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May 2024 Challenge

SMILLER

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Everything posted by SMILLER

  1. SMILLER
    Ya, anyway Yolanda, I would just report the critical value. Scott
  2. SMILLER
    This is not just a phase. There has to be a drastic way in which clinical laboratories are managed now. Acute care centers such as hospitals cannot function without a laboratory. Many systems have taken a cue from reference labs and consolidated their various facilities testing by creating a centralized lab for all but STAT work. I think this is the way to go. Smaller hospitals will have to cooperate with each other regionally if they want to provide reliable care for their patients. Scott
  3. SMILLER
    Thanks. I think we are OK then. Scott
  4. SMILLER
    I am also of the opinion that the "cold" antibodies discussed here are insignificant in virtually all cases (except as an artifact to get rid of when antibody screening!). Occasionally we will see an order for cryoglobulins--which may be a problem at RT during pump by-pass procedures. Scott
  5. SMILLER
    I have not considered this. (We have NOT been saving our interfaced UA analyzer tapes!) Can you quote a CLIA or JCAHO reg for that? Thanks, Scott
  6. SMILLER
    We are JCAHO accredited. We do not keep interfaced analyzer printouts. When we have downtime, and we have printed temporary reports, we save those. Scott
  7. SMILLER
    I am a generalist in a 270 bed trauma 2 hospital. The tech shortage is bad all over. If you are in a system that cannot find some way to attract new graduates (wages), then you are having real trouble. We can't hire people, in spite of the fact that we have a local college CLS program nearby that puts out about 15 graduates a year. We can' t even keep the students that have interned here! This shortage has been developing over years. We have been begging the administration here to wake up and do something, because its starting to get really bad. Unlike other times when we've had staffing shortages (been here for 30 years), there is no relief in sight. According to various articles in journals over the years, in the US we are seeing about 15000 openings a year with only about 6000 graduates. There will have to be some drastic changes to many labs to provide appropriate patient care. The changes have to be made NOW, they should have been done here years ago. Scott
  8. SMILLER
    Our policies and procedures are rather elaborate--- one ties in with what report is provided by our blood supplier when it involves a call-back. Like all transfusion services, we have other procedures for adverse events such as TRALI, and possible hemolytic transfusion reactions. I believe some form of policy/procedure is required by any regulatory agency over BB, including JCAHO and FDA. You would have to check their standards to see if you are in compliance. Scott
  9. SMILLER
    More likely the slips must be hung onto at least until after your blood provider gets their payment. If there is any dispute over what you are charged and/or paying for, then you have their packing slip to refer to as a sort of "receipt". Doesn't seem like you would need to hang onto them forever. May be a billing department requirement. Scott
  10. SMILLER
    Is your pathologist in charge of all of the labs in question? If so, it should be relatively simple (depending on the initial cooperation of the pathologist/director) to come up with criteria. Once he or she signs off on a set of standards, it will be your job, as a coordinator, to get all the techs on board with it. Start by sitting down with your pathologist and find out what they feel should be submitted. Then write up a preliminary policy. Keep in mind that it needs to be comprehensive but straight-forward enough so as not to boggle the techs at the various facilities that will have to follow it. (Ours only takes a few pages -- we also have it boiled down to a single-page "cheat sheet" that is posted in Hema areas.) Then take it back to the pathologist for final approval/revision. Follow up with the associates. If some of the techs are under other managers, make sure you get buy-in from them before you start education. Scott
  11. SMILLER
    I suppose depending on how the unit was held by the courier, a leaky segment could indeed be the culprit. Scott
  12. SMILLER
    We are using Mediware's HCLL in the BB. In general, ER will know through field triage what is coming so that they can use the registration system and give us a name/MR before the patient arrives. It takes about 10 minutes to order and print tags for a "initial resuscitation" cooler of 2 O neg RBCs and 2 AB FFPs. We are a level 2 trauma center so it is important that a patient can be registered before they arrive. Like many facilities, we always have at least two AB thawed units of AB plasma on hand along with a 5-pack of plts, in addition to the O neg RBCs. Scott
  13. SMILLER
