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OregonBB

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  1. OregonBB
    A question that also comes to mind as we are writing our SOP for thawed plasma, is it necessary to have the provider sign an Emergency Release form when A plasma is given to someone with no blood type on record. Does anyone do that? Or is the policy stating when to use the A plasma sufficient?
  2. OregonBB
    I messaged you - thanks!
  3. OregonBB
    Hello, We are going to begin keeping 2 thawed A Plasma units on hand at all times for MTPs and Traumas. We are a level 2 trauma center. A few questions come to mind: Are there ever any MTPs or Traumas where you would not use the Thawed A plasma? For example, you know the patient is Type B historically? Or an OB hemorrhage scenario (a non trauma patient) where the patient is Type B or AB? Do you always use the thawed A plasma units on all compatible patients. For example if you get an O patient needing plasma, and the A units are available but were thawed about a day ago (and still have 4 days until expiration) do you always give the A, or is it a case by case basis? Does everyone limit the use of A thawed plasma to 2 units, until the blood type is known and type specific plasma can be given? Is anyone willing to share their policy? Thanks, Jesse
  4. OregonBB
    Thank you tcoyle. I hadn't thought of looking on the donor side. Of course most of the drugs I'm thinking of are on that list. Great starting point!
  5. OregonBB
    Hello, Maybe a long shot, but here's what I'm looking for. Does anyone have or have they seen a list of medications that are especially relevant to transfusion medicine. Darzalex, fludarabine, plavix, aspirin, tranexamic acid and many others. I find myself not always remembering how the drugs work and have to look them up to be better informed. What I'm thinking, as an example, is an order for platelets when the count is normal and helping to confirm they are on a medication that causes dysfunctional platelets. Has anyone compiled a list of these and how they effect blood bank, mechanisms of action, etc? Have any suggestions? Maybe I'll make my own list but thought I'd ask first. Thank you!
  6. OregonBB
    Very true Malcolm!!
  7. OregonBB
    Our peds actually agreed to stop doing the babies of O moms! They said they want to do a Type and DAT as part of a bilirubin check - so if the baby is getting drawn for a bili, they will add on the Type and DAT. This sounds like a good compromise.
  8. OregonBB
    Great point Malcom.
  9. OregonBB
    Thank you very much cswickard! The link worked great. I really appreciate you sharing your SOP.
  10. OregonBB
    Hello, One of our facilities was recently inspected by DNV and they asked us to edit/update our SOP for Look Backs. I haven't updated our SOP in a few years. We are a medium sized facility and do not get many of these notices from our supplier. I think we've only ever had to have our Medical Director contact a patient's physician once. It would be helpful to see how other's in the US have written their Look Back SOP, as we edit ours. Would anyone be willing to share theirs? Thanks! jbower@samhealth.org
  11. OregonBB
    Thank you all for your comments and answering the poll question. It seems like many of us are still doing this even though the value of the test is pretty limited. We'll be discussing this at our facility...but the final decision depends on the pediatricians of course
  12. OregonBB
    Hello. We have been looking at our policy regarding when the nursery orders Cord Blood Workups (Type and DAT) on babies. Currently we do all babies of Rh Neg moms (of course), as well as of O moms. I have read that many blood banks have dropped performing these on babies of O moms, and only do them as part of the RhoGam workup. In talking to a few of our pediatricians, none of them seem to care much when we call them to inform them of the positive DATs and they shared that they do not treat differently based on the result. This article states that testing babies of O moms is not required (American Academy of Pediatrics): https://pediatrics.aappublications.org/content/pediatrics/114/1/297.full.pdf What are your thoughts? What do you do at your facility? We are discussing this currently at ours and appreciate your feedback.
  13. OregonBB
    Question. If the patient is registered, why can't you use the SoftBank emergency issue function prior to the Type and Screen being completed?
  14. OregonBB
    Yes, Epic/SCC. I'd love to join the emails - please! (We also decided not to pay for SNUG this year so I no longer get the SNUG group emails, would love to be included.) Thanks!
