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SMILLER

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Everything posted by SMILLER

  1. We have to have a current ABO/Rh, otherwise its going to be AB plasma. Patient ID is not 100% reliable as pointed out above. (If patient is arm banded and comes in later, that is a different situation.) Scott
  2. It's a nursing thing, but I am pretty sure you cannot reconnect any kind of IV once its disconnected. Scott
  3. Appreciate Kip's observations. above. Here our rationing policies involve cooperation between the four regional hospital systems along with the supplier that serves us. We have decreased transfusion thresholds for many types of patients--if a physician wants to override we are passing the request down the administrative line for approval when expedient. All hospitals are keeping inventories low voluntarily. If there is a real emergency at one of the hospitals the others will transfer stock as needed. Things are a bit better this week. Hope this is blowing over. Scott
  4. In general, an MTP policy is set up between ER, OR and the Lab. Here it was the OR and ER physicians who decided what it should include. We started with an MTP partly directed by lab results, but found it unnecessarily cumbersome in practice. For our BB, an MTP includes setting up sets of blood products until the MTP is called off. If you search here with the word "massive" you will see a number of threads that may give you a few ideas. Scott
  5. We are a smaller level 2 trauma center here. For example, we normally would want to keep our O pos inventory at 20. Today we ordered 15, they sent 2. This is the worst I've seen it in working 30 years here. Scott
  6. Here in Michigan, we are now instituting rationing policies due to the severe shortage of available random donor blood. I was wondering how other North American facilities are doing. Scott
  7. As a nursing task, the amount for each transfusion needs to be documented, if I am not mistaken. Scott
  8. We only QC the antibody panels, both for pos and neg reactions, when they are being put into use--specifically to make sure they were not "damaged in transit". Scott
  9. Our antibody-ID section in our procedure manual has gotten a bit bloated, but only because it is reasonably comprehensive. While we, like many, use the "3x3" rule, it becomes more involved when you start looking at individual antigens and antibody characteristics. (For example, a patient that is only producing anti-E is likely to start producing anti-c after they are transfused a few times. For this reason, most labs will screen units for anti-c for c-antigen negative patients producing anti-E.) Also, there are other considerations for certain situations, (such as a patient with a previously identified antibody need not have 3 positive cells to rule it in). In general, we have a procedure that details the 3x3 step by step. Then there are individual charts, tips, and notes for common specifics regarding certain situations, such as how to get around cold agglutinins, or the use of enzymes. You should be able to figure out what to put in your procedure from looking at the AABB manual. If your current procedure for antibody ID seems totally inadequate, you may want to start from scratch. Hope this helps. Antibody ID is the most robust procedure we have in our BB manual. Scott
  10. And Happy Boxing Day! Scott
  11. I believe the topic -- QC for panel cells -- has been discussed a few times here on Pathlabtalk. As far as "validation", not sure you need anything beyond what the manufacturer suggests. And I think Ortho only mentions QC. Scott
  12. We check speeds and times quarterly, "calibration" (cell-button acceptability at different times) annually. Scott
  13. It seems that there is simply a difference in terminology here betwixt "collection" and "issue". In the US (and perhaps some other countries), the term "issue" is for that process whereby the crossmatched unit is being sent out of the laboratory for transfusion. (In our lab, a tagged unit in the blood bank waiting for issue is in a "crossmatch" status.) Here, "issue" reflects what the Lab department is doing. I could see the use of "collection" as that is what the transfusing department is doing when they pick up a unit--collecting a unit from the blood bank. But here the only thing we use the term "collection" for would be in acquiring a specimen for testing. A particular country's regulatory agency would be careful to use terminology that matches practice in that country. Scott
  14. Woo hoo! Snow and Xmas lights! They are so cool! Ooops! I just broke one... darn! broke another.. Ooops... Scott
  15. It's not snowing yet on Pathlabtalk! Scott
  16. We are in the process of switching our specimen collection tubes to Greiner Vacutte (previously we used BD). For some reason, with one of our STAT fuges, the stoppers keep coming off while being spun. Not all the time but enough to be annoying. The centrifuge in question is a Hitteck EBA200. The vendor has recommended a certain insert for these Greiner tubes, but they still keep popping off at random. The stoppers are slightly different from the BD tubes, but we cannot see what is causing this. If anyone has any ideas for fixing this they would be appreciated. We are trying to see if Greiner has any ideas. Scott
  17. You are not overreacting. You are being responsible, which is what all healthcare workers need to be. Other than discussing all of this with your department administrative director (your manager's manager -- maybe you have done this already -- at our hospital, this is at the department director level), I am not sure there is much else you can do within your department. You mentioned talking to the FDA and your risk management department. Your hospital should also have a corporate compliance fallback for things like this (that cannot be resolved through management -- you can report anonymously if you desire) For corporate compliance issues, the business must respond to your concerns and report back to you within a limited amount of time. Good luck. Scott
  18. How nice it must be to live in a country where people do not have to borrow another's ID to receive health care! Scott
  19. Welcome Vivek. You may note, from some of the old posts above from 2017, that many labs do not use grading. In my lab, for instance, we have a chart of all appropriate morphology that we report here. The chart lists the proper name for each, causes, and what a significant level would be when reviewing a slide. If a particular morph is not present in significant numbers, it is not reported. When it is reported, we do not grade it. Scott
  20. Also, I am pretty sure that our inspectors over here would also have a problem with D+ platelets being given to a child-bearing-age female who was actually D-! Scott
  21. We went through this a few years ago. The problem with any kind of written worksheet is that it becomes your primary record -- the computer entry is secondary. -- resulting in both sets of records must be retained. When results are directly entered into the computer, almost all written testing records are not needed. Scott
  22. Except, as been noted here on various threads over the years, it can happen that a patient becomes admitted under someone else's identity. Scott
  23. Agree with Ward's points, above. Any change in policy will involve discussion with ER, Surgery, etc. that includes education once a decision is made. When we became a level 2 truma center a few years ago, we had a rather elaborate MTP process that included things like Coag and CBC results. We have two different orders for emergent situations: An "Initial Resusitation Cooler" order (2 RBCs, 2FFP), and an "MTP Protocol" order (5 RBCs, 5 FFPs, 1 5-pk platelets). We repeat the MTP order until it is called off. In addition, individual orders for uncross matched products can also be made. Scott
  24. Here we have to positively ID a patient for each admission. This involves arm banding and at least an ABO/Rh for plasma or platelets. Scott
  25. I would think that the rephrasing was to emphasize that is is the reagent in the vials (not just the vials themselves!) that expires after 7 days. I think it is clear that they are saying they claim the reagent is stable for 7 days after opening. If I were an inspector, I would interpret the new phrase as indicating that the "performance characteristics" end after being "maintained" for 7 days, which would mean that you cannot use a vial after that time. Scott
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