Kathy

Gotta say that I disagree. I went from Cerner at my former employer to Softbank with my current employer and could not believe the number of steps involved with Softbank (selecting units before you can crossmatch them, building and clearing worksheets, the inability to dispense blood products without an order - real problem for traumas, having to open lots and modify the racks before you can can get them on QC, having to order the thawing and splitting process and result it before it bills....). I could go on and on. Maybe the newer version of Softbank is better, but this one is a huge pain. I am really glad that my current employer is switching to Cerner. It is going to save my techs and myself a lot of time. The only thing I don't like with Cerner is the inability to electronically document supervisor review of results and exceptions.

Update: my nurses nixed that idea because the specimen number is a little harder to find.

See what I mean? If your specimen number is on your patient and your specimen, then putting another number (ie. Typenex) seems like extra work and extra expense. If you could get that specimen number on your issue forms and you had a downtime procedure in place, it seems like this could work. Banding the patient would be simple with a generic red band that has a card insert. The phlebotomist would put the specimen label on the card, insert it into the band, and place the band on the patient. When the nurse transfuses, they compare the patient's hospital ID wristband to the tag and the red wristband's specimen number to the tag.

We do require a new armband with each draw and our specimen numbers don't recycle. We don't have the specimen number on the tag right now, but I could check into how difficult it would be to get it on there.

I have what I think is a brilliant idea, although I know that it can't be this simple. Why not make the LIS generated specimen number be the BB ID number? What I mean is that instead of taking a BBID# from a manufacturer (Typenex, Shamrock, etc.), the phlebotomist would place a red band on the patient with an insert that has the LIS label for the blood bank specimen. Reasons I can think of why this is a great idea: Fewer steps in the process=fewer opportunities for errorThe LIS specimen number is already barcoded = lest cost (no need to purchase special numbers)The LIS specimen number is unique to the patient and it is linked to the date, time and collector Reasons why it might not work: LIS downtime or printer not working (you would have to use a commercially generated barcode in that case)If the phlebotomist labels the tube with the wrong specimen label (WBIT), you would never know (but, in fact you would, because the patient would be wearing a hospital band with their actual name and a red wristband that had a different name)Feel free to poke holes in this idea. Thanks!

Great suggestions from everyone. Mabel - I like your idea of putting the new lot QC with the actual product that needs QC. I am going to see if I can make a combination order/receive/QC checklist to go with each supply/reagent. Eoin - Funny how people think alike. Before I read your response, I had been compiling offenses and good things about each of my techs. Recently, I took the offenses and placed them on the horizontal axis. I put the techs on the vertical axis, and then I put dates of each offense. So basically I did the first part of what you mentioned. I like your idea about giving each tech a report so they could see how they compare. Smiller - I agree with you that techs set bad examples for each other. I remember before I was promoted I was told that it was fine to leave received units and elutions for the next shift. Maybe misinformation is being spread. I will need to put a stop to that. whbb - great idea about giving people tasks so that they can feel a sense of ownership. I will see what I can come up with. LabCare - do you still have the "Do it correctly the first time" chart? If so, would you mind sharing? Jamie - We aren't having trouble with individual products being entered. We have problems with whole shipments being put in the bottom shelf of the refrigerator and not being entered. I think your idea about printing out a received list is a good one provided we were having trouble with a random units being missed.

Thanks for all of the suggestions and I love the reference to herding cats. We have 289 beds, transfuse about 480 units of products per month and process about 300 type and screens per month. The hematology supervisor reports having similar problems and one of my best techs tells me that the prevailing attitude seems to be that someone else will take care of it. I would LOVE to have dedicated BB techs, but I don't know if that is reasonable. I think it's time to really crack down. There is really no excuse for some of the stuff like putting the unit on the wrong shelf or putting the older unit toward the back, where it doesn't get used first. I like the idea of putting the paper on the stuff that needs QC and leaving notes about important things.

