SMILLER

We are starting to get the idea that whilst OR will write the P&P, our director will be signing off on it, as well as the myriad of hospital committees that have to sign off on everything.  Should be done by 2016.
 
Scott

Yes, as Terri has mentioned the Medical Director is the one who interpretes the Transfusion Reaction,so untill he/she interpretes NO further Transfusions.
And we put a note for that to alert coleuges.
The reaction could be from Anti- IgA that requires either IgA deficiency blood or washed RBC's OR  FNHTR that may require Leukoreduced or HLA match in case of Platelets. 

Don't forget that the standards also include as a requirement for the evaluation:
 
Review and interpretation by the medical director.
 

"If there are no clerical errors, visual inspection is okay, DATs are negative, and there is no drastic change in the serum/plasma  we are to call nursing/physician with results and additonal units of blood may be issued for transfusion."
 
I would think that if all of the above is true, then there is no transfusion reaction, and the policy should state that the transfusion can be restarted at the discretion of the attending physician.
 
There may be some confusion on your administrator's part between a reaction workup and a transfusion reaction. Just because a workup is done, does not mean that a transfusion reaction has taken place.  Rather, the workup is to determine if one has taken place.  If one has  not taken place, you do not need  specific approval (to restart or give other units) from the Lab director as long as BB is following their P&Ps.
 
Scott
 
 

Thanks Terri.  The second reference may be a model for our P&P if we have to provide one (even though some of the words are spaelled funny!).  I had come across the other two earlier.  The third one in particular appears to be from a AABB publication, though it is hard to tell just where.
 
Scott

Here's the CAP perspective:
 
TRM.41525 Perioperative Blood Program Phase II
The authority, responsibility, and accountability of the perioperative blood recovery and
reinfusion program is defined.
Evidence of Compliance:
✓ Memorandum or policy describing the program
 
TRM.41550 Intraoperative/Perioperative Safety and Efficacy Phase II
The procedures for intraoperative and perioperative blood recovery ensure the safety and
efficacy of the recovered blood components.
 
TRM.41600 Medical Director Involvement Phase II
The transfusion service medical director is involved in establishing policies and procedures
related to intra- and perioperative collection and reinfusion procedures.
NOTE: The intra- and perioperative collection and reinfusion procedures are part of the transfusion
medicine procedures. The transfusion service medical director must be aware of, and participate
in, the development of policies and procedures to help the institution ensure efficacy and patient
safety.
Evidence of Compliance:
✓ Written policy defining responsibilities of transfusion service medical director
 
We use a vendor for our cell salvage. Their quality plan/P&P manual is available in the OR and blood bank and has been reviewed/signed off by our medical directors. All the documents are developed by the vendor but we do meet with them yearly-ish to discuss a wide range of topics including the P&Ps they follow.

Right, got all that from the Watchtower references.  But our problem is that we have no P&P for OR, and other than a $100 AABB book I found available on their site, I can't find much regarding recommended procedures on the internet.
 
All this for a situation that may not arise again here for months or years.  But we have a surgeon that wants it set up for next time.  Oh well, maybe we can get him to spring for the book?
 
Scott

Looked for that article today online, could not find it, but I found out there are a number of hospital systems that do the double-check (as opposed to the readback) for things like meds and transfusions.  One of the hits was an old thread here on independent double check from 2013! (no references there either though)
 
I think it may have been in an old-fashioned paper-based journal that I read last fall.  The gist of it is a read-back may be appropriate for actually reading back a written order to a doc over the phone, but that it really is not so great for verbally checking a tag between two people when comparing it to an order for blood.  In the second case, there is really only one check being performed, and since it is between two people, there is too much room for missing something.
 
An independent double-check is a true double check.  A single set of eyes compares a number to a number or a name to a name on two pieces of documentation.  Then it is done again by another person, greatly decreasing the chances of missing an innaccuracy.
 
Scott

A note on confirmation bias.  I came across an article recently that suggested that a "read-back" confirmation with two people (such as at the bedside before hanging a unit) was not as reliable a check as you might think.  This was due to the not insignificant likelyhood of people tending to check off stuff when heard by ear from another without really verifying what they are looking at. 
 
In fact, they concluded that a safer "re-check" was for each person individually to a check between two pieces of documentation, and avoid the read-back altogether.
 
