bbbirder

I can't help with the Emergency Issue/EXM thing, but couldn't you just enter NP for your reactions and then an interpretation of "P" for presumed compatible? That is what we do if we transfuse Emergency Issued Group O blood and never get a patient specimen (due to the patient dying or something). Linda

We had a discussion about this in the past, and as I recall, it isn't absolute that it is a pharmacist is in charge of it or must review it, rather that it was a qualified, licensed practitioner. A patholgoist meets those requirements. I wish I could quote the actual regulation, but I can't find it now. Linda

We no longer stock any group O FFP/FP24, instead with thaw A's for the group patients. We don't have much wastage, but this has helped to reduce waste even more.

We have been having a discussion about when a Kleihauer-Betke stain (or even flow cytometry for fetal cells) becomes a worthwhile test to perform. We already do not perform a fetal screen (rosette test) at less than 20 weeks gestation, and only give one vial of RhIG (300mcg), assuming that the fetal blood volume is less than 30 mls prior to 20 weeks. However, in the case of trauma to the mother, the doctors often want a KB stain. I have not been able to find any reference that states it is of no value to do before XX weeks gestation. I assume there is one, where even if the fetus was exsanguinated, you would be unlikely to detect it in the mother's blood. Any thoughts? Thanks, Linda

Has anyone used Immucor's "HPC" (Human Platelet Concentrate) product? I am considering using it, but would really like to use it on specimens on our Echo analyzer that have reactions in solid phase but are negative in gel or tube. I think some of these are HLA related, just based on how they react and the patient characteristics. However, the product insert says to use it on serum (because it can cause some clot formation in plasma specimens) and we almost never have serum readily available on these patients. And, it indicates using it in tube... but if the tube testing is negative, there is no point. Thanks for any insight into this. Linda

Could you elaborate on the UDI product? Thanks, Linda

Merry Christmas to everyone, from someone working this day! Linda

Like Brenda, our nurses must signe off that there is an order. This is the responsibilty of both nurses doing the bedside ID checks. Linda

I agree with John, generalists are a challenge. But I am really proud of the generalists we have. I really try to keep on top of problems every day. And tell people what they did 'wrong' every time, don't let it go. If you let it go, they get the impression it is ok. For minor, annoying things, reminders. After 2, then I get more serious with notes into their performance evaluation file, then comes counselings. This gets there attention, if nothing else does. If it is serious, then counseling right away. Annoyances: Forgot to add the stir balls to the indicator cells on the Echo analyzer. More annoying: Can't figure out my panel because I pulled the wrong antigram! (Echo panel) Linda

We dispense all RhIG (Rhophyllac) from BB. The NDC is attached somehow in BAR. We are Meditech Magic. I can get details for this if you need it. Linda

At our facility, it is nursing's responsibility to confirm the order. In fact 2 nurses are required to confirm the order (due an error in the distant past when blood was given without an order). Monitoring is done by Quality Care Management (a nurse is the auditor). I would not want BB to be responsible for this. Linda

No, I really meant Rh-positive. Our Massive Transfusion Protocol (greater than 4 units per hour with continued bleeding), calls for switching to Rh positive blood on all males and females greater than 50 yoa. We will also switch Rh negative females of childbearing age if needed. We are 2+ hours from our supplier and can't afford to use all our O negs on one patient. We have never had to do this, but we will if we need to. Linda

We do vitals pre, 15 min and hourly AND then 1 hour post. The Outpatients (who are usually return customers) are encouraged to stay and given written instructions on what to watch for when they leave. Many of these outpatients do not stay (I doubt the nurse really twists their arms), if they leave prior to the one hour check, the nurse documents that the patient declined to stay.

Ditto to the last 3 responses. The nurses performing the transfusion are responsible for verifying the physician order. Linda

We have an Echo and get these antibodies from time to time as well. We have gel and tube available to us, and test with those, and due a full XM. Most patients who are positive with all cells on the Echo but neg in gel and tube seem to have some sort of autoimmune disease, at least the ones I have looked at. I don't think we'd benefit from sending these to our reference lab, since they only do tube testing. If our tube is negative, I assume their tube test will also be negative. Has anyone used Immucor's "Human Platelet ... something..." product (sorry I forgot the exact name) to neutralize Bg-HLA related antibodies? And, if you have used it, do you run specimens treated with it on the Echo? Linda