This job is slowly driving me bonkers. Every day I find things that the techs have missed such as forgetting to return units in the computer, not logging them into the computer, not changing the current lot number of reagents in the computer, putting the units on the wrong shelf, not cleaning up, leaving paperwork out....I could go on and on. I am getting frustrated and am beginning to think that maybe this isn't the best position for me to be in. I'm not sure if I am an ineffective leader or if I am just dealing with a normal problem that is part of this job. I do talk to the techs, and it doesn't look like it is the same tech making the same mistake all of the time. My techs are mostly generalists. I know that the blood bank is a very complicated department and if you don't work there all of the time, it is easy to forget the details. The problem I struggle with is the fact that we have rules that must be followed. There are A LOT of rules. Is it reasonable to expect a generalist to remember all of those rules? Is there a way to simplify things for them (checklist, charts, etc?).

Apparently urban legend because our lab's CAP team came a few months before my CAP/AABB inspection. This being my first inspection as a supervisor and the fact that the CAP team came before the scheduled move of the laboratory, I was constantly in fear that my inspectors would arrive during our move.

While we are on this subject, we currently require all of the following information on the specimen, the patient blood band, and the big Typenex card: Patient name, MR#,DOB, Typenex #, phlebotomist ID#, witness ID#, date and time of collection. I really wonder what is the point of putting all of this information on the big Typenex card. Would it be sufficient to have it on the blood band and the specimen?

I made up a few custom courses (tests) on the CAP website to assess my techs' ability to catch errors. I made up several specimens that should be rejected, took pictures of them, and uploaded them to the website. I was able to make up questions about them: What is appropriate to do with this specimen? A) Accept it B)Allow the collector to fix the missing info C)Reject it... I did the same with tagged units of blood, asking if they were acceptable to issue and if not, why not. My techs say that it is a difficult test, but I think it is a good way to illustrate how important it is to pay attention to the details.

Please tell me why, if I use my sterile connection device to attach the syringe/filter set, I have breached the sterility of the syringe, but not the original red cell unit. It seems to me that if you breach sterility, the entire system is compromised.

We use opaque red ziplock bags that do NOT have biohazard printed on them. Why opaque? So people in the hallway don't freak out. Why red? So that the nurses will know that it is important and it stands out if someone leaves it on the counter.

Thanks for the replies. I went ahead and got her to come in on the day shift to do the full competency. As for what Goodchild said about seeing enough simple errors as is...this is the part I dislike about my job. It is so frustrating. There are so many details to remember in the blood bank and the only people who remember them all are people who work in the blood bank a lot. I struggle with which of these little errors to let go by and which ones to talk to the techs about. Obviously, the ones that are patient safety issues are dealt with promptly, but there are others that I let slide like ordering and billing problems. I fix them myself or have my one dedictated blood bank tech take care of them.

We have a tech who was working every other weekend in the blood bank. Her competency was due in January, but I did not do it, since it was at the time that she was leaving and I didn't expect her to be working here anymore. Now, 4 months later, she is back working in other areas of the lab every other weekend and the techs working in the blood bank would like for her to cover them in case of emergencies or if they need to go on break. Their argument is that she works in another hospital blood bank full time. I don't think I can take that into consideration when determining her suitability to work in our blood bank. I feel like the full competency needs to be re-done before I can let her touch anything in the blood bank, but some people think that is overkill. Is there anything she can do in here without me doing the full competency? I also have concerns about anyone that works in my department who only does so infrequently. What is the minimum amount you would have someone work in your blood bank and still feel confident that they would remember your procedures?

