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Everything posted by pbaker

  1. Circular of Information states "Transfusion should be started before component expiration and completed within 4 hours." Doesn't really specify within 4 hours of what??? I'm guessing us blood bankers interpret this to be 4 hours of issue, since it is no longer "maintained in a controlled environment".
  2. This is how our tubes are viewed for micro reactions. Issitt seems to be OK with this method.
  3. How does everyone record reactions that are only detected microscopically? Here are the versions I have seen in my various jobs and from my various techs. I am trying to get it more consistent. +/= wk+ mic+ 0m+
  4. We used the carryover validation exercise provided by Immucor when we received our instrument. No problems with CAP.
  5. We have not had the greatest experience with Aeroscout. It frequently fails to send readings even though it is still reading the temp. I don't know that I would trust it to monitor a cooler.
  6. We require a ABO/Rh specimen for the current admission.
  7. We are currently building the Bridge system for transfusion documentation. I know AABB and CAP standards require "amount transfused" to be in the patient record. Does anyone know if this is by individual unit transfused or a cumulative amount?
  8. A true trauma stat (not a drama trauma) is 60 minutes for ABSC and 35 minutes for ABO, from receipt in lab. All other stats are 65 minutes for both. We batch our cord bloods and do them every 4 hours. The nursery has it in their brain that it must be completed by then in order to treat the baby accordingly. Of course, when they don't send it down for 3 hours and miss our run time, they get mad at us.
  9. They are in an MTP cooler that has a separate RT platelet storage box. Although we occasionally get them back in the cold part of the cooler. They claim it's just easier to put them in there. SIIIIIIIIGH!!!
  10. Our current MTP states that the first immediate cooler will be 2 RBC/2 FFP, second cooler is 4 RBC/2 FFP/1 SDP and all subsequent coolers will contain 6 RBC/4 FFP/1 SDP. One of our trauma surgeons wants to move the first platelet pack to the first cooler. My medical director is very hesitant to do so for several reasons. We only keep 2 platelets in house and about 60% of the cases that are called MTP actually end up using minimal amounts of blood products. When do other facilities include in each MTP pack? P.S. We are a level 2 trauma center that gets about 1-2 MTP activations a month.
  11. We use the 2nd person to identify, knowing full well that it is not very reliable. We recently had a safety fair, prior to TJC arriving, and used an armbanded model as our patient and laid the collected specimen next to it. The names were similar, but different, MRN were different and DOB was similar but different. Only about 50% of the nursing staff caught the discrepancy. We then explained to them that the specimen was labeled properly only from the wrong patient. Since blood bank does not see the patient or the armbands (we use a BB armband), we would have accepted the specimen and resulted the testing for the wrong patient. Some understood and were scared, some just wanted the stamp on their paper to get their CEUs. Please don't ever put me in the hospital!!!
  12. Here is another question to add to the mix. Our computer system (Cerner) will auto order an ABO confirmation WHEN the first specimen is received in the lab, if there is no previous history. We will then either send the phlebotomist to collect the second specimen or, if patient is on a nurse collect floor, send the label to the floor for collection. If we receive a call asking if a second specimen is going to be needed, we tell them we don't know (even though we do) because we want a new, independently identified specimen. We will not give type specific blood products until both specimens have been resulted. OR would like special dispensation to collect 2 specimens at one time so that one can be used for a confirmation. They feel that they are a controlled enough environment that errors should not occur and they are usually drawing in a crisis situation and cannot wait to get the order to draw the second specimen. We would not deny them emergency blood, just type specific. What do other facilities, that require two specimens, do in the cases of emergent (or not) situations in the OR?
  13. I am curious regarding specimen collection when patient is in the OR. For those of you that have a phlebotomy team for the house, do you send someone to OR or does the OR staff collect specimens?
  14. We have the same set up for basically the same reason - a patient was transfused with no transfusion orders. However, blood bank only gets notification of the product order. Also, no specimen collection label will generate if only a transfuse order is placed. We had a case where a transfuse order was placed on one patient and a product order was placed for a patient with a VERY similar name on the same floor. RN came to pick up blood for the patient with the transfuse order and couldn't understand why we did not have it ready. "Patient was bleeding!!!!!" Our transfuse and product orders are going back to being linked together so you can't order one without the other.
  15. We very rarely transfuse neonates (like 3 times in the last 4 years). Because of the rarity, we no longer stock a quad unit. We have gotten approval to give the baby the freshest O= on the shelf until the quad unit can get here from the blood center. Here is my question for others like us. When you get an emergency request for blood for a neonate, do you take the time to aliquot for the nursery or do you issue the entire unit and let the nursery physicians aliquot what they need?
  16. Nursing orders to transfuse are just that - NURSING orders. The blood bank does the testing required for the product orders received and makes sure blood products are available and/or ready. If the RN/courier appears at the window to pick up a product and we have a valid product order, we will issue the product. It is very frustrating when the lab gets blamed when the nursing staff cannot follow/clarify a physician order.
  17. Hematology tried to move it to the blood bank and our medical director vetoed that!! She said it is a stain and stains are done in Heme!!
  18. When physicians are required to sign for high-risk transfusion (ex. presence of warm auto and no compatible product), what frequency of signature do you require? 1. Signature with each transfusion order 2. Signature once for length of specimen 3. Signature once for length of admission
  19. We always require an ABO/Rh for each admission, just in case someone else is using that patient's information.
  20. What is your process for issuing blood to patients in OR? Are there any special "exemptions" when the surgeon feels this is an emergent need? Do you require patient ID when issuing products? What patient information is required? We are being told that we are "killing the patient" because we have so many rules. Just gathering information from other institutions.
  21. We have a semi-electronic method for documentation of transfusion on the nursing side. I have been auditing every unit transfused since we went live in August of 2016. The electronic documentation is complete only about 80-85% of the time. (OR and MTP are still on paper) We have "dumb" bar code scanners and they sometimes scan the product code, ABO/Rh or expiration date instead of the unit number. They forget to enter the completion time or final volume. They often document two separate units under 1 unit number, sometimes days apart. I have submitted all of the AABB, CAP and JCAHO regulatory requirements for medical record documentation and my director is totally on my side. However, we are getting pushback from upper management stating that they should be able to go back and fix any error or that 80% compliance should be acceptable. Are there any other regulations that could force them to comply? I am very frustrated!
  22. Our pharmacy runs a daily report looking for Rh neg moms or diagnosis of preg/*** bleed to ensure RhIg was dispensed.
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