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DebbieL

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DebbieL last won the day on June 22 2017

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About DebbieL

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  • Birthday 08/30/1955

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  1. DebbieL

    TRM.30700

    You do not need to register with the FDA if you are just pooling, thawing, changing FFP to Thawed Plasma or splitting units like for pediatric use. The end product is basically the same as the beginning product. However, if you take a product and make a new product then you would need to register with FDA. An example would be combining RBC with FFP to make whole blood for an exchange transfusion. The end product is different from the starting product. I found a good explanation for this on the AABB site. 2012 ASK THE FDA and CLIA Transcript question #29. You can access and print these transcripts even if you are not a member of AABB. Hard to find on the site but persist. A CAP inspector once told me I had to register with FDA because we used Thawed Plasma. He had a VERY superior attitude that he knew ALL things BB and his mission was to impart his wisdom to someone so inferior to him. I knew he was totally wrong but I wasn't going to call him out during an inspection. I'm dumb but not stupid. LOL
  2. DebbieL

    Antigen Typing Alternate Proficiency

    We use the J series for antigen typing. The way I read it, the J series includes antigen typing and it is an CAP approved PT since they make it. They probably would like us to order the RCBCAT since all their PT are pricey but I think "J" meets the letter of the standard. We will be inspected in the sprig, I will see if I get called out on this.
  3. DebbieL

    proper use of PPE in the lab

    Remember, you have to follow it to a "T" if stringent rules are written in a policy. You can be dinged for not following your policy. I would be a bit vague when writing the policy with a lot of wiggle room: wash hands after removing gloves or when leaving area, no lab coats outside of lab area, no eating or drinking or applying makeup, etc. All of our area is considered dirty, including phones, community pens, benches, door knobs and refrigerator handles. We couldn't swing a clean area and a dirty area here since everything is in one room with phones and computers scattered around. All it takes is one person with gloves answering a "clean" phone on a busy day to mess up everything. I agree with Ensis01, if it is too hard, your techs won't adhere to the policy and an inspector would notice. PPE is available to protect the tech and is readily available for them. If someone wants to be absolutely safe they should wear gloves all day no matter what they are doing and consider everything dirty. (I never thought of putting tape on paper with blood spots- good idea)
  4. DebbieL

    Group A plasma for traumas

    I am on the trauma committee where I brought up the idea of using A plasma instead of AB several years ago. The head Trauma physician was there and thought it was a great idea. He just wants plasma when he needs it. I approached our Medical Lab Director and had to provide him with documentation I found from Mayo so he felt better about it. Unfortunately, my pathologist limits us to only 2 until we have a confirmed blood type. I pushed for 4 but couldn't change his mind. I wrote up my policies and was done with it. I did not bring this up to nursing We keep 2 A thawed at all times. We rotate it by sending thawed plasma to surgery when they need it and thaw out more. We discard very little except around holidays when there is not much surgery. It works for us.
  5. I just answered this question. My Score PASS  
  6. DebbieL

    Extending specimens past 3 days

    We have a process to extend the crossmatch that has worked for several years. It is complicated and involves 3 departments. Everything has to be exactly right. The patient comes in to pre-test. We have a form that is put with the pretest packet. On the top part of the form is the patients info along with today's date and expected date of surgery. The nurse asks the patient two questions- have you been pregnant or transfused in the last 3 months? The nurse signs her credentials and sends the form to us along with the specimen. We perform a T/S and write our info into a section for the BB. There is a spot on the form that we put whether we need a second type on the morning of surgery. We put a sticker on top of the tube to signify the tube has to be saved when specimens are thrown away. Two days before surgery, the night shift faxes the form to surgery holding so they can put the forms in the charts. The morning of surgery, the nurse scans the form to see if they need to collect the second specimen and they ask the patient if they have been pregnant or transfused since pretest. Nurse signs form and faxes to us and sends the 2nd specimen if required. We get the form, do the second ABORH, find the original specimen, look at form for all signatures, etc. If all the stars are alligned, we order a specific test in the computer which extends the crossmatch for 3 days, answer the specific things in the computer and perform an electronic crossmatch if the physician wanted blood set up. If the patient had an antibody, we request a new specimen on the morning of surgery to do a new T/S and crossmatch the units we antigen typed before the patient arrived. Works great. Most are only T/S done 3-5 days before surgery with the occasional cancelled surgery that tries to get in at the end of the month. We tried to do 14 days but extended to a month (30/31 days hard stop) because the physicians kept pushing the envelope. We did 30/31 days because it is easy to see if the surgery was canceled for too long. If there is any question about ANYTHING, a new specimen is collected and we start over. It works well for us and we have had very few problems after the nurses realized it helped them
  7. DebbieL