I don't think we will be karyotyping the babies, and being male-female, they are most definitely not identical twins. I am in a pediatric hospital, and very familiar dealing with maternal antibodies in babies. We usually give O to babies because they require such small volume transfusions and this way we can use one unit for a few different babies, regardless of their blood type. If we are going to give non-group O blood to a baby, we do the reverse Coomb's to detect maternal IgG antibody against A or B cells. If negative, we give the non-O blood but if Mom has the IgG anti-A or anti-B, we will stick with O blood. This situation was a challenge for us. It seemed that it would be safe to give the type A1 blood because the baby's plasma lacked maternal anti-A1 and we even went so far as to crossmatch the dad's blood to the baby at the AHG phase. Everything was fine, and we won't expect the baby to start making ABO antibodies for a while. I read more on chimerism in twins and I think that makes perfect sense. This baby could very well really be type O with some of her twin's blood in her circulation. I most definitely do not want to be giving type A to a patient who may be group O, regardless of the lack of circulating ABO antibodies. This baby is a preemie. I would be very interested to see what her typing looks like 1 year from now, but with any luck, she will not have any reason to come back for more transfusions at that age.

Malcolm, Interesting. I did not think about chimerism. Unfortunately, our pretransfusion specimen was drawn more than two weeks ago. Our current specimen is not representative of the patient's own red blood cells, since this patient has had multiple transfusions (with type O blood). RBC phenotyping would be useless at this point. The parents don't seem to object to us giving O blood rather than the directed donor unit.

On this same line of thought, I assume that you would also give type A1 blood in the following scenario: Twins <1 month old at our hospital. One is type A (positive with A1 lectin), and the other is possible type A3 (mixed field reactions with anti-A, has not been transfused, negative with A1 lectin). Neither has anti-A1 in their serum at immediate spin or IgG. We have a directed donor type A1 unit from one of the parents. Unit is fully compatible with the A subgroup twin. Do we give the directed donor unit to the A subgroup twin? If so, should we get specimens every 3 days to ensure that the baby doesn't start making anti-A1? I know that babies don't normally make anti-A until 3-6 months, but I'm not sure I want to take any chances.

Congrats! Are you enjoying your job?

For those of you who are blood bank supervisors, who ensures that YOU are competent to do all testing/procedures in your blood bank?

Are you printing the ISBT label before you actually split the unit so that you can do the label verify? Right now I am just setting it up to capture the Tech, unit number, lot number of transfer bag, expiration of transfer bag, and the acceptance of the weld. I wanted to also have the blood type of the unit, but it doesn't translate directly on the report. I did end up making my own barcode labels for lot number and expiration. One thing I don't like is the inability to barcode username/password. I am not terribly worried about someone who doesn't work in the blood bank coming in and using the device. I would rather not even have the username and password, but since it has to be there I would prefer to streamline the process with a barcode entry.

I validated my platelet coolers in a room that was about 16C...worse case scenario for platelet storage in the OR. I didn't do that for red cells because it will never get to 1C anywhere in my hospital, so the red cells would never get below 1C...I am only concerned with a high temperature for them. I have gotten platelet coolers back after spending the night in the OR with temperature indicators showing that the temperature went below 20C, so it was definitely worth doing the validation of those coolers in a cold room. If the cooler is going somewhere that has a monitored refrigerator and the products will be transferred from the cooler to the refrigerator as soon as it gets there, I call that transport. If it is going somewhere that doesn't have a refrigerator, I call that storage and validated those coolers for 1-6. I don't have an ice machine, so I rely on refrigerated gel packs for transport and Thermosafe coolers for storage.

I almost got cited for this a few days ago because I have expired anti-Jka in the refrigerator and my policy defines anti-Jka as 'rare'. I was told that only reagents that aren't readily available like anti-Cw are rare.

I don't want to hijack your thread, but we have a new Trucise system and it looks like you have had it for a while so you have the bugs worked out of your process. How do you deal with syringes or aliquot bags that don't have barcoded lot numbers and expiration dates? I think I will have to find a barcode making device and make barcode lot numbers for them.

I did challenge the deficiency, so hopefully all goes well. We had trouble with the Safe-T-Vue 10 indicators turning pink or red during the issue process, so now we place the units on refrigerated gel packs when we have them out on the counter. I can only imagine how bad the Safe-T-Vue 6 would be. I do have a datalogger that I use for cooler and refrigerator validation. I really like it, but the program is only on my office computer, so the techs can't use it.