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pbaker

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Everything posted by pbaker

  1. I was always taught that you titer the previous specimen in parallel to help eliminate tech variability. What you are really looking for is a significant increase in titer from one month to the next. The previous titer may have been 4 by that tech and 8 by this tech. The current titer may be 64 if tested by the previous tech and 128 when tested by the current tech. Either way, that is an increase, regardless of the actual number, and the doc should probably be concerned.
  2. The product description on the package insert states "HemoTemp II Indicator is ....for blood during transit and storage outside the blood bank." We just had our CAP inspection and they didn't say a word.
  3. We place Hemo-Temp stickers on every red cell issued. They stay activated for 10-12 hours. This can verify what happened to the unit while it was out of BB control. We did have to discard some that came back from OR because the surgeon took them out "just in case" and then changed his mind and put them back in the cooler. The units were cold when returned to BB, but the Hemo-Temp flower was unacceptable.
  4. Currently, we use manual Capture when our Neo is down or we need a little faster TAT. After we record the results on the paper worksheet, we enter the results for each individual patient into our computer system and the paper worksheet is discarded. Since controls are tested with every run, I am curious as to how others are documenting the control results from paper to computer. Do you keep all the worksheets? Do you have a way to enter into the computer (we have Cerner)?
  5. Did a new article come out recently? I have never seen this before and we have had 3 patients in the last 10 days!! One was hereditary angioedema and 2 were on ACE inhibitors. Our pathologists have never heard of it either.
  6. pbaker

    SBB

    I "grandfathered" the SBB exam 20 years ago. Not sure if it still works that way. I would think if you have all the right experience it should be possible.
  7. We issue around 300/month
  8. We had the same correction factor when I came here and I had never heard of it either. Apparently, neither had most of the techs. There were little flags on all the thermometers, but no one seemed to know what they were for. We finally got to the procedure originator and the addition/subtraction thing is how it is supposed to work (according to our SOP)
  9. We put hemotemps on every RBC issued. If you only take the temp when the unit is returned, you have no proof that it was treated correctly while it was gone. Maybe the RN left it sitting on the radiator and then said "Oh #$@#, I can't return it hot, so I'll put it in the fridge for a few minutes to cool it back down."
  10. We are having the same conversation. Have been having the same conversation for years. They refuse to change tubes unless it can be sterilized and the only sterilized tubes we can find come in a kit with a red and a purple top. We don't want to pay for a tube we don't want. It would be so much better for workflow if we could put them on the Neo. About every 6 months, I bring it up again!
  11. For consistency, we do 3 days for everyone.
  12. For those of you that have phlebotomy staff collecting your laboratory specimens: Do you have a limit on the number of attempts each phlebotomist may make to collect a specimen? If yes, what is the limit? Do you have a limit to the number of phlebotomists that may attempt to collect a specimen? If yes, how many phlebs may try? If you have limits and they are reached, what happens then? Order from the physician to continue? Make it a nurse draw? Make the physician put in a line? Thanks for your help.
  13. If the name, DOB or MRN changes while the patient has a current BB specimen, someone from the BB must go and witness the armband being changed. We take the current specimen with us for comparison and correct the label to match the armband. If they change the armband without the blood bank involvement, we start over with a new specimen. We strongly encourage them to wait until the specimen expires, but that doesn't always happen.
  14. We get totally unlabeled specimens that 2 nurses supposedly verified at the bedside. Be careful!
  15. Unfortunately, nursing and blood bank systems don't "talk" to each other, so it is very possible to document something that never came through our blood bank. I discovered it when performing documentation audits. We don't currently have a policy, so that is what we are trying to develop. I guess it has never happened before or no one ever caught it.
  16. We have recently implemented electronic transfusion documentation and, with a few exceptions, done away with paper documentation. In performing the documentation audits, I discovered a patient had electronic documentation for a unit that was never processed through our blood bank. In digging further, it appears that the patient was transferred from another facility with a unit of blood hanging. For those of you that have electronic documentation, how would you have handled this event? I'm still researching to see what kind of documentation the unit actually came with.
  17. pbaker

    Cleanbath

    The solution you put in waterbeds also works and is less toxic.
  18. When they are adults, they will get run on our instrument (NEO) that picks up most weak D reactions, so they stay Rh pos. If not, we will change their type and put a comment regarding testing methods and why the change. We have the same type issue when prenatals are done at outside labs that perform weak D (+) and then the moms come here to deliver and we don't (=). Or a weak D blood donor (+) becomes a patient (=). We just explain the discrepancy to the physician, call them Rh neg and offer them RhIg, if indicated. I used to work in a facility that also collected autologous blood. We were required to weak D donors units, but not patients, so sometimes that got really confusing when their blood type per blood bank is Rh=, but their unit is labeled Rh+.
  19. We do not weak D type our adult patients. We treat them as Rh negative.
  20. We use BB armbands that are placed on all inpatients at the time the blood bank specimen is collected. Our specimen labels print with a label for the tube and a matching label for the armband. Unfortunately, we receive several specimens where the armband was not placed on the patient (even though 2 people are supposed to double check that). Then we start over. If the armband gets removed for any reason and the blood bank was not involved, we start over. We do not place them on presurgical patients because we are going to do a new type and screen day of surgery. That is when the armband will be placed. OP that come in day before transfusion are asked to keep their armband on. We have had barcode armbanding in the budget for about 5 years and it keeps getting pushed back. My last employer (a much smaller community based hospital) had Mobilab and it was awesome! My personal opinion is BB armbands are no safer than using the regular armband for ID. At that point, it is still up to humans to ensure things are right
  21. Ours is a simple policy that says we will provide testing and blood products to the clinical areas.
  22. Our computer system looks for patient history and will automatically order a confirmation if it does not find one. It does not order the confirmation until the first specimen is received in the lab to avoid having the 2 specimens collected at the exact same time. The second specimen must also be collected by a different person than the original to help ensure patient reidentification. To expedite treatment, trauma confirmations will be auto ordered at the time of T/S order but must still be collected by a second individual. ER staff draws the original, lab staff draws the confirmation. If the blood bank determines that a confirmation is not needed, they cancel the order. Due to the nature of the specimen, infant cord blood confirmations auto order on the same specimen but must be tested by a different tech.
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