pbaker

Until recently the BBK had to deliver blood to OR. That took staff away from the BBK where we should be preparing blood products for other patients that are equally as important. It is a tricky give and take within the hospital.

We only require an ABO/Rh for plasma or platelets. The testing must be done on the current admission.

I have a few questions I hope you all can help me with. We have cut staff in the blood bank (really, the entire lab) and are having some issues continuing to maintain the services we have provided in the past. 1. How does blood get to the OR? Does the blood bank run it over, does OR have a transporter, do you use a pneumatic tube system, etc. etc.?? 2. Who does you patient specimen collection, nurses or a phlebotomy team? 3. If you have a phlebotomy team, what is your policy for line draws? We currently must have a phlebotomist witness the nurse draw the specimen. This is a nursing request because they are afraid they will get dinged for a mislabeled specimen. 4. Who draws your nursery specimens? Not the cord blood but things like PKU, bilirubins, etc. 5. When a patient pretests for surgery, what testing, if any, do you perform on the day of surgery? I am especially interested on patients with antibodies and if you completely work them up again. I apologize for the number of questions in this request. We are having some big staffing issues and need ammunition to take to lab and nursing management to try to get some resolution. Thanks so much in advance for all your help!!!!!

We had a policy WAY, WAY back when to give CMVN, irradiated products to all potential transplant candidates regardless of the type of transplant. Since most of the transplants occur somewhere else, I do not have access to the CMV status of the patient. When I request that the patient be tested, I get a lot of push back from the physicians. When I ask if they still want this product based on past protocols, most of them just answer yes without any idea what or why I am asking. We have had charges rejected by Medicare/Medicaid because they do not meet the criteria for use of that particular product.

What is your policy regarding transfusion of adult sickle cell patients? Do you give sickle neg units to disease and trait? Does the physician need to order these units or do you have a policy?

Our facility is going to a centralized, hospital wide temperature monitoring system. We have had virtually NO training, so I am not sure of all the details on how it works. Currently we have the temperature wheels on all the equipment and manually take the temps at midnight. Obviously, all equipment is alarmed for out of temp and they are on a separate alarm board that also rings the operator. When the new system (Docutemp) is final implemented, they state that our wheels can go away. However, they only want to record the temps every 4 hours, because any more often then that seems to use up the batteries too fast. The equipment will still be on our current alarm board and the individual equipment alarm. For some reason, not having continuous monitoring makes me very uncomfortable. I realize that AABB and CAP standards state that temps must be taken every 4 hours if not continuously monitored. Do you think this new system is an acceptable alternative? It just makes me kind of nervous.

We are going live with a new computer version on June 1. We also have an identifier called a "random number" that is ONLY found on the armband and it assigned by registration. This has always been difficult for the blood bank to deal with. Here is my problem. When our new system goes live, ALL the armbands must change. This includes the random number. Nursing will be responsible for replacing the armbands. From the blood bank perspective, I believe that both armbands need to remain on the patient for a minimum of 3 days to cover any existing BBK testing. Nursing wants to cut off the old armband about 6 hours prior to go-live and attach it to the patient chart for reference. I am VERY uncomfortable with this. Has anyone had this experience with a computer change? What would you do in this situation?

We transfuse about 5000 RBC/year. Our blood supplier did a usage audit for the last 3 years and determined what we used by type. From that they calculated the best mix for out shelves. We have cut our inventory in half. We rotate our shorter dated stock once per week. If the unit is set up on a patient we do not take it down. If the unit is a special need unit, we do not send it back until later or request a replacement prior to sending it back. Although the staff was VERY resistant at first, they have come to see how helpful this really is and that it really does work. P.S. We are not a trauma center.

On which babies do you perform cord blood testing? All babies Babies of Rh neg moms only Babies of group O and/or Rh neg moms

A second type on a second specimen if there is no historical type is mandated by FDA to perform electronic crossmatches. We have a second specimen drawn by a different phlebotomist at a different time. The only exception is more than 12 hours have passed, then the same phlebotomist can draw. The confirmation is not ordered until after the first specimen has been recieved. I have never seen any rules regarding who should draw. I think that is up to each facility.

