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kirkaw

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Everything posted by kirkaw

  1. kirkaw
    Good Afternoon, According to CLIA (and I think Joint Commission and CAP), evaluating and documenting competency of personnel responsible for testing is required at least semiannually during the first year the individual tests patient specimens. How do you define 'semiannual'? Is this 6 months into employment? 6 months after the completion of initial competencies? Furthermore, how many sets of competency assessments do you have after 1 year of service? 3: initial, semiannual and annual? or just 2 semiannual and annual? Thanks, Amelia
  2. kirkaw
    This makes more sense to me now. Thanks! We do not record PT results in the computer. I have not had an inspector question my K-B stain competency assessment either, but our entire lab is struggling with this element in relation to tests of low volume. I wanted to put it out to this group and my best example of a low volume test was a K-B stain. Thanks for your input.
  3. kirkaw
    I should clarify that all transfusions were with phenotypically matched red cells.
  4. kirkaw
    Is there a Joint Commission or AABB standard that says you have to get a conditional release signed for 'least incompatible' blood? Also, suppose you have a patient with warm auto-antibodies and no allo-antibodies. The patient is transfused and the subsequent specimen still has a positive antibody screen but at strengths not stronger than the pre-transfusion specimen, do you do the entire workout every 72 hours?
  5. kirkaw
    So David, you interpret that standard as the knowledge of how to properly record the result, am I correct? When you have folks repeat a test, then the reporting is already complete, so you are not really monitoring the recording and reporting of test results. I guess my interpretation of this standard is more about the proper recording of the result than the performance of the test. Some computer systems make this a challenge! Also, I am wondering how an inspector interprets this. Thanks for the input!
  6. kirkaw
    Greetings! For the competency assessment element 'monitoring the recording and reporting of test results', what do you do for testing that is performed infrequently and may not be performed by all staff but that should be available 24x7? For example Kleihauer-Betke stains. Thanks, Amelia
  7. kirkaw
    This continues to be a stumbling block for techs. My predecessor allowed for rule-outs on heterozygous cells, which I do not like with the exception (big) K. I was taught that it is OK to rule out on a single homozygous expression when there is a negative reaction. I was also taught that to get p-values you had to have 1 positive and 7 negatives or 7 positives ad 1 negative OR 3 positives and 2 negatives or 2 positives and 3 negatives. I guess this is how we defined 'ruling in' although in my Med Tech program that verbiage was never used. Is this defined as a recommendation from any authoritative/accreditation body or in the AABB Technical manual?
  8. kirkaw
    Greetings, We are currently accredited by Joint Commission and AABB and get inspectors from both agencies. We are considering switching to CAP from JC. Is AABB still have deemed status for CAP? Thanks, Amelia
  9. kirkaw
    Eagle Eye, I have SafeTrace version 3.9
  10. kirkaw
    We are noticing that physicians are finally starting to look for signs/symptoms of TACO and TRALI. I wonder if we need to change our adverse event form to be more definitive on these. Has anyone done this? This thread was originally started in 2007, so I'm interested to know if more people are doing something. Also, if the patient reports shortness of breath, do you look for a chest X-Ray or administration of diuretics or any other indication that the physician suspects TRALI or TACO? Thanks!
  11. kirkaw
    Hi, Our hospital is in the process of evaluating new software for the entire institution. We have looked at Cerner, Epic and McKesson. We (blood bank/TS) currently have SafeTrace (HBB) and personally, I dislike it greatly. But it has been a very long time since I have worked with anything else. Can folks give me some pros and cons of Cerner and Epic? I heard that Epic does not have a BB/TS module so if our administration chooses them, we will be stuck with SafeTrace. SafeTrace has horrible reporting and the emergency release for an unknown patient doesn't work very well. So if we get Epic, is there any chance that I could get some better statistics, even though we would still have the same BB/TS system? Any advice would be most appreciated. Thanks, Amelia
  12. kirkaw
    We have SafeTrace and use a paper tag (p-tag) that is attached to the unit at issue. It remains attached until the unit is transfused and then the paper is removed and placed on the chart. The only time I have seen a sticker affixed to a unit was when I was working in a hospital that used Cerner Classic. At that time, there was also a multi-part transfusion report form also.
  13. kirkaw
    Was antigen typing done on the patient for K and C at the time the anti-e was identified? When was the patient last transfused? Can you antigen type them now?
  14. kirkaw
    This discussion is quite helpful! I am very happy to hear of so many (good and bad) experiences with blood bank software. I worked with Cerner Classic years ago and really liked it but have never seen Cerner Millenium. I am currently using Safetrace/HBB - the Haemonetics/Wyndgate product and I am not a fan. I am not sure how it would work for a single facility or a small one, but it's management reports are terrible....or nonexistent and it is not intuitive to use at all. I will say that it has some nice safeguards and we do have it interfaced to the McKession product HLAB and to our automated Ortho analyzer, the ProVue.
