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SMILLER

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Everything posted by SMILLER

  1. SMILLER
    Simular to that above, we check approriateness at the time of issue. Requisition forms must include indication, such as low Hgb, OR holds, low Plt, etc. In most cases, we require that the actual Hgb or INR or whatever is on the form before we issue. This is writtento in our BB policy (and nursing) so if we fail in this, we get cited. I am not sure who has cited us for missing info in the past--FDA or JCAHO or both, but inspectors habve checked this because its in our procedure. Of course, we have to have an order put through the hospital's ordering system in the first place. Exceptions being for Massive Transfusion Protocols or calls for a cooler to be packed for OR. Both situations are covered by pathologist-approved policies that allow us to order the products and/or tests directly from BB. Scott
  2. SMILLER
    You didnt say what type of system you are getting, but it should come with a backup database that automatically keeps record of stuff in case the primary system has a catastrophic failure--so no worries there. Like others have said, you will find it easier to displays lists of lots of this stuff on the computer than to try to maintain some sort of redundant bulletin-board system for what you want to review on a regular basis. Before this thing goes live you will be having a great deal of training for users. You should also be able to talk to current users by asking your vendor about them--for questions about how others are already using the system. i think you will find that many of the things you think you will need posted on paper will not be needed. We do have a white-erase board in our BB for shift communication. Who is in intensive care, special units on hold for certian patients, units about to outdate, reminders like those. Scott
  3. SMILLER
    Yikes! TVC15, I would ask what state you are in, but I understand if you would not like to disclose it! Even if the Pathologist or MD in charge of BB approved it, I would question whether that decision can be delegated to a med tech, even with an approved policy in hand. Nurses yes, but a lab tech? Are we talking about Benedryl or something more potent from pharmacy? Scott
  4. SMILLER
    The gist of the regs seem to be that 25 Gy reach the center of the unit (with at least 15 Gy overall). So if you also have a 25 Gy one there I think you are covered. I am not really sure what we have downstairs here to prove that our system is validated. The only other reg I can see is that you cannot exceed 59 Gy anywhere on the unit. Scott
  5. SMILLER
    We put 25 Gy indicators towards the top of the unit, above the label. Scott
  6. SMILLER
    Don't think so either. And i am glad i agree with all these people here! Scott
  7. SMILLER
    We do use the test system on our Mediware BB system to set up various training scenarios. Everything on that system is a mock up. Normally its used to validate software upgrades. We have used it in the past for such elaborate (and critical) practices as the release of uncrossed matched products for massive transfusion prorocols. But here, there is no actual testing being done (which is what our JCAHO and FDA inspectors focus more on). Scott
  8. SMILLER
    We also have never had an inspector question why we do not bother to enter proficiency cases into our BB system. Scott
  9. SMILLER
    Seems like a good question. Nothing special here in our hospital that I can find. It would have to be something really bad, like a fire in the Lab or a tornado, in which case, salvaging blood would not be a high priority. I would think that any local emergency patients would be triaged to another hospital. Or what happens when, for whatever reason, any critical department is unable to perform its function (like Lab, ER, OR). I am thinking of a toxic or bio-hazard spill, fire, etc. Does the facility notify the community emergency call people to stop patients from being sent to the facility? Scott
  10. SMILLER
    The majority of our OR patients here walk in the day of surgery and have a T&S drawn by the pre-op unit. Needless to say, we are not real happy about this. Years ago we used to do T&Ss as part of pre-admit testing--usually 3 or 4 days before the surgery. The patients had to go home with armbands on. I believe at that time we would do that for up to a week before surgery. Of course, if they lost the armband, the T&S had to be repeated the morning of surgery. Scott
  11. SMILLER
    In our lab we have some areas, like Micro, that use the LIS in this way to record proficiency results. Mostly we do not bother, as we already have to enter it online to submit results, and adding the step of ordering faux tests and resulting them on the LIS is redundant. Why do you feel a need to use the LIS at all? Scott
  12. SMILLER
    By any chance, has anyone seen this thing in action? Its not supposed to be ready for at least a year, but there is some information on the net about it. This analyzer reports out everything a typical analyzer does, CBC, diff, retics, etc., but does it all from a slide that has had specimen sprayed on it (like an ink-jet printer I guess) and then stained. It uses a digital scanner to get all of the results, including a display of as many cells as you want to see for review. Theoretically making microscopic reviews virtually obselete. Thanks, Scott
  13. SMILLER
    Well gee, I just found out that our blood supplier has indeed been sending us male plasma (and non-gravida female) plasma for some time. Doesn't seem to be a supply problem even though its cut in half--it would be much worse if the pRBC supply was cut! Scott
  14. SMILLER
    Does anyone have an opinion on the idea of using only male plasma as a way to cut down on TRALI cases? A study in the Netherlands found a reduction of 33% with this idea. Supposedly male plasma is less likely to contain antileukocyte antibodies. Thanks, Scott
  15. SMILLER
    What! Should we really be catering to the stalwart pagan last-century anarchists, who waste time practicing useless cold-reacting IgM antibody immunohematology psuedo-testing, wallowing in thier cobwebbed beds of antiquated techniques straight out of the dark ages! Perish the thought! Scott
  16. SMILLER
    (OK then, I am guessing you really DONT mess around with mini-cold panels either?) Scott
  17. SMILLER
    LOL! Scott
  18. SMILLER
    Well I ,for one, thought it was a good line! I had assumed that your "tone" was a bit of a tease and (at least a bit) tounge-in-cheek! Scott
  19. SMILLER
    Actually, if the cold interference causes a big problem with our gel screen (we have a pretty good idea what cold agglutinin interference looks like), we would start a prewarmed tube screen. If time is a big deal, we would also simultaneously start a 30 min and a 60 minute settle. (I would think that "verifying" the cold with a mini panel does not help much by itself.) Scott
  20. SMILLER
    Same as Banktech, above. Scott
  21. SMILLER
    Same here. Since switching to gel (no IS) there is little need to run a min-cold panel for interference investigation. Having said that, a google search should turn up some procedure references for you. And of course, to change your SOP, you need your pathologist's input. If you are doing gel, you may want to ask if you can just drop it all together. Scott
  22. SMILLER
    This is revealing, though, in one sense. There is quite a bit of variation in how labs handle weak D testing: whether its done at all, only for prenatals, reported as positive if 2+ and above only, etc. There is another thread here about weak D testing that showcases this variation. We currently have a student doing a research project on the issue. Out of four hospitals in our area, we have found that there are four different protocols regarding how weak D testing is done! So the fact that this one question causes so much confusion is not too surprising. Who knows, those sneaky devils at CAP may have worded it ambiguously on purpose just to see what kind of backlash they get! Scott
  23. SMILLER
    It seems to me there are at least two ways for techs to initiate test orders without getting into trouble (when preliminary results indicate follow-up needs to be done ASAP). The most common is to have a pathologist-approved protocol for reflex testing, such as ordering and reporting antibody panel/ID results when a screen is positive. The other is to simply call the ordering physician (or pathologist) with critical preliminary results and ask for futher orders. Scott
  24. SMILLER
    We started using a Beta Hydroxy Butyrate (BHOB) test on our Vitros FS. Works well. Apparently better for detecting ketoacidosis than the Bayer tabs anyway. Scott
  25. SMILLER
    Terri- just curious, what does your manufacturer's insert say, if anything, about QC? The Ortho insert says to check for weaker Ag reactivity "periodically". Thanks, Scott
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