Does your facility use tissue in the OR? Who is responsible for ordering, storage, issuing, documenting, etc., etc., etc.? Is it maintained in the Blood Bank or the OR?

In our current computer system (Meditech 5.6), we created a mother-baby identification number that appears on the cord blood tube and the requisition and the armbands. June 1 we will be upgrading to Meditech 6.0 and the mother-baby number can no longer be pulled into the requisition. I tried to stress the importance of being able to tie the baby to the correct mother and the nursing staff looked at me like I had 3 heads. They actually suggested putting 2 labels on the cord blood specimen (mother and baby), since "it is really the same blood". How do others collect and identify cord blood specimens to ensure correct mother-baby correlation? I would especially be interested in anyone else who has Meditech 6.0.

Does your facility utilize any type of Transfusion Order Form to be completed by the physician? This could be paper or electronic. Does it have indications for transfusion that the physician must complete? Would anyone be willing to share a copy of any order form that you use? We are trying to improve our transfusion committee and educate the physicians on the "proper" utilization of blood products. Currently, if they ask for it, we give it, the end. Thanks for any help you can give:)

We currently have a system where we take 2-3 units of blood to the OR in a transporter (cooler). When we arrive in the OR we take all the units out and do the entire issuing process with each unit with the nursing staff who picks up the blood. This means a lot of time that my staff is out of the blood bank. The nursing staff still has to do the bedside check prior to transfusion. For those of you that take blood to OR in boxes/coolers/transporters, what is your system?

US techs are trained in all departments while in school. Depending on where and what shift they end up working, they may be working in one department, some departments or all departments. We have 3 BB only techs on days and several that are cross-trained in 1 other department. Evening shift techs are all cross trained in a minimum of 2 departments. Night shift techs are cross-trained in all departments. Microbiology off shifts only does set-ups and the day cross-trainers are only trained on set-ups and 1 micro bench. Cross trainers do come in very handy when there is vacation, call-ins or mandatory hospital training and/or meetings.

We do ABO/Rh on all cords and a DAT on babies of O or Rh negative moms and those with clinically significant antibodies. Only elutions for babies of antibody moms with a positive DAT (not ABO).

I couldn't find the attachment Eoin :-(

Would anyone be willing to share a copy of the "card" or "form" that you use for pre-testing?

We just had this happen over the weekend. A patient came to our ER in January and was O+. When she returned for her pre-surgical testing in February she was A+. We went back to the signatures of the two registrations and they were markedly different. The true patient was A+ and someone else had used her identity to come to the ER (not sure with or without her permission). We changed the 2 blood types to unknown until the discrepancy was resolved.

We have 2 automated instruments (same manufacturer). One is heavy duty (Galileo) and one is lighter duty (Echo). Automation is not perfect, as I'm sure you know. There are times, even with 2 pieces of equipment that we still need to do testing manually, either due to timing or questionable results on automation.

What is your protocol for giving patients units with special needs, specifically CMV seroneg and irradiated? Do you have a set type of patient that gets the product (ex. BMT) or does the doctor order specifically what he/she wants? Do you have specific patients that DO NOT get special units (ex. solid organ transplant)? Do you request the CMV status of the patient when asked for CMV seronegative units? I know this is a lot of questions. We currently give a lot of special products for which we do not get reimbursed based on the diagnosis and which the patient probably doesn't really need. This is all based on past "protocols" and I am trying to improve or discard them. I know that once the patients are identified, they must always be identified as needing special things. I just want to make sure that we are identifying the correct patients with the correct products.

WFMB, If they come in the next day, do you change the PRE account to a REG account and use the same account number??

I understand that each patient may be different, but do you have general guidelines such as hgb of ???, platelet count of ???, PT INR of ???

What are your transfusion triggers for packed cells, platelets and plasma?

We are currently Meditech Magic, moving to Meditech Client Server in June. We have a Galileo and an Echo instrument and have been unable to get them to interface with Meditech. Is there any Meditech user out there that has been successful in interfacing with automation?