goodchild

There's also something to be said about Generally Accepted Practice/Performance Standards for a particular industry, from a healthcare quality/risk perspective.

To me, this really sounds like something was "lost in translation" between department/disciplines before the communication reached your friend.

We go with 4 hours from the time they spike the bag.

That was beautifully random and much appreciated on a Monday morning.

If your hospital is using "Temporary Locations" it will populate the temporary location (e.g., Dialysis, OR1). You can have your IS team design "customer defined screens" with fields in the issuing units screen that could cover things like cooler IDs/etc.

I remember continuously calculating the remaining seconds until graduation while I was in army basic training (did the same thing in sergeant's school). The drill sergeants thought it was hilarious and would call on me randomly to sound off the countdown while we were in formation or in line for "chow." Congrats Dave.

Carolyn, do you want it to warn if you have an A Pos patient being crossmatched O Pos units? Tell me the specific and I can help you build an assign/issue rule. Do you have Magic or C/S?

I love your flowsheets designed to make things easier for generalists. Please share more!

I completely agree. I have no intention of switching to 2-cell screen, but these sorts of discussions always give me pause. We identify so many antibodies in patients who are transfused, where the reactions are only identifiable on cells with homozygous expression. I am also a fan of free rule out cells on the screen itself.

Terri, who collects blood in the ED?

To bounce off what you're saying, I don't think I've seen any studies that looked at an increased rate of "informative eluates" based on changes in the DAT strength since last testing.

We perform a screen. Why would you give RhIg if the patient is already immunized to D? Or if they were recently administered RhIg? We don't issue the RhIg either, it's in pharmacy.

We notify ED/OR/Oncology by phone when blood is made ready. We expect every other department to use their nursing status board, which has an indicator for blood being ready. When a nurse wants blood they send a request slip through the pneumatic tube system (or in person). We print the labels after the blood is crossmatched/assigned. We also have two orders set up in Meditech. The order for blood bank to set up the blood and the order for the nurse to transfuse it.

We switched to labels this year, from a 2-part continuous feed paper form. Love it.

I just remembered what else I saw at that hospital! (I was racking my brain yesterday trying to coax out the memory.) They also did autocontrols with every antibody screen and were using albumin as their routine enhancement medium.

Are these materials that are often taken out of the fridge and left at room temperature for lengths of time for testing purposes? I would focus my corrective action on why it took two hours to discover.

Way more than you'd think Scott. There's plenty of resistance to change in our industry. I inspected a transfusion service where the entire hospital was on EMR, the laboratory had an LIS, but the blood bank supervisor had won their case to keep blood bank computer-less. They also did all IAT crossmatches. Interestingly enough, most of the techs weren't even aware that you could opt for IS crossmatches, leading me to believe that most other hospitals in that region were doing something similar.

Would be interested to see some of these findings published.

My impression is Ortho used the "periodically" term as a CYA. I think it's sufficiently vague to be defensible by Ortho when there are problems with the reagent: "well, did you do your periodic QC?" and also vague enough that people like me can completely disregard it without being out of compliance, technically: "I define periodically as the 7th of never, unless inconsistencies are noted."

I think I'm with you exlimey. We don't do any QC with our Ortho gel panels, other than review every antibody ID within one business day and monitor for trends.

That might happen depending on what antigens we're talking about and the strength of the patient's antibody, but generally no.

We'll hopefully be getting our Erytra within a month!

We avoided this issue by never creating a comment/marker.

I'm surprised that I haven't seen that flowchart before. I'm impressed with how comprehensive and simple it is, at the same time.

That was my exact reaction when I saw them. Thanks for the quick reply!