    high or increased risk form

    We have one form- Emergency/Medical Release form. Top portion is Emergency release with one of 2 parts we check- Emergency O uncrossmatched or Emergency type specific uncrossmatched. An emergency situation exists and transfusion prior to completion of testing is necessary due to life threatening conditions. I have been informed and understand the risks blah, blah blah. The lower portion is the medical release with things we check, AB of undetermined, compatible units available, AB of undetermined- unable to find compatible, Rh positive product to Rh negative female of childbearing age, Blood Consent signature unattainable, Other. I am aware of problems encountered during compatibility testing. The medical status of this patient necessitates blah blah blah. I have been informed and understand the risks involved blah, blah, blah. Physician signs at the bottom. Our policy states that we do not have to have the signature prior to either of these conditions. If it is an emergency, we will get the signature when the crisis is over. If it is medical, we call the physician and tell them the issue and tell them they must sign the form. We will allow them to sign the next morning. If they don't sign I sic the HIM department after them when the patient is discharged. The physicians get in trouble here if they don't sign their orders. If it is something that is really out of the ordinary, I have my pathologist talk to the physician.
  8. Sorry for the delay in replying. I am not receiving this newsletter in my email anymore for some reason. Yes we use Cerner. I don't think the baby and mom are linked. If they are, the lab can't see it on our side. We used to put the cord blood workup under the mom's number. That changed when the EMR came along to foul things up. Now the baby is ordered under their own medical record number. We have L/D wrap a mom's chart label sideways on the top of the cord blood and the baby label is placed up and down in the normal way. That way we have the mom's name and number when we are putting in the baby results. We look up the mom to make sure we have a current blood type. If current, we type the mom's type into the results. If it is not current, we get a new specimen. Blood Bank history is not always reliable. Unfortunately, the computer doesn't compare the baby type to the mom type, we have to do that. Talking about the history is not always reliable..... a patient came in to have a baby. The blood type didn't match the history. Had her collected again. It still didn't match her history. Started digging in the computer. Turns out, she had a baby 3 months earlier. (???) Called L/D to see if this was some type of weird OB case. No, it turns out the one that gave birth 3 months earlier had a Medicaid card and it worked so well when she gave birth that she loaned it to her friend. Just a little bit of fraud. Go figure. Never rely on computer history
  9. DebbieL

    Electronic Quality Control

    Our previous computer system allowed us to put in the antigen typing QC when testing patients and donor units. It was horribly cumbersome. Our rule here is that we only do QC on antisera once in a 24 hour period, starting at midnight. We could never tell if QC had been done by an earlier shift on a particular antisera so we would do it again. My boss finally relented and went back to paper forms due to cost savings and we also saved tech time and frustration by using a paper form. Are you using a shared excel sheet that all techs use to enter QC? If I was inspecting, I would want to know how you could protect the info already entered, e.g. could someone change the entered information whether intentionally or by accident. In order for things to be added daily, you would need to prove that previously entered info is secure. If it is not secure, how would you know if something was changed on a excel sheet? Could you see a print out of the changes and who made them? I have had files disappear. Yes, our stuff is backed up but you have to tell the IT people when you thought it was deleted so they can look thru the dumped files of the whole system. I have lost files myself by moving them accidently to another file. I freaked out for a period of time. How would you document review within 30 days? You would need to add your electronic signature and date and it couldn't be changed or altered. If there is something wonderful out there, I am interested. Otherwise I will stick with the old fashioned paper forms. They don't take up much room in a file and I don't have to worry about them disappearing into nothing. I think I'll let the next supervisor do something wonderful when I'm gone. There are just too many questions surrounding electronic QC. (I sound like an old fuddy duddy. LOL)
  10. DebbieL

    Disinfecting Blood Bank Coolers

    We just use regular clear tape like you would use to seal a box. About 3 inches wide. I do admit the tape starts peeling up after a year or two, so she could have a valid point. I have typed up instructions for the outside and "laminated" with the tape. A lot of good it does since they don't seem to read what is in front of them. A different lady in Quality suggested we use the sticky pouches so we could put the patient name on the outside. I don't see the difference between a sticky pouch and sticky tape but whatever. I think I will redo all the coolers with new tape and see if I can get it past the next infection control person. We have had several in the last few years. One concentrated on corrugated boxes and upended the entire hospital.
  11. DebbieL

    childbearing age

    We use 55. My CMO and pathologist declared that was the outer possible limits. I wanted 50 but was overruled.
  12. DebbieL

    childbearing age

    We use 55. My CMO and pathologist declared that was the outer possible limits. I wanted 50 but was overruled.
  13. DebbieL

    Disinfecting Blood Bank Coolers

    Our interim infection control person said TJC was cracking down on coolers. She liked that I had validation of temps but no proof of cleaning. She said I had to get rid of the tape on the outside because they couldn't be cleaned properly. She went all thru the hospital leaving havoc in her trail and then left. The coolers are taken into surgery but not into the sterile field. They leave them close to the door and only get into them if blood is needed. We have only cleaned if we thought they looked dirty which is not often since they are not close to the bloody patient. I agree with Exlimey. Even if we sanitize the cooler inside and out, multiple people touch the outside as it is passed from hand to hand. They won't be clean because we don't wash our hands before we touch the cooler with the gloves we are wearing while we are crossmatching. The blood bags themselves are not sterile, they have been thru multiple hands before they ever reached the hospital. The blood bags actually do make it close to the sterile field. They pose more of a threat to the patient than a cooler in the corner. Now if surgery tells us a patient had a particular bad something, I would clean to knock down the cooties.
  14. DebbieL

    Disinfecting Blood Bank Coolers

    Do you document that the cooler was cleaned or is that something you automatically do? Trying to keep up with cleaning documentation of multiple coolers sounds like a nightmare. Our coolers sometimes go out several times a day. We have never consistently cleaned our coolers. Sounds awful doesn't it We currently have tape on the outside of our coolers and were told by Quality that it has to go. The thought of a "naked" cooler going to surgery scares me. I have thought of using one time use disposable paper tags that we could put a patient label on and attach to the handle so it would at least have the patient name on the outside. How do others make sure the correct cooler gets to the correct patient? How do others document cleaning after use?
  15. CSWICKARD- Thanks for the reply. You calmed me down a bit. I feel like I have my reagents under control. I just didn't want to be blindsided by a random inspector or TJC. Well I wouldn't be blindsided because I have documentation of everything. It just feels like all the rules multiply and become overwhelming.
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