blarney

Brenda, We also see this problem sporadically, and we check the following things: make sure there are no plasma splashes on the white diffuser plate, dust particles on the outside of the card, any hazy looking areas in gel which could be rouleaux. Also, one of the latest mods that has been added to the Provue is enhanced reading of the ABD/Rev cards to pick up any possible subgroups or reverse discrepancies. The techs just review the card manually and approve. If anything looks suspicious, we just repeat in tube. Sometimes it is a matter of asking for a camera ajustment - ask your FSE to show you how to check in the software in the image files if the cards are being read at an angle.

We are also a network of 7 hospitals in the St. Louis area and we are in the process of standardizing all of the SOP's and forms. We have created a document control site on our network - a sharepoint site, controlled by an admin. It controls all documents in and out with complete tracking, pathologists can check a doc out, review and sign-off. It also sends reminders when SOP's need review. So far, it is working nicely for us and we checked it out with CAP and it was OK with them as far as compliance with doc control regulations.

Hi tbostock, We have EPIC as our EMR, HCLL as our BIS and HBOC as our current LIS. We are to go live on Epic Lab (Beaker) next Oct/Nov 2012. Are you on Epic lab? and if so, what were your implementation issues, problems with the HCLL/Beaker interface???

Has anyone worked out the cost comparison between using the MTS antigen typing cards vs. using buffer gel card with separate reagent antisera and controls vs. doing antigen typing in tube with reagent antisera and cells.

We frequently experience that internal power cord getting caught up inside when the techs shut the door. We have Biomed come up and open the unit to free the cord, but it has not been damaged enough yet that we need to replace it. We did however manage to break the door latch. The bad part was that Biomed had to break another part to get the door open, so now we have to replace two parts! Apparently it is not easy to get to the internal parts of the MTS centrifuge. We are part of a multisystem of hospitals, so we have an extra centrfuge we share just in case someone is down.

We currently use Saf-T-Vue 6 temperature monitoring devices on all packed cells which go into validated coolers to be transported to the ED during a trauma or massive transfusion. We apply the devices on two O-Neg and 2 O-Pos stored units (for a regular trauma), but activate them when the unit is issued. The devices can remain on the unit indefinitely as long as the indicator is white, but if the indicator turns red at any time, then the unit must be discarded. For those of you who have a Massive Transfusion Protocol, do you apply temperature monitoring devices on all of the packed cells going out in coolers? At times, when we get a bad MT, we may be issuing packages containing 6 red cells, 6 FFP and 1 plt so fast that sometimes the techs do not get the stickers on the red cell units in time. I am trying to avoid placing devices on all the Oneg and many of the Opos units ahead of time, which would mean buying many boxes of Saf-T-Vue stickers. How have you dealt with this issue during a Massive Transfusion?

We did extensively validate buffer card IS XM when we went live with the Provue 4 years ago. We also do a method to method correlation between manual tube, manual gel and Provue for all crossmatch methods as well as type and screen and DAT to satisfy TRM.31450.

Thank you BLipkin for your great response. I agree with your point about tube crossmatching, but we have 24+ generalists rotating through the blood bank and patient safety and consistency using the Provue has been a big satisfier for us. Although we still do use tube xm for super stats and traumas.

One of my blood bank peers emailed me today about the following scenario: Ortho does not have a claim on doing Immediate Spin crossmatches in the Buffer Gel Card and therefore does not meet the FDA standard of potency. When I looked at the package insert for MTS Buffered Gel Card it does state on the front 'No FDA Standard of Potency'. Supposedly some hospital up north just got cited for that during a Cap Inspection. Have you heard about this and do you run immediate spin crossmatches on your ProVue or even manually in the Buffered Gel Card? Does anyone run immediate spin crossmatches in a buffer gel card on the Provue or manually? Is this then considered off-label use? What if you have validated the buffer gel card using suitable pos and neg controls?

We just started keeping one AB plasma thawed at all times, good for 5 days for our hemorrhagic stroke patients who have intrancranial bleeds. We are a stroke center of excellence in our network of hospitals and the neurosurgeons insist on getting FFP on board to these patients super fast as they will not operate on them if their INR is not below 1.3. We found that being able to release the thawed product immediately provided better patient care and allowed the surgeons to evaluate them quickly as time is of the essence with a stroke. We also use this AB plasma for MTP and/or traumas since we are a level II trauma center. We have wasted only 4 AB FFP since January, so at this time, the benefit of getting the plasma out the door to the patient immediately outweighs the cost of the wastage. An added benefit is that we can thaw the plasma, modify it to a 5 day plasma and label verify it in HCLL. We can then give it out with an emergency release if the patient ID is unknown/no specimen or we can just allocate it to the patient, tag the unit and issue it within 5 minutes of the order.

When I asked CAP about checking the audit trail in the computer, they said that it did not fulfill both requirements for EOC. They insisted that there was separate documentation that a tech had physically verified/checked patient history. It just seems that this is asking us to take a step back, when most hospitals are going paperless and are implementing electronic medical record systems.

I checked with our blood supplier since we are not billed for the products until they are transfused. They wanted us to monitor the temp every 4 hours for two weeks as that is the standard procedure they follow for new equipment at the blood center.

We have not experienced problems with hemolysis in the 0.8% reagent red cells. We do see a fair amount of a fuzzy, light pinkish haze due to rouleaux, which we confirm by tube testing and saline replacement.

The current edition of the Technical Manual (16th ed) has an appendix 1-3 in Chapter 1 on Statistical Tables used to determine adequate sample size and level of confidence for validation pass/fail. I found this very useful in dealing with the new CAP checklist question regarding method to method correlation. Hopes this helps you out!

How are you documenting the historical record check when a sample arrives in your blood bank? EOC required includes "records of historical checks". We are using HCLL, and the system functionality allows us "to compare ABO,Rh and antibody screen results against previous results to detect discrepancies and identify patients requiring special units". When I called CAP about this regulation, and even explained the safeguards and features of HCLL they said they require documentation that someone physically viewed the required information. They suggested we add a patient comment that a history check was completed for each new sample received. This really appears to be duplication of work, but is there any other choice?