mrdth5

I am still trying to wrap my brain around IQCP but the way I understand it, you don't have to do IQCP as long as you follow the manufacturer's instructions. I think as long as you do QC on the day of use following manufacturer's instructions, you are good to go. So I think BB will be OK, for the most part, with daily QC on our regular reagents as long as we do a negative and a positive for all reagents. (I beefed up my daily QC to add negatives for this part.)  Rare antisera will need QC on day of use but we already do that. If you have automation, as long as you follow their plan, you are OK. We have an Echo and it won't work if QC is not done when it is supposed to be done. I'm glad it shuts down because my people would try to stretch it for a few more hours.
 
I think the things that will need IQCP are the possible odd things such as Lui-Freeze or auto absorption. These are procedures from a book, not a kit with instructions,  so these sorts of tests will need IQCP. If you have a lab created test or something you do that doesn't follow the manufacturer's insert, you will have to do IQCP.
 
I went thru my procedure book and got rid of things that we never do anymore (auto absorption) and came up with a very small list. Lui Freeze is the only thing I can up up with that might need one and we are doing a study to possibly go to acid elution when a physician requests more work on a cord DAT.
 
Just so you know, I listened in on a long webinar from CMS about IQCP on July 15. At the question and answer portion where you write in a question and they answer after a few minutes, I asked specifically if we must do an IQCP for for panels for antibody identification. They had a very short answer. NO. (Whew!) The write up for that webinar should be on the CMS site somewhere. The title was IQCP for CLIA Laboratory Non waived Testing: Workbook Tool. There were workbooks to work thru the process that might be helpful.
 
I really think BB will come off easy on this IQCP process. The department that will be hit hard would be Micro. Evidently, micro tests media once per batch or once per week or something.  So to keep from doing QC everyday of use, they will have to write IQCPs for a ton of procedures.

The CDC does have good information and makes no mention of using a buffy coat smear for malaria. I can't figure out why this was required in our procedure but I'll be talking to our pathologist about removing this step.

The CDC does have good information and makes no mention of using a buffy coat smear for malaria. I can't figure out why this was required in our procedure but I'll be talking to our pathologist about removing this step.

The CDC website has excellent info for making and staining smears.
 
http://www.cdc.gov/dpdx/diagnosticProcedures/index.html

This is very common with solid phase and from what I've read, gel as well.   In our experience, it's almost always a "solid-phase antibody" or a strong cold.  Seen many a cold antibody identified by the reference lab that was 3-4+ on Echo.  Immucor does not agree but I have to go with the reference lab on these.  
 
I suggest that you and your medical director develop a workflow on how you want techs to handle these scenarios, either very conservative or liberal, institution variable.   I did and it stopped all the off-shift confusion.
 

This is very common with solid phase and from what I've read, gel as well.   In our experience, it's almost always a "solid-phase antibody" or a strong cold.  Seen many a cold antibody identified by the reference lab that was 3-4+ on Echo.  Immucor does not agree but I have to go with the reference lab on these.  
 
I suggest that you and your medical director develop a workflow on how you want techs to handle these scenarios, either very conservative or liberal, institution variable.   I did and it stopped all the off-shift confusion.
 

We have a clipboard in our signout area. Whoever picks up blood must read and sign the document as a one-time training event:
A copy of the file is attached. At the top left is a place for a logo or facility ID
 
 
Blood Transporter Training 
By signing below I signify that I understand the following requirements for transporting blood components:
Blood must be transported directly to the area where it will be transfused (no side trips). Blood should never be put anywhere where it could be heated or cooled. If blood is issued in a cooler it must be kept in the cooler during transport. Do not leave blood unattended at any point. Hand blood over to an appropriate staff member immediately. Blood must be returned to the blood bank as soon as possible (no more than 30 minutes) if it is not going to be transfused. When the Blood Bank tech reads patient and blood information you must verbally read back the followingUnit number Medical Record Number Patient’s name. Blood Type of unit and patient.  
Date
Printed Name
Signature
   
 
 
   
 
 
   
 
 
   
 
 
   
BloodIssueTransporterTraining2.doc

If i'm not mistaken, you only need to save them for 10 years (AABB 5.13.5).  That being said I obviously see that you would want to keep information on any potential patients who might come back in.  We had a similar situation here with an old card file that was kept before the implementation of our LIS system.    What I did was enter the information that I could (patietns that were in the current LIS but hadn't had any BB testing done) and then weeded out the patients who were not coming back (as in patients 100 or older, patients we knew had passed) then finally we had the remaining cards converted into an HTML format.  We have an icon on our pcs that when you click on it a screen opens and you can search for the patient name.  We use it when we have a patient who has no history on file in our LIS.

I agree that it is pretty questionable if you have no DOB for full patient ID, but if you wanted to enter these patients in your system (because if Cedric Herzenschnerltzer comes in again you might want to know that someone with that name had an anti-Jka in 1987 so you could antigen type him and give him neg units if needed), could you create a bogus MRN for them, maybe mostly letters like History1987CH so it is clear that they are from that untrustworthy lot?  Then you could either ask Medical Records to provide you with a DOB or you could enter them all with a DOB of 1/1/1880 or something so you know it is bogus.  You could also search a social security death index and only keep the ones that might still be living.
 
I guess ask yourself what you would do with these if you had the information.  Would you antigen type them and, if negative, give antigen negative blood even if the screen were not reacting?  If you wouldn't do anything with the info, it is not worth having.