mollyredone

Immucor does that.  They underline anything that has changed and use a closed triangle for anything deleted.  I've attached a copy of one from 2010.  What bugs me we get a new insert in 2016, and it was changed in 2013!  Where has it been all this time??changes.pdf

We also compare DATs since we perform them in gel (newborn) and tube (hemolytic anemia)

My Helmer Quick Thaw manual says you can use tap, distilled or deionized water and gives the advantages and disadvantages for each.  We have used deionized water for years.  The disadvantage in the manual states that it can cause pitting but we haven't had that problem.  We drain weekly and add CleanBath.

We don't have bags returned to us.  We take off 2 segments when we retype the units and save for a month, 1 week in each bag.  It's easy to find by when it was retyped in the computer and there are only four small bags to check for the correct date.

We don't have bags returned to us.  We take off 2 segments when we retype the units and save for a month, 1 week in each bag.  It's easy to find by when it was retyped in the computer and there are only four small bags to check for the correct date.

We don't have bags returned to us.  We take off 2 segments when we retype the units and save for a month, 1 week in each bag.  It's easy to find by when it was retyped in the computer and there are only four small bags to check for the correct date.

Our procedure says that + 1 degree is acceptable for blood bank.

It does not say that the mechanism has to be in blood bank. There are other checklist items in CAP that are just managed by nursing, and that is how we interpret it. Never had a deficiency about it.
One item I did take up with nursing was TM.41025, regarding transfusionist training. Nursing had nothing in place, so I worked with the educators to create a testing module that is administered by nursing.

When we had our shooting here two years ago, we just handed out emergency release OP and ON PRBCs to the ER.  There was no documentation regarding these units, and we still don't know which patients received which units.  They did not ask for blood for a certain patient, just that they needed units.  One doctor charted that he gave a unit of platelets to a patient-we didn't issue any platelets.... To comment on Carolyn's post, if we have another mass casualty, we will send a med tech down to the ER with the products in boxes with ice, and the tech will coordinate with the nursing supervisor to make sure when we hand out a unit that a sticker gets put on that patient's chart.

I even have that section bookmarked in our book.  It can help explain a lot of reasons for a DAT to be positive.

Another good source is towards the back of the Blood Group Antigen FactsBook.

We don't have bags returned to us.  We take off 2 segments when we retype the units and save for a month, 1 week in each bag.  It's easy to find by when it was retyped in the computer and there are only four small bags to check for the correct date.

I just run the old controls with the new lot kit.  Never had a problem with inspections.  My anticipated results are positive with the old and new pos cts and negative with the old and new neg cts.

The short answer: Money - throwing stuff out is expensive.
The long answer: To get a good price for printed materials (package inserts, labels, etc.), one must purchase tens of thousands of copies. If changes are required, but not especially critical, the regulating bodies (FDA) will allow manufacturers a fair amount of leeway to use up current stock. Throwing out anything has an associated cost and since the commercial manufacturers are in the for-profit arena, they will tend to shy away from such actions. I'm sure this contributed to Immucor's tardiness.
Another contributor to slow moving changes: In the US, any changes to a package insert (or label) must be approved by the FDA before that new document is distributed. This process can take 6 - 12 months depending upon the complexity of the changes and the number of times the document goes backwards and forwards between the two parties.

Immucor does that.  They underline anything that has changed and use a closed triangle for anything deleted.  I've attached a copy of one from 2010.  What bugs me we get a new insert in 2016, and it was changed in 2013!  Where has it been all this time??changes.pdf

As Eagle Eye said, check into low titer A plasma.  We use it for all our massive transfusions and emergency release, in the form of liquid plasma.  They have quite a few studies done (including over 8 years at Mayo) with using A instead of AB.  And of course stress patient blood bank specimens ASAP.  We actually quit carrying O plasma since it was outdating and use A instead.  But we have very few "real" MTPs.

