goodchild

I feel like I was just struck by a blinding flash of the obvious with a little dash of "we've always done it that way." When we do an elution, we perform an antibody screen with the eluate and the last wash, and an antibody ID panel for positives (or selected cells in rare cases when a lower incidence antibody is considered). 86860 is to cover the process that makes the elution; are we completely failing to charge for the additional antibody screen and antibody ID?

Don't you have any of the reagents where the inserts include "use of an optical aid" as acceptable or recommended? Any time I've broached the topic of microscopic reading and its controversy this is brought up.

Our procedure is for micro to do it, but they end up calling me upstairs to help them every time because it's such a rare thing.

Resurrecting an old thread. We've been extending Type and Screens for patients who come in through preadmission testing up to 7 days in advance of their day of surgey for a number of years. We have a new chairperson for Anesthesia and they've requested we extend up to 14 days. I would like to accomodate their request but I have a list of logistic/IS issues that will need to be tackled (on top of my already intimidating action item list). My primary question for the community is how do you handle the specimens? Right now we have an 'archive rack' database system. Every day we fill one to three racks (72 tube slots). After testing is complete the tube gets added to a completed specimens rack. At least once per shift, or as needed, tubes in the completed specimens rack are scanned into an archive rack for that day and stored in the fridge. Once the racks reach their 15th day, the tubes get chucked. Our initial thought is to simply extend our racks out another week. But what about antibody patients? How good are 14 day old specimens for AHG XMs? Do you ask for a new specimen closer to or on day of surgery for crossmatching? What does everyone else do? I need to do some more reading.

That was essentially my take. "Ask AABB for best practice" and the best practice is to follow manufacturer's recommendations, which says nothing about testing each vial every day of use. I'm glad our laboratory accreditation isn't through TJC for that standard alone. People complain about QC documentation for CAP, I can't even imagine the world people like Cliff live in for reagent management. On the other hand, you are probably very good at inventory management because of the extra work.

Interestingly enough, I was at a conference recently where forum threads from Bloodbanktalk were used as source material and included as part of the lecture.

Cliff thank you for asking and posting.

I'm sorry this isn't answering your question, I'm really just curious. Your LIS has result fields for individual panel cells? How do you document selected cell panels?

Semantics are very important. May is optional. Should is equivocal. Must is a requirement. I'm still trying to weed through several old procedures that have inappropriate uses of 'may'/'should' when they're really 'must'.

I would argue the semantics of antibody detection (screening cells) vs antibody identification (panels). CLIA says something along the lines of, you don't have to do panel QC but follow manufacturer's instructions.

I'm not sure how you're using them at your institution, but I would point the TJC assessor in the direction of the CLIA interpretive guidelines, recently updated (effective January 9, 2015): §493.1271 Standard: Immunohematology (a) Patient testing. (a)(1) The laboratory must perform ABO grouping, D (Rho) typing, unexpected antibody detection, antibody identification, and compatibility testing by following the manufacturer’s instructions, if provided, and as applicable, 21 CFR 606.151(a) through (e). When in-date reagents are unavailable, it may become necessary to frame written policies for their temporary use beyond their expiration dates until non-expired supplies become available. Under no circumstances, however, should a laboratory adopt policies that would allow for the regular use of expired reagents.

We should really just get someone under each accreditation agency to get their standards interp. group to interpret this one for us and post it. It crops up on these forums so often.

By your own logic why do you need the form then? Can't the electronic record have a field for who takes responsibility?

If your computer system captures and retains all the information you would need, why would you need a form?

Thank you for the form Terri and the narrative MERRY. No one else is willing or able to share? C'mon!

The article I posted references <2+ for tube and <3+ for column agglutination technique. I'm sure there have to be similar studies for Echo/solid phase. I vaguely recall reading one from the Canadian blood services. If I can find it I'll post a link.

I completely agree.

I'll also confirm no unexpected positive reactions in cell 9.

I'm kind of right there with you. There's compelling arguments for the moneysavings for healthcare as a whole and there's definitely benefit for those annoying circumstances where between different visits or between other hospitals/laboratories there are discrepant RH results and the physicians immediately assume that our results are "bad." I actually wrote a process document that matches what the NY Blood Center recommends for my institution. The medical directors of transfusion services and maternal/child health both approved, but we're still not live while we get the charges established, figure out exactly how this will work in the IS-world, and how to make this as user-friendly to the bench-staff as possible.

http://www.ncbi.nlm.nih.gov/pubmed/18067505 Here's one recent study.

Resurrecting this thread. I would love to see Emergency Release process/procedure documents from anyone who is willing to share. Definitely still curious how everyone else handles the unique situations; such as when the antibody identification is incomplete or if the patient has multiple antibodies (or an antibody to a high prevalence antigen) and uncrossmatched/incompatible-crossmatched blood is requested. Also curious in general how people handle trauma situations. What level of detail your institution's process/procedure goes into. Is your policy more rigorous to ensure traceability or more liberal for providing large volumes of blood for the patient. Do you issue an emergency release form for the physician to sign for each unit? Do you have a single form that lists all the blood products? Do you have a single form that simply approves emergency release blood for a particular time period? Do you use electronic orders instead of/in addition to forms and what kind of information is inside the electronic order? Stuff like that. Molly you were basically right. I'm just kind of curious how other institutions handle some of these equivocal scenarios. There's such a wide range of variability between blood banks so it's an interesting topic to examine. I was recently talking with someone from another institution out of state where the blood bank delivers the blood during a massive hemorrhage scenario (despite the fact that the blood bank has only one technologist on duty during most shifts) and that blew my mind. I'd also love to see some forms.

Here's one of several previous discussions on this topic: http://www.pathlabtalk.com/forum/index.php?/topic/7409-rh-interpretation-policy-at-your-institution/?hl=interpretation

Godspeed Dr. Pepper. Do you have an electronic continuous temperature monitoring system or device specific alarms only?

What cells are you seeing unexpected reactions on?

I think what galvania is trying to say is how would you know? So you'd issue the blood.