StephanieM

VSS741. The screen cells and affirmagen cells are aliqouted out each morning.

Has anyone had any issues with their gel screen cells hemolyzing?

It can connect the names and I can add a comment but future visits would be a mess. You can't see the comment until after the patient is pulled up and you can't pull the patient up until you confirm the name. On a future visit, the tech and more than likely the nurse isn't going to know the patient had a previous alias for us to be able to confirm the name. We have McKesson by the way. It is taken care of now, apparently the nurses and registration got confused on how to handle this patient, they were not suppose to register the patient with the alias, the alias was only suppose to be used on the board and the outside of the chart...... - - - Updated - - - It can connect the names and I can add a comment but future visits would be a mess. You can't see the comment until after the patient is pulled up and you can't pull the patient up until you confirm the name. On a future visit, the tech and more than likely the nurse isn't going to know the patient had a previous alias for us to be able to confirm the name. We have McKesson by the way. It is taken care of now, apparently the nurses and registration got confused on how to handle this patient, they were not suppose to register the patient with the alias, the alias was only suppose to be used on the board and the outside of the chart......

How do you handle patients who are registered under an alias? Not John or Jane Doe but and actual name. I have a patient who has been here in the past but to bring in the current specimen, our system is going to make us change the name from the patient's real name to the alias name. I'm not 100% on the legal issues with this (units to be transfused has been ordered) but I'm also thinking about the issues that are going to be created when the patient comes back again but under their real name.

Please disregard After I posted this question it hit me! Sorry moment of stupidity

This may be a silly question but I have a doctor wanting to check for FMH on an O Positive mother. Obviously the fetal screen would be invalid but what about kleihauer-betke? I know this will actually show if there are fetal cells circulating but the baby is also O Positive so wouldn't this be moot? Plus she wouldn't need RhIG.....please help?

Does anyone have any suggestions on how to make up an elution unknown? I have people who need practice working up an elution, our CAP sample isn't scheduled until March and there usually isn't enough to pass around.

How do you all issue blood to the nurses? Do you call every time you complete a crossmatch or do your nurses take the responsiblity to look in the computer to see if the units are ready? Do you have pneumatic tube stations? Is that the primary method of transporting units? Do you make the nurses or an approved courier come to blood bank to pick up units? How do you track the blood administrations? Faxed paper with patient ID, form with the courier for window pick ups? Blood administration orders in the computer? I'm trying to see if what we do could be improved or not. Thank you all in advance for your replies

We did Verax testing when we were receiving random donor platelets but discontinued it when we switched to only receiving PLP or Acrodose. After reading the AABB bulletin, it sounded like they were suggesting performing Verax testing on PLPs and acrodoses as well. Is that what everyone is doing? Verax testing on all platelet products???

I know, I hate changing the policy because of one person. We had talked about the mid levels not being able to authorize emergency release but it seems like there are more NPs or PAs treating and ordering everything on patients so how can we really say yes you can do everything but make the call for an emergency release??? And yes, the NP should definetly be held accountable for this. I know the doctor was upset about it and I'm sure my pathologist is planning on speaking to her. I had placed a Midas report on her and I was told nursing was doing one as well...I did find documentation in the nursing notes that the NP ordered an emergency release but as to being able to sign emergency release orders in the computer??? As of now our system isn't capable of this. The Lab and the rest of the hospital have different computer systems. I can get on and look at the other side but most other people in the lab can not so if they did add it to where the doctor could electronically sign, it would have to be set up to cross to HLAB too. I'm sure it should be something that can be done but how is the compliance with this? We have just started CPOE and it has been a challange for some of the doctors....

Within the last two months, we have received two patients who, no matter what we do, can not get a valid type. Same issue with both. Forward typed as an A back typed as an O. The problem was that they both have a STRONG cold interferring with the reverse type. The first was a CAS probably with anti-I and second had a strong anti-M. No matter how long we prewarmed these patients we still had reactions on the A1 cells in the reverse typing. (the first patient I even went to the unit myself with prewarmed tubes in a warm water bath and kept the specimen warm throughout the entire testing. It still didn't help. Everything we could do had been done and we do testing that borders a reference lab and a normal basis....which makes finding experienced blood bankers even harder...but thats another problem. Both patients had been send to our reference lab, both results came back as Apos. When asked about the reverse, "oh we didn't have any problem with the reverse, just prewarm and you'll be fine"......the Echo picked up on it in the reverse, 1st pt 2 BB techs and myself worked on her, second was over a weekend but I know of 2 for sure BB techs worked on him and they are experienced too. Now to my question I can't help but to question the reference lab when they claim to have had no problems when so many good experienced techs and using multiple methods could never get it to work. Anyone know of an explaination to this? I believe the reference lab uses Gel. Maybe that doesn't pick up colds but the Echo isn't suppose to either....but when they are as strong as these two were, it will pick it up.....does the GEL not?

I realize this may have been answered in previous threads but the few I have looked at did not mention this aspect of the Emergency Release form. When an emergency release of blood and/or blood products are requested, how long do you all give the ordering physician to sign the release form? When I first started, we brought the cooler up to the requested area and had the physician to sign right then. Eventually it changed (probably due to the off hours when the doctors aren't on location) to where they had up to 24 hours to sign. This has worked well for us until recently. We had a doctor order Stat FFP on a patient who did not have a current specimen. The nurse taking care of the patient called the BB tech saying the Nurse Practitioner did not want to wait on the specimen to make it to the lab and for the testing to be done, she wanted the FFP emergency released. AB neg FFP was thawed and issued as an emergency release, the patient had an allergic reaction, the original doctor who ordered the FFP tore up the release form saying he wasn't signing it because he only wanted it STAT not Emergency. Come to find out the Nurse Practitioner knew he didn't want it as an emergency release but she ordered it anyway....leaving us with no one to sign the release form. Because of this we are not suppose to issue emergency release products until we have a physcian's signature. Have any of you had issues like this? What did you do? And again, how long do you give for a signature?

DAT negative by auto I meant cold autoantibody No history of transfusion no pregnancies the full prewarm panel is incubating 37 degrees

We are doing a cold screen and it is reacting 4+ at room temp and we are in the last stage of the screen. We are thinking a cold auto? We are also in the process of performing a panel to see if we can rule in or out anti-M but so far everything is reading 4+

Okay, I'm looking for some advise as to a type discrepancy. I have a patient forward typing as an A, reverse typing as an O. Reacts with A1 lectin and A2 cells. The patient plasma was warmed to see if it could have been a cold and would warm away but there was still reactivity. Any suggestions?