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Posts posted by Dansket
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Also check the Access dictionary for Override Blood Type Calc Mismatch? setting.
David,
Whether it is set to Y or N, it has no effect on this issue.
Dan
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We are in the middle of doing the same upgrade. What was the exact scenario that you were able to enter the wrong blood type?
Thanks
Are you planning to implement the electronic crossmatch?
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Gerald,
1. Enter results for anti-A, anti-B, anti-D, Rh control, A1cells and Bcells for Group O Rh positive.
2. Observe the calculated ABO/Rh in the blood type field.
3. Move the cursor back up the screen to the line for anti-A
4. Change the anti-A result from 0 to 4+
5. System should display warning "Invalid blood type calculation"
6. Click on "OK"
7. Press F12 to Save
8. Press spacebar
9. Press F12 to file
10. Re-enter specimen number
11. Observe that OPOS is displayed at the top of the screen, yet anti-A was resulted as 4+
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Currently we are updating from Meditech C/S 5.64 to Meditech C/S 5.66. During a validation scenario, I discovered that it is possible for a user to enter and file serological test results that do not match the calculated blood type! I reported this to Meditech and they offered this solution (overnight Saturday-Sunday
).Background
Whenever a Blood Type calculation is created in the BBK Calculation Dictionary, Meditech inserts generic code below into the Calculation Formula field:
Existing code
[bbk truth table]^X,
IF{'X [bbk err msg]("Invalid blood type calculation.")},
X;
Enhanced code
[bbk truth table]^X,
IF{'X [bbk err msg]("Invalid blood type calculation.")},
IF{'X [f bres delete]^X},
X;
The introduction of the line IF{'X [f bres delete]^X}, tells the system when the answer is not equal to the calculation for X then delete the calculated result for the target test, BT.
As a result, whenever an “Invalid blood type calculation” warning is displayed, system also erases the currently displayed blood type calculation, preventing a user from filing serological test results that do not match the calculated blood type.
I strongly encourage Meditech users to take advantage of this enhanced code to prevent the potential for ABO incompatible blood transfusion.
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What do you use as a positive and negative control to QC the MTS Diluent ?
There are two diluents, MTS Diluent 2 and MTS Diluent 2PLus that should not cause or prevent agglutination. If you are doing QC to determine that the diluents are inert in all situations, you would have prepare test cells suspended in each diluent.
You would then have to test the cells in MTS Diluent 2Plus against each gel reagent (anti-A gel, anti-B gel, anti-D gel, Buffered Gel (immed-spin xmatch), Monoclonal Gel) and test cells in MTS Diluent 2 against anti-IgG gel (both DATand -IgG xmatch) using a test cell that gives a positve result and also a test cell that give a negative result.
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You could have a rack in continuous use for extended periods of time . . . I don't care what the regulations allow, I feel that good practice demands that each rack in use be qc'd each day of use. My personal bias.
I agree with David. Theoretically, testing one vial of each lot each day should be sufficient. However, it would not detect a vial from a non-QC'ed rack that had been mishandled or inadvertantly contaminated during usage.
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Our requisition is the 'set of specimen collection labels' submitted with the blood sample container that is identified by a specimen collection label. So regardless of a truncated long patient name the 'requistion' does match identically to the label on the blood sample container..
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1. Currently in a small facility with an average census of <50 patients. Active, ER, OB and Surgery. Average of 74 Type and Screens monthly. Transfuse 100-120 RBC monthly.
2. Our goal of 70 minutes is met 80-85% of the time.
3. Receipt to Verify. Samples are delivered directly to Blood Bank unspun. Centrifuge for 3 minutes with Statspin.
4. Two (2) ProVues, no manual testing (tube or gel) is done.
5. We are using Meditech 5.64 going to 5.66. Have a custom NPR report to download data and then sort in Excel.
6. We have similar situation as LCoronado as a barrier to reducing TAT
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I QC a reagent Shipment/Lot on-receipt and then QC on Day of Use. I do not QC a vial retreived from storage (of a Shipment/Lot that had been QC'ed on-receipt) after Day of Use QC had been done. Day of Use QC and On-Receipt QC may be performed simultaneously. This protocol is based on the assumption that QC is performed/documented in a timely manner and reagents are stored properly.
Is Pa referring to the State of Pennsylvania?
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Who is your accrediting agency? Do you use a computerized laboratory information system?
We don't require phlebotomist initials/signature on the blood sample container label because that information is captured in the LIS in the Collect/Receive blood sample routine after entry by the phlebotomist.
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Our goal was issue 2 units of RBC in a cooler into the surgery dumbwaiter is less than 5 minutes using the electronic crossmatch. Over time all staff could do it in 3 minutes or less and some could do 1 unit a minute. Of course a cooler was not used for RBC issued into the pneumatic tube system...
The timer started ticking upon receipt of a request to issue blood component printed on our blood bank printer.
We scanned a barcode printed on that form into SoftBank, performed the electronic crossmatch, printed a crossmatch tag and then scanned the crossmatch tag and bag into the blood issue routine. RBC unit bagged in biohazard bag and put into pneumatic tube carrier.
This process above did not require use of the patient blood sample. No serological testing was done for patients who qualify for the electronic crossmatch.
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There is an article titled "Debunking the 30-Minute Rule" in the May 2010 edition of the AABB News. The 30-minute rule ignores the laws of thermodynamics and is unacceptable today. The temperature must be taken on all units returned unused to determine if the unit can be re-issued for transfusion.
You didn't mention the pneumatic tube transit time. It is likely the reason why units are exceeding 10C as Deny Morlino mentioned.
