mollyredone

Karrieb61, Is your blood center charging you for those antigen typings? If so, you can charge any patient that needs antigen negative blood for those antigens. We get a "historically negative" antigen database from our blood supplier, so we know which units to type, and it has really cut down on how many we have to screen, but we do have to screen them, and we do charge the first patient for whom they are screened.

We still do type and DAT on every newborn in our small (139 bed) hospital. We have bigger fish to fry in blood bank to fight that battle.

WOW! That program looks splendid...but I'm still going to Tahiti!

We are not AABB, just CAP and it says: TRM.40780 There is a system to identify all potential Rh immune globulin candidates. NOTE: Information about every pregnant woman's Rh type should be available when the possibility of alloimmunization and subsequent Rh disease of the newborn may occur. The INSTITUTION (my caps) must ensure that all Rh-negative women receive the manimum protection against Rh immunization. There's more but I think this sums it up. Since it is nursing and pharmacy who are involved, they have the policies.

Our pharmacy dispenses RHIG. We are not notified at all. The nurses/physicians notify pharmacy. So do the nurses in family birth or ER ask you if the patient needs RHIG, or do they just order it and you dispense it? If they just order it, they could order it from the pharmacy just as easily. We are not involved in the calculation of dose either, as we send out fetal Hgb F. So it is the physician's decision. Not very helpful, I know, but an informed letting everyone know what the process will be should work.

How long ago was that? It used to be that way, but the last billing talk I went to through the Red Cross stated that you could use probability to bill for the number of units screened. So you wouldn't expect to screen 10 to get 2 K-negative units, but you might screen 10 to get 2 little c or Jka-negative units. Is that the way everyone else understands it?

We don't keep any paper records on patients that don't have antibodies. Their results are put in the computer. The only charts we keep are patients with antibodies.

So you can rule out anti-E with a heterozygous cell in the presence of anti-c, just like you would anti-C and anti-E in the presence of anti-D? I haven't seen that on any lists, but I would love to be able to use it.

We only charge for the first typing, but I will be checking with billing compliance. We have antigen typing worksheets that I go through and charge for patients.

I keep deceased patient charts for 10 years then I toss them. I emailed CAP about this, to which they agreed, although they did say I should check with Risk Management to see if they had a different requirement. Of course, their antibody results are still in our computer

We do a moderate amount of emergency release, without tests being completed. That being said, it is the blood bank's responsibility to complete testing after the fact. I think goodchild was just looking for info on what type of forms different hospitals have to deal with different scenarios, to ensure the physician is aware of the particular risk involved. (goodchild-correct me if I'm wrong!)

I agree with Scott. A CAP inspector tried to cite us for not doing negative controls with our A,B antisera, but we showed the package insert and it is not required. It is required for Anti-D.

We also just use one certain tube to send blood. It is a different color than all the other ones we have. So if we don't get it back it's obvious and we keep the unit ready slip so we know where we sent it. At times I have gotten a request for a unit and had to call another location to ask for them to return the tube, but I think having our own tube that we keep in blood bank helps us keep track. Our tube system is not in blood bank, but I expect it may be with other hospitals.

We used the AABB guide to validation of pneumatic tubes for transporting blood. We send our tubes by "secure send" which means they have priority and are tracked. When they arrive at their destination, they don't drop down into the bay, but stay up and an alarm sounds. The alarm doesn't turn off until the four digit secure code is entered, then the tube drops down. Our system is a Translogic system. Our nurses request blood by tubing down the unit ready slip, so they are expecting to see the unit shortly.

Maybe you could record it and post it on Youtube for us less fortunates, although I'll be in Tahiti/Easter Island then, so I guess I shouldn't complain!

If air transport returned the used bags to the blood bank where the patient went, they could use a segment from the bag and get a specimen from the patient. I don't know how far away the hospitals are or if it would be feasible to transport a specimen to the issuing hospital. I agree that there should be an eventual crossmatch, if only for root cause analysis if there is a problem.

Auntie D, these patients were on cards before the computer was used and I was double checking the information to see if it was right. We haven't actually seen this patient for 15 years! I just wanted to make sure the reporting convention was interpreted correctly in the computer since it was handwritten.

Carolyn, It looks like they have changed it. I do put in the birthdate and social security number if I have it. I'll have to play with it to see if I can come up with a system that works. Mari

That was what I understood as well. That is why I was confused to see a c (C?) with a line under it. Does anyone do that for a big C?

How do you indicate a little c or little s when you are handwriting antibodies? I have seen it written with a line above the letter. But I was going through some of our old records today and noticed a c with a line below it. Would you think it stands for big c? This also comes up when I am handwriting our antibody cards for patients, so I would appreciate some guidance and where to find the proper protocol. Thanks, Mari

Social Security numbers are usually found in our patient demographic section, along with address, phone, religion, etc. If they are not in the system, I sometimes will access the SS death index http://search.ancestry.com/search/db.aspx?dbid=3693&cj=1&netid=cj&o_xid=0000584978&o_lid=0000584978&o_sch=Affiliate+External and I look for the patient to have died in our county in Oregon. It probably wouldn't be as easy to do in a large metropolitan area, but people tend to not move around as much in our area. But I never delete based on someone with the same name who has died in Florida, for example.

I have used Social Security Death Index to determine if people are deceased and then keep the paper records for 10 years after that (that's what CAP indicated should be done) We only keep paper records for antibody patients. I also check the obituaries daily because otherwise our antibody shelves would get overloaded.

Our OB department insists on glass red top tubes for cord bloods for normal delivery because they sterilize them in a pack. A C-section cord blood is sent down in a pink top EDTA. They are not sterilized. We do them manually, but I have had no luck getting them to switch to all EDTA.

As far as our pathologist involvement, we don't call them for regular emergency release, unless we are running low on O Neg and might need to switch. They are also not usually contacted about high risk either, unless the doctor insists, or the tech has an incompatible crossmatch. Usually they want blood for the patient before we have gotten a crossmatch done if there is an antibody involved.

Just got the new lot, 48833 of Immucor's FMH kit and the positive control is better, so that's good!