cthherbal

Yes I am an AABB Assessor and I believe this is what most think it isn't. I know a reference lab and I worked in a Transfusion Service in a hospital where there were work stations and each station's equipment was ID'd with which reagent rack, heat block, cell washer, etc. being used. If you are a smaller lab and can get by with having 1 of everything in use then do that. Then when you have a problem and your backups are put into use, you have a mechanism to document this. I seem to remember this being more of an FDA thing but of all the agencies I think AABB is the most aligned with the FDA requirements.

We buy 3 pH buffer standards from our distributor (cheap)- low normal and high. We test the 3 buffers monthly along with our saline on pH paper. This works out well and we've had no issues.

Eagle Eye you are correct in that it depends on the state. In NJ APNs can order blood products independently, but PAs require co-signature by the physician.

You may want to consider loading the tissues while freezer is still out of BB, and allowing both freezers to recover from the unload/load, then move it to the new BB location. It takes awhile for the temp to raise (door closed) when power is lost-unplugging and replugging in the freezer after a few minutes should not be detrimental. Then you would have your other freezer close by if you needed it.

We do the same as Dansket.

We have the patient answer 4 Y/N questions on a form: 1. pregnant in the last 3 months (Females) 2. transfused in the last 3 months 3. Do you have Sickle Cell Disease 4. Have you had a Bone Marrow or solid organ transplant (or are you on a list for a future transplant). They answer the Qs and sign this form when the Type and Screen (TAS) is drawn and submitted to BB with the sample. We do essentially the same as HillDi and keep the same sample until 3 days post-surgery (they can be drawn up to 10 days prior to surgery for the TAS). If the answer to Q 1 or 2 is Yes, the sample is only good for 3 days from draw, (which occasionally requires a new sample day of surgery). The pre-admit nurses are good in that they will not draw a patient if it's too soon (past 10 days out) or if the patient answers Yes (they will have the patient come back within 3 days of scheduled procedure). We are CAP and AABB accredited. My understanding is that if you go past the 3-day AABB sample window you must validate that your results are the same on day X as they were on the day of original testing.

Thanks for your input. When the floor presents with the pick up slip we will use option #1- because the current account number is on the slip and we will enter it as the alternate account number when we issue in SoftBank. Next I have to ask how to fix it if someone forgets this step!

We are getting ready to go from paper to computer. For Outpatients, typically the patient comes on day 1 for type and screen and sometimes comes back the next day for transfusion. When they come back on a different day, a new account is established for that day. For SoftBank users, how do you manage this process? If RC are ordered on a different day, they will not link to the original type and screen order. I understand there are 2 workarounds for this and I am curious what other users do and why: 1. use an alternate # at issue so the bill goes to the correct account. 2. order a no charge type and screen on the new account and re-enter the original results from day of testing. Thanks, Colleen

We initially saw the Safe T Views center turning pink right out of the frige when applied to units. When I called the company they recommended we apply them while units are still in the frige. Since we tried that we haven't had issues. Perhaps if blood is set up ahead of time, kept in frige for some time, then the temp applicators are put on right prior to issue, you will see less issues. We use the 1-6, only for cooler issuance, and require units be started or returned within 4 hours of issue. Although our coolers maintain temp longer than that, we decided to keep it as 4 hours because everyone is used to our "transfuse within 4 hour of issue" policy. Our overall RBC wastage is less than 1%.

We are planning to implement soon but are planning to keep the process the same with 2 nurses.

I would say that anyone who is a super user of the system that knows the "why" or anyone trained to understand the "why" of the particular override, could theoretically have permission to do it.

We do the same. Patient sample is the QC.

All except Rh Ig (Rhophylac) is done by pharmacy.

We do the same as David. Beautiful reactions in gel.

I would have done the same as you. In fact I did this week on a patient with anti-E, -K -HLA (historical) and only the K cells reacted on straight panel in gel. E reacted with ficin-treated only. 2 extra E, K neg cells reacted but everything ruled out and E, K neg units were full XM compatible.

We are a small(ish) hospital, 280 beds. We have been reporting transfusion reactions for a little over a year in CDC's Hemovigilance. We have about 30 transfusion reactions a year, not a tremendous amount but since I am the one reporting, it can be somewhat burdensome with my normal workload. After seeing a year's worth of data I fail to see the value in this reporting. We are struggling to get legal approval for the AABB database to be able to compare ourselves nationally with more participating facilities. Is it worth our while to get to this level? I am considering dropping Hemovigilance altogether. What do you all think?

We are struggling with this as well. We are manual in BB but use lab labels for some of our paperwork. When names are changed, even if its just adding/removing a middle initial and or Jr/Sr. It's a huge mess. We normally require a new sample in these situations but do get approval to deviate from policy when necessary.

Good information, Mabel. Thanks for sharing.

[ATTACH]708[/ATTACH] Ok I think I have it ready for Transfusion Committee review. Any final thoughts? I really appreciate all of your assistance. -Colleen

What I was going for is that the crossmatch may be compatible, but antigen typing or complete rule-outs of other possible antibodies may not have been completed yet.

Here's what I came up with as a draft. We manage using O negs RBCs for Emergencies. I basically combined both our Emergency Release and Least Incompatible forms into 1.

Thanks so much. These are both great examples!

We are looking to revise the wording on our Least Incompatible form that the physician will sign when units are not compatible or not compatibility tested for transfusion (serologically). Can anyone share examples with me? chinrich@rwjuhh.edu -Colleen

Same here.

We detected in gel. Reference lab detected in both tube and gel.