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Posts posted by cthherbal
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We do the same as kirkaw
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If you are AABB Accredited there is a standard requiring validation of changes to the LIS for Transfusion Service activities. I have a policy specific to this with verbiage right out of the standard. Is it possible to bring this to the attention of Risk Management, Quality, or Transfusion Committee? If you can't get any support, I would contact AABB, etc. as DANSKET suggested.
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No it looks completely different. The incubator and centrifuge are all in one unit.
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. Is this a plastic or glass blue top tube?And you can put the thermometer in a tube, add saline to the top of the well only and then seal with parafilm. You have to occasionally replace the parafilm and refill the tube, but we have used this method for years and it works very well.
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We do the AHG reacting antisera testing in gel IGG cards. This process has been in use for probably 10 years and works very well. Pipetting is same as David's above.
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Ditto with Malcolm!
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Well since we are a community hospital we'd send anything we couldn't identify to you, Malcolm. But since we are in the states, our IRL, lol.
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What do you do when you find an anti-Ch, an anti-Rg, an anti-Kna, an anti-McCa, etc by gel cthherbal?
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We consider any antibody reacting in gel clinically significant, and give antigen negative accordingly.
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We require a 2nd specimen, and always test it by tube method (primary method is Provue or manual gel). This way we pick up discrepancies and transfuse with Rh neg appropriately. I was considering the Quotient D panel but given we only have sent 1 pregnant patient sample in 3+ years for molecular D testing, I am not sure it's worth the expense, or if it will be necessarily helpful. Anyone using it that have found it worthwhile?
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We built the required questions in to the electronic order. About 50% are electronic order entry. We require sickle cell disease and transplant (history of or on list) at order entry. The order will not be placed unless these questions are answered. We also put the same questions on the consent form that the patient fills out and signs.
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We do pre-admit specimens up to 2 weeks before the procedure if the patient has not been pregnant or transfused in the past 3 months. We have been willing to use the specimen to do gel crossmatches until 3 days after the procedure (might be as much as 17 days from collection but usually isn't that long). We usually set up the units the day before surgery (on all pre-admits, not just those with antibodies) so as not to tie them up unnecessarily. We could have to set up additional units in the few days after surgery too. We do not freeze the samples. This policy was in place before I came here and was probably created with negative antibody screens in mind. The reason we all do AHG xms in patients with antibodies is as a double-check on our unit antigen typing and to catch antibodies to low -frequency antigens, right? So how long will antibodies remain active enough in the sample to cause an incompatible crossmatch with that mis-typed unit or the one with the low-incidence antigen? Does anyone have data on how long the usual antibodies we identify tend to remain stable in a refrigerated specimen? And do you know how long antibodies to low-frequency antigens can be trusted to remain stable? Obviously any antibody can do whatever it wants and it depends on the original strength. I know that Kidd system antibodies tend not to store well, while Rh antibodies do. What's a reasonable rule of thumb that will prevent patient harm? Must we do all gel xms before the specimen is 3 days old, 7 days old or???? Our manufacturer's instructions seem to be getting more vague over time. I don't see anything in them that would say we can't use the specimen at 17 days.
Currently we use 10 day prior to surgery samples up to 3 days post-surgery (so 13 days total), but I've worked as a large university hospital that used 30 day old samples to crossmatch units for the patient on day of surgery only, then requried a new sample the following day.
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We use expired panel cells also, not for primary ID but for additional rule outs. The patient sample serves as the positive control.
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We investigate each one we find (with a newly identified antibody) and consider it a potential delayed. Most are serologic only and patient is not symtomatic or showing signs of hemolysis.
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We check all histories (our system requires it prior to any testing).
The scariest is just a few weeks ago where there were duplicate records on the same patient (one with antibodies and one without). Current sample antibody screen= neg.
We had units crossmatched before we realized this but luckily had not issued any, and released the units in time.
We check every sample by name to avoid these types of issues.
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One place I worked also had the policy of 100% Irr. Yes we did charge for it as it was agreed on by Med Exec, like Terri.
For those facilities who don't own an irradiator, like my current one, we'd be paying about $50 more per unit for irradiation. Hard to justify when less than 1% of our patients require it.
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Similar to both replys. 280 beds, 2 in BB on days, 1 on 2nd/3rd shifts. Weekends it's 1 on all shifts. Everyone (except me the supervisor) is a generalist.
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We contract with an outside service which does quarterly QC. We get quarterly usage/QC reports and review them at our Transfusion Committee meetings.
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Our policy is that the nurse returns the slip to BB in person after the transfusion and we check it. If there are any problems they are corrected at that time. If there are any that are missing, there is a team of nurses who go to medical records and get us a copy. There are very few that go missing entirely each month (~3) which get incident reported individually. The idea is that nursing must take ownership of their part and get support from nursing leadership. Return compliance is 98% or better (we require 95% or better).
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We do 3-part DATs in gel only. Polyspecific, IgG and Buffer cards. Beautiful reactions, clear cut.
For the buffer cards we do 50 uL cells (0.8%) and 25 uL of the anti-C3b, C3d (Immucor).
Pos QC = Complement Control Cells
Neg QC = A2 cells.
We normally use Immucor Complement Control Cells but with the recent shortage, we validated Hemobioscience which works just as well.
No problems with CAP surveys.
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we do the same, no low alarm.
2.5C - 5.5C Alarm Systems for Older Blood Bank Refrigerators
in Equipment
Posted
Our reagent fridge is a backup for our blood fridge so we keep the alarm points the same. We also store Rh Ig and Tissues (on a separate shelf) in the same refrigerator as RBCs. All our temp alarms are set for 2.3 and 5.5 (Low/High).
Sometimes the chart recorders stop recording (for whatever reason) or have unexplained "gaps". So, I recently purchased USB data loggers for all of our storage devices ($50-100 each depending on type of device). I print out chart, review temps and save data monthly. I have the temp being recorded on the data loggers every 5 minutes. I think this certainly meets the revised standard for continuous monitoring. I don't use them for alarms, just as a backup for the charts for continuous monitoring. Alarms go off on the device itself, plus they are wired to our security desk, who notifies us of any alarm.
The data loggers were a much cheaper option than paying thousands for a wireless software continuous monitoring system.