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Posts posted by pbaker
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When you issue blood that is "least" incompatible for a patient with a warm auto antibody, is the ordering physician required to sign a release for that blood?
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I LOVE that idea of the plastic ornament. I just received many "old" ornaments from my parents/grandparents attached with many memories. I would be devastated to think they could be gone forever. What a wonderful way to save those special things!
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So what about all the folks who discarded files because standards "inadvertently" said 10 years?
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Our cord blood specimens are currently collected in a red top clot tube. I would like to change this to EDTA so that the ABO/Rh and DAT testing can be performed on our Neo. The OB department wants the tubes to be sterilized to be taken into the OR for C-sections. Our tube manufacturer states that neither tube should be sterilized by autoclave or ethylene oxide (although OB is already sterilizing the red top, which we did not know). What type tubes do other facilities collect cord blood specimens in and does OB care if they are sterilized for C-section cases?
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We also have Meditech but can't count on the admitting department correctly entering everything in for an accurate audit trail. If any identifying information changes (name, MRN, DOB), admitting MUST call the blood bank before changing. If there is a blood bank specimen, we do an armband verify where a blood bank staff member physically watches the old armband being removed, comparing to the current specimen and watching the new armband being reapplied with a corresponding new label attached to the specimen. If we find an armband has been changed or records have been merged without contacting the blood bank, we start all over with a new specimen. If it is an emergent situation, they now get uncrossmatched O=.
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Our babies don't get a name until they are discharged. Until then they are mother's last name, boy or girl.
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We also use the 3 and 3 rule.
Don't we rule out on single homozygous cells all the time when the screen is negative???
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Did the patient get a stem cell/bone marrow transplant?
- Maureen, jayinsat, David Saikin and 1 other
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4
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L106
That is my biggest question since the majority of my KB moms are not anywhere close to term.
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We do them because the physician orders them. Most come through the ER as "fall". Many are only 10 or 11 weeks pregnant. I have asked our medical director and he is afraid to confront the OBs because of law suits. That's why I am trying to get ammunition that we do waaaaaaaay too many for no real reason.
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In our ER 40% of all the type and screens performed are on patients who are not admitted and receive no blood products. Many of our diagnoses are things like weakness and dizzy. Even had one diagnosis of insect bite. Does anyone else have "statistics" of the number of TS performed in your ER and are they for real reasons or just because? Since there is really no diagnostic value to a TS, I think we do too many.
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It is only 6/5 and we have already done 7 KB stains. Does this seem excessive to anyone? How many are routinely done in other institutions? We are not a high risk OB facility or a trauma center. Does anyone have any references on the usefulness of KB stains? It seems like such a subjective (questionable) test to me.
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Hospital policy states that blood bank must be contacted ANY time an armband is changed to determine if we have a current specimen. (We all know that doesn't happen consistently) If we do, we go to the patient and witness the armband change and document on the current specimen tube. If they don't contact the blood bank and we find out it is a different armband, we make them redraw the specimen and we start over.
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You have to have a second type by AABB standards to perform electronic crossmatch. Although our policy states it must be a second specimen, AABB does not get that specific.
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Does the nursing staff actually have correct data to put on the order form? We also have a form, as well as CPOE, but the doctor still write "transfuse 2 units today". Then the RN or unit secretary fills out the form and guesses as to the indication for tranfusion. We have been fighting this battle for at least a year. The blood bank gets iffy data and the nurses don't like having to guess.
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one blood type per admission
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But why would you have transfused A+ (current type) to an A= patient (previous type) to create the potential sampling problem.
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Since we do electronic crossmatches, we make it the RN responsibility to see if the test results are done in the LIS. If the type and screen is done, the blood is ready. We only call if there is going to be any kind of delay (i.e.Aby) and document on the transfusion order.
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We have a separate test called a P Neg (pretesting negative) that gets ordered day of surgery. Assuming the patient has not been pregnant or transfused (answers to those questions are part of the p neg test) and the pretesting screen was negative, all that is performed is an ABO/Rh. However it was built (not by me) Meditech accepts that result as the screen and allows us to issue units to that P neg specimen. We do pre testing up to 30 days out.
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If you have blood type in the history and this is the first specimen you have recorded, then the blood type had to come from the conversion. Our conversion also has a user name of C12345 that we can see in the history details tab.
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We do the testing, tell the nursing floor a recommended dose and then they order it from pharmacy. Pharmacy takes care of everything from there.
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We allow blood issued to the OR heart rooms in a cooler to be transferred with the patient when they go to ICU.
I don't think we have ever had the question asked about transferring it anywhere else. I agree with Mabel that the biggest risk is misplacement of the unit.
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We only issue coolers to the OR for our heart patients. They are allowed to take them with the patient when they are transferred to the ICU.
Dispensing RHIG
in Transfusion Services
Posted
At my previous employer, the pharmacy felt very strongly that RhIg is a drug and should be in the pharmacy. Blood bank recommended the dosage based on testing, but it was dispensed from the pharmacy.