  15. kirkaw
    Thank you AMcCord. You are correct in that we issue uncrossmatched blood <1x/month. It is different techs that are forgetting the subsequent crossmatch. I did an 'emergency release' training session including contest a year and a half ago and it went really well. The actual emergency release process is working much more smoothly. But the follow-up is still lacking. Dansket, is every test you do automated? The expired reagent we used was 'rare' antisera so we still do that in tube.
  16. kirkaw
    I have been reading about error prevention and creating an environment conducive to risk assessment and self reporting. Our institution uses the Just Culture algorithm. I am curious as to how many others are using this. One of the premises of this program is that 'to err is human' and that to expect perfection is unrealistic. However, it is incumbent upon management to create a system that is as fail-safe as possible. So where is the line between personal responsibility and system failure? 2 situations that I have encountered recently were: 1) expired antisera was used and 2) no crossmatch was done subsequent to an emergency release. The only way this is caught is on work review. How far do folks go to try to put stop-gap measures in place to prevent errors? The form error has only happened once in 2 and half years but the 2nd one has happened 2 or 3 times for sure. Thanks for your input!
  17. kirkaw
    For pre-op specimens obtained >72 hours prior to surgery, we document that the patient has not been pregnant nor transfused in the past 3 months. That is the only specimen we get pre-operatively, even if the patient has an antibody. When the patient is admitted, we use that same pre-op specimen for crossmatching. Once the patient is transfused, the pre-op specimen becomes subject to the 72 hour rule.
  18. kirkaw
    We do do 'live' transfusion audits, but I agree with Kate, that I do not think this is mandated by AABB standard 8.2. I too find, that my nurses are 100% compliant. Our current audit process involves following transfusion practice from blood (specimen) collection, through testing and transfusion. I have a form that I use to check off each step. However, I attended the AABB annual conference and went to a wonderful seminar on internal and external audits. One thing they pointed out, was to check all QC and inventory records from the day of the transfusion that is being audited. We haven't ever checked everything that could have affected the transfusion. The advice was, if you have 100% compliance then either the audi is not effective or you are missing something. There was also talk about having a variety of audits and a schedule of audits that is approved by the medical director. I plan on trying to revamp our quality assurance program to include audits on adverse events, on suppliers and on transfusions adhering to (or not adhering to) the institutions transfusion guidelines.
  19. kirkaw
    To reply to goodchild's inquiry about repeating a DAT. We do DAT's on cord blood specimens. If one of my staff reports a positive DAT on a cord blood which types as O pos on an O pos mom, I might be inclined to repeat that.
  20. kirkaw
    I agree with David. Sometimes you have to be a realist, i.e. pessimist when dealing with other areas who might not be quite as picky as we are about blood storage. We use Hemotemp stickers on our units that go to the OR and they work great and I think they are slightly cheaper than the Saf-T-View.
  21. kirkaw
    I am interested in the 'overcooked' plasma issue too. I was taught in school (>20 years ago) that it was better to massage the last ice crystals out of a unit of plasma rather than let it get too warm when thawing. What is current philosphy on this? As for the 30-min. rule, there was a talk on this at the AABB annual conference and there was a lot of science presented but a lot of people argued that the studies did not correspond to 'real life' scenarios. At our hopsital, we still adhere to the 30 min rule and/or take the temp of the unit before returning it to inventory.
  22. kirkaw
    We are not CAP accredited so I cannot speak for their standards. AABB does not specify the interval that your pipettes need to be calibrated. It just says 'at prescribed intervals' (Std 3.5.1, 29th ed.) We actually calibrate ours quarterly; that is defined in our QA policies.
  23. kirkaw
    This antisera was not exceptionally rare; it was anti-Jkb. So I do not think this qualifies for the exception. also, the patient who recieved the units was getting Jkb negative red cells prophylactically so that he would not make the antibody, so I do not feel that we put a patient in danger. However, if I understand the FDA guidance correctly, we still have an obligation to report a breach in which the safety, purity, or potency of a distributed product may be affected. I feel that this qualifies as such an event. Agreed? Thanks.
  24. kirkaw
    On a slightly different note David, I found while doing work review, that a tech had accidentally used expired antisera. Her controls worked. I assumed that this should result in a BPDR even though the controls worked. Am I wrong about that? Thanks!
  25. kirkaw
    I agree with Mabel. We do not keep enzymes so that would not have been an option for us. The only failure I see (if you can even call it that) is the ambiguous transfusion history. I am also curious as to if the patient was symptomatic. Was this called a DHTR?
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