  15. OregonBB
    We don't require blood bank bands for inpatients or outpatients. All outpatients getting blood have their Name, DOB and MRN confirmed when they arrive for a blood transfusion. Then the Epic band is placed on the patient and the barcode is used for administering blood products etc. We do have a two ABO policy as well where all patients require two separate types (not same draw). Honestly when we first started this change (we stopped using bb specific bands about 7 years ago) I was a bit nervous. But it really has been a non-issue. Our Infusion nurses are very careful and know their patients well. Us
  16. OregonBB
    I apologize if this has been discussed previously. I'm sure it has but I had a hard time finding it. In the situation where you have anti-E (but no other antibodies) in a patient that is c antigen negative, and they want to transfuse...in what situations do you give c negative units? Is the rationale that they were likely exposed to c (I understand this part - because of the antigen frequencies) and so they will likely make it if they are exposed again? Is it simply trying to avoid future anti-c creation? I assume if there is an emergency that you'd have to bypass this step and just give E antigen negative blood? What are your policies/practices regarding this?
  17. OregonBB
    Thank you Malcolm! You are in England right? Where did those IRA bombings occur? Wow.
  18. OregonBB
    At your hospital, who do you call when you need additional employees in the blood bank during a Massive Transfusion event? Just looking to see what other facilities are doing. We are only an 80 bed hospital, so we don't get a lot of these. But I'd like to hear what larger facilities and trauma centers do as well. Thanks!
  19. OregonBB
    We got rid of them 5 years ago when we implemented our new BBLIS and started requiring a confirmatory ABO and using electronic crossmatching. We prefer the confirmatory ABO to blood bank bands. We require the phlebotomists ID to be written on all pre-transfusion specimens. We are happy with our system and its working well.
  20. OregonBB
    We require that every pretransfusion tube be signed by the phlebotomist. Our strong preference is the employee number/tech code. But we do allow initials/signatures. In these cases we can check the info in the HIS/LIS and connect the initials to the employee, if needed. But we do not have a policy that requires us to confirm this in the HIS/LIS. The main thing is that the tube must have the employee ID/initials or it's rejected. (For non pretransfusion samples, ie DATs, Cords, ABO Confirms, prenatals - we do not require an employee ID/initials. We simply depend on the HIS/LIS in these cases.) -Jesse
  21. OregonBB
    "If there is a question about passive vs. active Anti-D, a Rhogam is given (to err on the side of caution). " That is sort of what I was getting at. At our facility we do not require a new ABO\Rh test result each time RhIg is issued. We will issue with an historical Type (we do this for yellow products as well). Our current policy says that we "should" perform an antibody screen prior to issuing RhIg, for example to an ED patient. This is where I am seeking to clarify the SOP. I know that RhIg should not be administered to a patient that has been alloimmunized to D. But practically how do you determine active vs passive D, especially when you have a patient miscarrying in the ED and time is limited. Since it seems prudent to err on the side of caution and give RhIg regardless, I'm having a hard time seeing the value of the antibody screen test, since it seems RhIg would be issued regardless of the result.
  22. OregonBB
    Thank you. I see what you mean about a current type. Myoriginal question was do you require an antibody screen prior to issuing RhoGam? Thanks, Jesse
  23. OregonBB
    Hello, What are your policies for requiring an antibody screen prior to issuing RhIg? Is the policy different for ED patients vs clinic patients? If you have a blood type on file already, do any of you not require a sample for a screen in an ED situation where an Rh Neg mother gets an order for RhIg? It seems that in almost all cases you will issue RhIg regardless of what the antibody screen result is? Is the point of the screen to have a "clean" pre RhIg sample in case there is a need to titer? Thanks in advance, Jesse
  24. OregonBB
    I agree with Bill - keep it simple. We also would report out only the negative tube screen result, then add internal comments that would not go on the external report, but would help guide the next blood banker working up this patient in the future. We would not report out the Echo results at all. Seems like it would be very confusing to the provider to see both a positive (or inconclusive) and negative for an antibody screen result. Solid phase is so sensitive that it's going to pick up these insigificant "capture panagglutinins" from time to time. However David's point is good - how can you be certain that you are not missing a high incidence antibody? But the likelihood of non clinically significant "junk" with solid phase is much higher than a very weak (doesn't show up in LISS or PEG) high incidence antibody.
  25. OregonBB
    Hi rcc1974, It sounds like you have your settings set the way we would like them. If you don't mind, would you be willing to share your settings for: (In customer defined parameters): mismatch override (yes or no), restrict of no currenet blood type(yes or no), and (In Blood Type dictionary):allow emergency issue (yes or no and for which blood types), and did you allow all Rh Neg types to be compatible for all Rh Pos red cell types?? If anyone else has any tips, they'd be appreciated! We are having a tough time making this work the way we'd like. Thanks in advance! Jesse
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