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If you implement semi-automated blood bank testing, you must also consider 'backup' when your semi-automated instrument is out of service.. I prefer gel because both manual and automated methods use the same reagents. If you use manual tube Plus a semi-automated instrument, you have to maintain two reagent inventories, and maintain staff competency with two methods. In a small facility, I prefer to minimize the 'overhead' associated with multiple testing methods.. Use manual gel to backup instrumented gel or better yet, have two automated instruments to backup each other!
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Consider doing a survey in your facility of all newborns treated with phototherapy prior to discharge. Note the mothers and babys ABO/Rh, DAT results, and Bilirubin levels for each newborn. Look for associations between DAT results, how many newborns treated with phototherapy had a positive DAT, negative DAT? How many newborns were ABO incompatible with mom? How many were ABO compatible? How many infants had no ABO, Rh or DAT testing done but were treated for hyperbilirubinemia with phototherapy?
I did this on 1350 newborns of whom 26 were treated with phototherapy. There was no correlation between ABO, Rh and DAT results. 13 newborns were treated who had a negative DAT.
My conclusion was that routine ABO and DAT testing on all newborns had no predictive value identifying infants who would ultimately require phototherapy to treat hyperbilirubinemia. Bilirubin levels do!
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There is a Centralized Transfusion Service in Pittsburg, PA. Also Puget Sound Donor Center in Washingon state did operate a centralized transfusion service.
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It sounds like our policy is similar to others that have posted here. The anesthesiologist must sign the transfusion administration form as the transfusionist, and there must be a start and stop time included, the serial number of any blood warmers used, and an indication of whether any transfusion reactions were suspected. Regarding vital signs documentation before, during and after the transfusion, our policy allows a notation that states "see anesthesia record."
We follow the same policy, as well as a checkbox on the crossmatch tag "see anesthesia record".
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Using Meditech C/S ver 5.64, we print our "crossmatch tag" on 8.5" x 11" pre-printed laser label stock stored in Tray 3 of our HP LaserJet 4250 printer.There are die-cuts near the top of the form that create "labels" that are removed and affixed to the blood component container (provides permanent link to patient) and to the Request to Release Blood Component form at the time of blood issue.
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See the Polls forum on "Use of an Anti-A,B test result" for more ideas.
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The science is very basic! When you issue non-group O red blood cells in an non-emergent situation, there is a real possibility of transfusing ABO incompatible red blood cells to a patient, i.e., there is risk associated with this practice. What is the Lab Managers compelling reason to do this?
When you issue group O red blood cells in an non-emergent situation, there is no possiblity of an transfusing ABO incompatible red blood cells to a patient. There is no risk here!
Our policy requires that group O red blood cells be issued uncrossmatched unless all tests required by routine pretransfusion compatibility testing have been completed. There is no ambiguity for staff to address with this approach.
- maristelgp and Lbiggs
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I must disagree to some degree with almost every response (except Mabel's first statement). Well thought policies and training should prevail, not an opinion in the heat of the moment. I certainly do not think that the cost of doing business should enter into the decision whether or not to follow the antibody identification protocol. Tom didn't mention the urgency for blood transfusion in this situation, so I don't know if the patient's conditions supported his actions.
We don't re-identify historical antibody for transfusion recipients unless incompatible crossmatches are detected with antigen-negative donor units or antigen-negative screen cells are agglutinated. Just this one change in policy would save thousands of $$$ annually in Tom's facility and take cost out of the decision equation. Requiring that this patient receive Kell-negative blood is also an unnecessary cost incurred by such decisions.
Regardless, I do agree that the specimen should have been sent to an IRL to confirm Tom's conclusions.
As a new BBK supervisor, please consider updating the antibody identification protocol to allow rule out of anti-K with a single heterozygous panel cell (as Mabel said) and communicate this to all your staff.
Dan...
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Our antibody screen test is configured with two T tests, Cell 1 and Cell 2. These two tests are used to enter the serological test results of screen cell 1 and screen cell 2. Then Meditech calculates the Interpretation.
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I am currently trying to build a calculation for a DAT in Meditech and would appreciate any help you can give me. Unfortunately I don't have enough brain to wrap around this today. Thanks!
This is what we use, but does not include testing results with anti-complement:
; This DAT Calculation is for adults and newborns. It utilizes
; Profile Test: DAT NB Print# 120.1810 and DAT Print# 120.1800
; T Test: IGG Print# 120.2000 Anti-IgG
; T Test: DATR Print# 120.2200 DAT Interpretation
; Note: To invoke calc fields, press the Get key [F5], then "f b", then [F9]
IF{IGG#0="1" "Positive";
IGG#0="2" "Positive";
IGG#0="3" "Positive";
IGG#0="4" "Positive";
"Negative"}^X,
;IF{X [f bbk msg]("Value of X is "_X)},
IF{'X [f bbk err msg]("Invalid calculation.")},
X;
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To AMcCord and ALLOURBEST NLR,
Regarding the incident AMcCORD described, was your facility using a secondary blood bank ID band or did Nursing remove the hospital ID band from one patient and re-attach that same band to a different patient?
Blood Bank ID bands like TYPENEX are designed so they cannot be reattached. At the time of specimen collection, both the blood sample container and the patient are identifed with a unique number-letter code. This code is transferred to the compability label attached to the blood container. Nursing must match code on patient's blood band with code on form. In the incident you describe, the Nurse would arrive at the bedside and discover that there was no blood band on the patient.
Properly designed electronic systems mimic the TYPENEX system..
Dan
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Eliminate potential for ABO/Rh resulting error in Meditech
in Computer Systems / Software / ISBT128
Posted · Edited by Dansket
Be aware that after rbc's are issued uncrossmatched, Meditech does not allow computer crossmatch of those unit(s) regardless of a negative antibody screen, no history of clinically significant antibody and two blood types done.