pbaker

What is pphl?

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!!!

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.

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!!!

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?

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?

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.

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?

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.

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!!

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

We always require an ABO/Rh for each admission, just in case someone else is using that patient's information.

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.

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!

Our pharmacy runs a daily report looking for Rh neg moms or diagnosis of preg/*** bleed to ensure RhIg was dispensed.

We keep two years in the department. At the end of every year we go through our file cabinet and if we haven't seen the patient in the previous 2 years, their file is pulled and put into long term storage. We discard after 10 years. The actual history stays with the patient in the computer forever

We do not read back every unit at time of issue for traumas, emergency issue. We do insist that they bring something printed with the patient name (real or made up trauma) and the medical record number. We match that to the paperwork that goes with the units in the cooler and hand them the cooler. They are still required to perform the bedside check and the time of transfusion.

I have seen uncrossmatched be able to wait for crossmatched. It is amazing how the need becomes much less urgent when they have to put their name on something.

We skip the screen and run a selected cell panel to rule out all other clinically significant antibodies.

We keep them until the monthly invoice comes and then they are discarded. All documentation of unit receipt and final disposition is in the computer system.

Our computer system is set to search for a historic type. If there is none, it will automatically order a confirmation type once the first specimen is received. 1. A type and screen is collected at the preop visit, mainly to prevent any surprise antibodies day of surgery. Another type and screen is collected day of surgery that we transfuse from. This also will count as their 2nd specimen. If, for some reason, no blood bank was collected at preop visit and they have no history, a second specimen will need to be collected day of surgery. We send them the label after it prints in the BB. 2. Outpatients are always coming back to be transfused so, if necessary, we collect the second specimen the day they return. 3/4. The second specimen has to be collected by a different person than drew the type and screen. This can be phleb or RN. They shouldn't even know they need a confirmation until the first specimen arrives to prevent them collecting them both at the same time.

We use employee ID number that is then entered into the system when the specimen is received.

One of the advantages of double red cells is giving them both to the same patient to reduce donor exposure.

I am going to resurrect this topic from several years ago. We only do cord workups for O and/or Rh= moms. We had an AB+ mom with an Anti-K and the discussion came up whether we should request the floor order a workup. They did and the cord blood DAT was negative. Had it been positive, our current policy would be to perform an elution. We got to discussing WHY since we would predict what was on the baby cells and are pretty sure no treatment would change regardless of the eluate results. Back in 2006, it looks like eluates on cord blood was about 50/50 from those who responded. Just wanted to see if that still holds true or if more have done away with unnecessary elutions.