    We have a back-up procedure to use warm tap water - monitored by a thermometer. And we have found that the larger units of plasma do indeed take 35 minutes or longer to thaw. Scott
  14. SMILLER
    Whatever the cause, I do not think the unit should have been hung in that condition. I would think that, at the least, the RN hanging the unit would have checked with the BB or a supervisor first. Scott
  15. SMILLER
    I think you need to follow the advice in the CAP response. How does your ER ID patients when they come through the door? They should already have downtime procedures for patient ID (as well as a John Doe ID procedure). I believe our registration system assigns a new MR (Medical Record) number if there is no other admission on the system. For John (or Jane) Doe names, we simply use a system that reflects the year and "Doe" number (Doe2018-14, John). So our two identifiers are at the minimum the name and MR number. Practically, we require a birth date for history purposes as well as date/time, etc. I would think that you may want to start with ER and find out what they are doing down there for ID on these types of patients. In the US, you MUST h ave two Identifiers for everything. Scott
  16. SMILLER
    If I am reading this correctly, it seems as though you have a number of chronic problems there, In the US, I would think your lab would be in violation of a number of standards. Who are you regulated by? Those are your MINIMAL guidelines. In addition to following those standards to the letter, your facility will need to address some other things, like--why are you seeing WBIT and specimen mislabeling issues? Your problems seem to go way deeper than whether or not the work is checked after it is finished. Scott
  17. SMILLER
    Regulatory requirements are pretty strict. I would think that if you are following those, what you are doing is safe (and you have given us very limited information) . Scott
  18. SMILLER
    It may be seen as modifying Ortho's method, which means you would a have to have a great deal of data to validate it. On the other hand, if you can get Ortho to state that it is equivalent to their centrifuges (which may actually be made by Diamed!), then it seems like it would be OK. Scott
  19. SMILLER
    We do therapuetic phlebotomies here at our hospital from time to time. For patients with polycythemia, we check the H&H just before the procedure. (For hematochromatosis, we also check ferritin.) The patient is then processed or deferred based on those results. I would say in both cases, if a phlebotomy is indicated by the lab tests, that is still going to be valid for some time, maybe even weeks. i don't think blood counts are not likely to drop by themselves in polycythemia, and likewise iron levels are not going to drop. You need to have you administrator establish a clear policy in any case.. Scott
  20. SMILLER
    Sorry Malcolm, I was distracted by a problem that I was having with a computer crossmatch whilst posting last... Scott
  21. SMILLER
    Same in the US. 4 hours from when it leaves monitored storage. Pretty sure that is clear from the regs. Scott
  22. SMILLER
    So in that case, the point of the article seems valid. Perhaps enzyme-treated panels (and screens?) should be run routinely by transfusion services (hospitals), not just on those "problem specimens" sent to reference labs. It might be treasonable to run on patients known to be negative for things like Kell or Kidd antigens, and to have been transfused in the past? Scott
  23. SMILLER
    So it makes me think about delayed hemolytic transfusion reactions. If these "enzyme-ID'd-only" antibodies are due to a low titre, can we say that they are insignificant? If a Jka antigen negative person has been exposed to Jka, and has a titre so low that it cannot be picked up with a regular gel screen, does that mean a DHT is unlikely? Or, in spite of the initial low titre, can those nasty memory B-cells crank out enough anti-Jka in the hours or days to come to cause a DHT? Thanks, Scott
  24. SMILLER
    The AABB Circular of Information for the Transfusion of Blood Components requires blood products to be transfused within 4 hrs. We do monitor this is and write up cases where the 4 hour limit is exceeded. Scott Scott
  25. SMILLER
    Right. That's what I am wondering. In the article I cited, they looked at about 100 specimens that they had equivocal results in gel. Out of these, about 25 turned to have significant allo-antibodies that would have been missed if the initial non-specific panel results were ignored as not significant. Notably, some of those patients had things like anti-E where even homozygous cells were negative intiailly. The thing is, no one goes any further with a negative gel screen (including this studies facility), so there is no way of knowing how many "negative" screens results are reported on patients who may have significant amounts of allo-antibody. (Likewise, you have to consider how to detect those antigens that are destroyed by ficin!) Scott
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