Scott

A note on confirmation bias.  I came across an article recently that suggested that a "read-back" confirmation with two people (such as at the bedside before hanging a unit) was not as reliable a check as you might think.  This was due to the not insignificant likelyhood of people tending to check off stuff when heard by ear from another without really verifying what they are looking at. 
 
In fact, they concluded that a safer "re-check" was for each person individually to a check between two pieces of documentation, and avoid the read-back altogether.
 
Scott

This is the time of year when Blood Centers run low on blood!  Everyone is too busy shopping and going to parties I guess. We should all think about donating if we have the time over the next few weeks!
 
Scott

This is the time of year when Blood Centers run low on blood!  Everyone is too busy shopping and going to parties I guess. We should all think about donating if we have the time over the next few weeks!
 
Scott

Our tags have a section that can be checked and signed indicating that there was a rapid transfusion., and that vitals can be found on the chart.   Someone still has to review the tag and send the copy back to BB.
 
Scott

Our tags have a section that can be checked and signed indicating that there was a rapid transfusion., and that vitals can be found on the chart.   Someone still has to review the tag and send the copy back to BB.
 
Scott

This is the time of year when Blood Centers run low on blood!  Everyone is too busy shopping and going to parties I guess. We should all think about donating if we have the time over the next few weeks!
 
Scott

Thanks Malcolm.  I was at work yesterday, but thankful regardless!
 
Scott

We have transitioned to using group A FFP and liquid plasma for our trauma patients who are emergency released blood, and for all MTPs (we still use AB if we have an abundance of it thawed or if we are only able to get AB liquids to restock). My supervisor worked with the trauma program medical director and the CMO and we developed new SOPs for this. We have discussed putting together a short paper, as we've been collecting data on all emergency release patients. Since September we've had about 40 trauma patients receive group A plasma, and we've only had three B/AB patients in that group. On each of these patients we ran some extra post-transfusion labs (renal panel and LDH, DAT), nothing really notable so far. We've also been doing an abbreviated titer on the liquid plasma units we receive and setting aside anything with a titer of 64 or greater (only about 10%) for use on A or O patients only, if possible (which is most patients anyway!). FFP is not titered.
 
So far we've had no problems and it's been much less stressful than trying to restock AB after multiple traumas. In fact we had a day last month where we had 7 bleeding traumas in one shift, we would have been in a pickle if we'd used AB for them, so it was a huge help.

http://www.mayomedicallaboratories.com/media/articles/hot-topic/2014/2014-03-15-group-a-thawed-plasma-fulltext.pdf
 
There are a few articles in the references

I appointed a lab associate to "reagent czar" after too many incidents of no indate antisera available.  He checks the fridge regularly and knows when rare antisera is expiring and orders more when necessary. 

Note that if a patient has the wrong armband, a redraw is not going to help things much. 
 
Scott

There is good reason for that Scott.
 
Firstly, the reaction well at the top of the cassette will be at room temperature when you add your cells and palsma, and so a "cold" reacting anti-M will sensitise the red cells prior to the cassette being put into the 37oC incubator, but the incubation time is insufficient for the anti-M to dissociate from the M antigen.
 
Secondly, even if you warm your cassettes, prior to adding the plasma and red cells, it will still not be at 37oC, as you have to take the cassette out of the incubator before you add the plasma and red cells.
 
Thirdly, the gel/glass beads in which the AHG is suspended is slightly acidic, and anti-M just LOVES acidic conditions, and so will react more strongly with M+ red cells in such conditions.

Tattoos on the forehead (assuming, of course, we have a system to get it right the first time.....)

My inclination is that since this is not in the package insert, this is violating the package insert and shouldn't be done prior to use for in date antisera.
 
I think you are right with that.  Is this written up in your procedures as well?  I would make a few changes.  Lab practices that are done "just because" should be looked at very closely!
 
Scott

My inclination is that since this is not in the package insert, this is violating the package insert and shouldn't be done prior to use for in date antisera.
 
I think you are right with that.  Is this written up in your procedures as well?  I would make a few changes.  Lab practices that are done "just because" should be looked at very closely!
 
Scott

We do the same but it is partly because we are remote from our blood center and surrounded by smaller hospitals that don't do Ab IDs.  We think it is worth preserving the ability to give Rh neg blood in an emergency to a patient with anti-E, whereas if they also have anti-c already reacting strong enough to detect, there are fewer and poorer options.  Others will argue that it is not appropriate to use the limited c neg units on patients lacking the antibody.