) and work up the cords, if warrented. Any testing not warrented is canceled as "Test Contraindicated"
All cords (babies) have a note put in their BB history file which states the mom's 1st name, her med red #, and the mom's type.ie Mom (Jane 123456) is A pos. This is entered for all cords, whether they are worked up or not.
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Dade Model 569 - they are considered by some to be antiques. I've used them since forever. They are dependable, very easy to repair (parts are available from sources other than the mfg.), the head rides pretty high so you don't have to reach down into the centrifuge to retrieve tubes, ( that's my beef with the Helmer that is in storage), and if you are doing any manual washing the head comes out and you can decant all the tubes at once.
Wejust bought a Helmer Ultra CW as our Sorvall Cellwasher 2 are problematic. I love the soevalls but we bought a reconditioned one and it's been in biomed too often.
Helmer good points: saline can be below on the floor so no lifting, there is a beep when the washing or spining phase is done, and I'm told the saline is warmed to ?help diminish cold ab's? (I just found out about this feature. Supervisor likes this feature, I'm not sure it's proper). Biomed likes it as it's easy to reach all places to clean and repair.
Helmer bad points: You do have to reach down to get the tubes, which no one likes. If you're not careful you can bang the tubes. There are multiple wash programs available (we wash cells 2x and wash 4x for coombs), but only 1 program for spining. If we need a 60 sec spin (for manual washing or for spining down plasma) we use the old Sorvall as a centrifuge.
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Our step by step is essentially the same. We used to do prewarm automatically when all 3 screening cells were weak/sticky, but our ref lab always warned against junping into a warm techneique, cuz significant ab's could be missed.
We don't have prerequisite conditions before prewarming can be done. I like the ones in your P&P and will see about adding them. thanks
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I thought an O neg person coulf get O pos units just once in their life, then they develope anti -D.
So how would one know if your emergency guy had anti-D from a prior emergency transfusion?
We give O neg 1st, then work up the blood, giving type specific/compatible.
We have had a few massive bleeds where the pathologist had made the decision if and when to give O pos, so we don't deplet our inventory. One was a woman of child bearing age, but was in bad shape. We got the go ahead to give O pos, but it wasn't needed.
:confused:
for issueing platelets -should we type the pt?
in Transfusion Services
Posted
I thought typing a pt was unneccessary for issuing platelets?, yet I have seen some people post that they do.