goodchild

Definitely. Pretend that release of PHI was of no significance and that it was possible to have an instantaneous interface with an interconnected web of hospitals. Other significant barriers to overcome: Duplicate medical records. In the US something around 8-12% of every medical record number in the master patient index is a duplicate. I'll try to scrounge up a reference.Different HIS/LIS systems.Different nomenclature.Different blood bank policies/procedures.Just to name a few off the top of my head. We use our state's HIE only for patients with known antibody history, sickle cell patients, blood type discrepancies, unique situations, etc.

This may be an odd question, but is 'Lord' still in use as a title in the UK?

Welcome to the community.

Our state has a well-developed Health Information Exchange. Approved users are able to look up hospital encounters, lab tests, physician documentation, etc for patients who haven't declined the transfer of their PHI, for anything that takes place within the state since 2012ish. I don't know how many states have something like this in place.

I've heard of it but haven't used it personally.

They still do! We had it performed recently with very interesting results.

Change management as in, document control?

I believe this is what he was referencing: Guidelines for Pneumatic Tube Delivery Systems: Validation and Use to Transport Blood Components http://marketplace.aabb.org/EbusPPROD/Default.aspx?TabID=55&ProductId=624

I remember reading an interesting section in Geoff Daniels' Human blood groups 3rd ed. about HLA antibodies. pg 513 "Antibodies to HLA antigens on red cells have generally been considered clinically benign, but there is now substantial evidence that such antibodies have been responsible for both immediate and delayed HTRs."

We've sent tens of thousands of units through our pneumatic tube system. We have numbered/designated, padded/insulated containers for blood products. To request blood be released from our department we have a paper form with patient identifiers and product needed. We use this to match the patient info to the crossmatch/assignment card and to the patient's info in the computer system. We document a few details relating to the blood issuance in the computer and on the form. We keep a copy of the form in the blood bank, send a copy with the blood product, and set a blood bank timer for 15". (I hear some newer tube systems have integrated delivery receipt/timers/whatnot - ours doesn't) The RN checks that the blood received is for their patient and shoot us the form/pneumatic tube back to us as confirmation of receipt. If the timer goes off before we get the form/tube back, we call and annoy them until they comply (and to confirm they receive the blood, of course). We only send blood to certain locations and only send red cells/ plasma. We don't send blood for a patient with any special transfusion requirement (e.g. antigen-negative, irradiated, etc.) anything that would be difficult, costly, or time consuming to replace. Good luck! There's plenty of info out there to help you validate the process.

Brenda, sounds a lot like what we do/see. I would recommend instead of a routine double spin, re-spinning it until the tube appears clean, which cleared up a lot of the 'unexpected' reactions for us. Depending on the cells/acid ratio and the length of time it takes to take off the supernatant, it can take a wide range of spins to get it clear. We only occasionally switch to tube eluates, if we're grasping at straws hoping to find an underlying antibody.

So well bound in vivo, inhibited in vitro? Very interesting, thanks for the articles.

Will you be retiring also from BBT?

For me the questions are Are these panagluttinins unexpected based on the patient's history?How recent were direct observation competency assessments performed on the technologists you're seeing this from most? [i mean no offense by this. Prior to 2011 we weren't following CLIA stringently and were rotating which analytes/processes were competency assessed. When we started doing every analyte/process, every year, by each element of competency assessment, we definitely found some issues.]What is your algorithm/policy to perform an eluate? e.g. elution performed with every positive DAT, certain DAT strengths, within a certain timeframe of transfusion, physician order.

Well, for one: reagent costs are usually on contracts and the terms of the contracts generally include not sharing details about prices.

We have supervisors for each section (still an opening in one department for a while now). Supervisors do participate in weekend rotations currently as bench techs but this is going to be phased out soonish (at least for core laboratory). We also have an evening shift supervisor. In the absence of a supervisor, there's a core laboratory charge tech who isn't compensated for additional duties and is generally a senior technologist. We have a bench-support on-call system but no formal on-call system for supervisory things, we're just available 24/7. I had to take a call last night while at a funeral home viewing. There's talk about getting compensated for electronic consultation. There's also talk of getting a night shift supervisor. Who knows. ~300 beds.

As fun as banging your head against a wall

We also test eluates in gel. We don't test pH but rely on technologist evaluation of 'blue.' We see the same problem occasionally (saw it within the last few weeks, training a brand new technologist). After adding the buffered solution, we give it a hard spin and transfer it to a clean tube. Then we do it again. And again. Essentially you keep respinning until no stroma/discoloration can be seen on the inside wall of the tube. That's worked out the best for us.

I apologize if I came off as rude? I had no intention, I was simply responding to my experience. There's a number of factors involved and it should definitely be researched if a large volume are bad. Regardless, manufacturer instructions indicate they need to be visually inspected prior to pipetting. Another one that we see rarely: if you're using Ortho gel system you might see an anti-E or anti-K that reacts in the antibody screen but not in the gel panel. Then if you switch to tube testing with PEG you can see a clear cut antibody. The manufacturer points out that Es and Ks can be missed with this test system.

If you're using gel cards, it could also be a gel card well problem. Enforce the visual inspection of each card before use and give people a rack to put the 'bad ones,' if they're uncomfortable of wasting reagents.

The phone call from security would be audible? As long as that was part of their alarm activation validations, it seems reasonable.

I only just realized how rude I must have come across, I didn't mean to be. I was kind of 'talking' my questions out loud. At our facility, if someone tried to completely redo QC sheets, it would have to be a collaborative effort of all of the techs involved. That would end up being at least four techs for weekly QC worksheets.

I'll have to have a look at that Excel spreadsheet. I'm filled with questions. It doesn't seem like it would fly with FDA because documentation wouldn't be indelible. Someone could go and change the spreadsheet later and there's no way of seeing an audit trail or anything like that. Things could also get overwritten accidentally and not realized at the time.

Same thing happened to us a number of years ago - we dropped AABB. Interestingly enough, our state regs regarding blood banks follow AABB standards, so we have to follow them anyhow.

We've been using it for quite a while, no weak/rough reactions come to mind..