That's an awful situation!  I have had to retrain several techs who made mistakes.  How long do you usually train them?  I would document everything he does wrong.  Does your procedure state that you have to put your results in immediately?  Ours does, since that is what CAP requires.  What's worse is that your higher ups aren't alarmed by your observations.  If he is not following procedure, or changing his actions based on what you have communicated to him, I would not sign him off as being competent.

We have a form to fill out and usually have the tech repeat the test and comment on anything that might have caused the problem.
PROFICIENCY REVIEW.docx
 
This is a copy of our form.

Brenda, why do you need the unit number on the label?  You are attaching the label to the unit, correct?  We have red antigen positive labels and green antigen negative labels.  We also document in the blood bank module that the unit is P/N for an antigen.  That way if there is a label that comes off the unit, we can still see that the unit has been tested and verify it in our antigen testing log.  I have found that attaching the label to a little bit of the whole unit label helps it stick on better.

We recently stopped documenting the unit number on our tags and just document antigen neg/pos, date and tech. The antigen results are in our LIS too.

Brenda, why do you need the unit number on the label?  You are attaching the label to the unit, correct?  We have red antigen positive labels and green antigen negative labels.  We also document in the blood bank module that the unit is P/N for an antigen.  That way if there is a label that comes off the unit, we can still see that the unit has been tested and verify it in our antigen testing log.  I have found that attaching the label to a little bit of the whole unit label helps it stick on better.

Turnaround times for crossmatches...routine, ASAP and STAT.
Turnaround times for emergency release/mass transfusion protocols.
Patient blood management - track patient Hgbs vs transfusion rates, do peer comparisions (look at a specific group of physicians to see if they transfuse at higher Hgbs, look to see if there is an individual whose transfusion rate is higher than his/her peers, etc.)
Specimen labeling - how many rejected, how many missing initials/collection times, how many WBIT (this delays patient care)
Track transfusion rates for specific groups of patients - we monitor OB patients for transfusion if Hgb <8.0
Track ordering problems - duplicate orders, give order for nurses but no prepare order for Blood Bank - education needed for staff/physicians placing orders results in delay of care
Transfusion documentation - check patient flowsheets for missing information (like no 15 min vitals, missing donor #, no signed consent, etc.)
You could spend your whole life on stuff like that, so be selective. Don't just go through the motions with multiple graphs. Choose 1 or 2 things where you can have a positive impact on patient safety or quality of care. Once things are going smoothly with a project, continue monitoring as long as needed and add a new project. Hospital quality will love you for that because its something they can show inspectors from JC, the state, etc. (It can get the lab noticed in a good way!) One of our recent projects came about after receiving complaints about how long it took for us to send blood to the ED for traumas. We started out with what seemed to be a lab problem, but it quickly became obvious that it was much larger. We've now spent almost 3 years working on emergency release processes from order to transfusion, not just working on blood release times by Blood Bank.
Using a multi-disciplinary approach with nursing, we developed job aides, educated, and documented to drop our TATs dramatically and improve the entire process. Nursing staff now has a better grasp of what is expected of them in those kinds of situations and they know what we are going to be doing about providing blood products. Physicians are aware that there is an actual protocol. It makes for pretty graphs for Quality, but most importantly, it greatly benefits patients. As an added bonus, you can develop strong team relationships with staff from other areas. This has the potential to make tackling future problems much easier.
We are not a large facility. It sometimes stretches me pretty thin working on stuff like this, but its worth it over the long haul.

That's an awful situation!  I have had to retrain several techs who made mistakes.  How long do you usually train them?  I would document everything he does wrong.  Does your procedure state that you have to put your results in immediately?  Ours does, since that is what CAP requires.  What's worse is that your higher ups aren't alarmed by your observations.  If he is not following procedure, or changing his actions based on what you have communicated to him, I would not sign him off as being competent.

Ditto what AmcCord and Tricore said.  The medical director's name is on every result.  If he/ she is unconcerned that is a very bad situation!

Ditto what AmcCord and Tricore said.  The medical director's name is on every result.  If he/ she is unconcerned that is a very bad situation!