slsmith

reply to SusieQ132: yes we our satisfied with the label. Sorry for the delay in my response

No we have not.

Since all elective surgeries have been postponed and restaurants/bars have closed the BB has been incredibly slow which is rather scary in itself (the calm before the storm?). Due to this we have voluntary reduced our inventory to help with the blood supply.

What AMcCord says plus if you can find one of the seminars called "passing the first time"

We use a system called CAPA(corrective action/preventive action). I don't know if it is something the QA people built or what. Anyone can write one but after that only the leads, supervisors and managers can review and follow up on. Some techs have felt it is punitive but that as seem to have ebbed once the number of CAPAS you received is no longer brought up in your yearly review . It begins with a brief description of what happened, when it happen and the name of the Tech involved (if applicable) then entered in the file for new occurrences. The QA specialist assigns it a tracking number and puts it in the departments "in box". Once in the "in box# one of the leads investigates starting with the Tech involved. And the explains what was the immediate action, how did this happen and what was being done to prevent it from happening again. Then it is moved to either a folder for preventive action. Where it stays to up to 30 days for either further comment from another lead, supervisor , ect. Then it is moved to the closed folder Or it may be moved to the corrective action folder where you have to do a RCA and an effectiveness check. This can't be moved until the manager and medical director of the department review it.

We don't QC the saline we wash with, never thought about that. Something to ponder. We do QC the saline squirt bottles with the daily control as we still test ABORH and DAT using the tube method, thus saline suspensions.

No it does not.

We have both the Helmer DH8 and DH4. The DH4 is really a backup (but always in service) as sometimes on a long massive the DH8 decides to take a time out so we use the DH4 until DH8 is happy again. We drain and clean once a week per manufacturer's instruction. It is filled with DI-water which fortunately we have a tap on the sink the plasma thawer sits next to.

400 bed level 1 trauma center which just changed the mtp protocol which seems to be working well. Previously, 4 red cells were sent out every 15-20 minutes with platelets, plasma and cryoprecipitate being sent base on lab results. As Scott mentioned above cumbersome and it seem like we couldn't keep up. Now every 15 minutes; 6 red cells, 6 plasmas (usually low titer A) and a platelet pheresis is dispensed. If the patient is an OB then a pooled cryo is also sent. Part of the MTP start order includes lab orders that can be pulled 6 times during one start order. I don't have any idea how that works or what happens when the 6 orders are used up. But the orders are PT-INR, fibrinogen, platelet , ROTEM and H &H. The other level 1 trauma center is using whole blood low titer O which they send out 6 units every 15 minutes. Which sounds heck of a luck easier than what we do. But they use a different blood supplier than we do (ours doesn't have low titer O). Also we are AABB accredited and there is some issue with AABB and giving low titer O whole blood to non-O patients.

> Trauma T & S is 45 minutes >Stat T & S is 60 minutes >Stat cord blood 15 minutes( don't know when there has been a "stat" cord ABORH/DAT ordered)

Right now we are using Radsure but are going to switch to RAD Control(made by TYPENEX). It is a smaller label and stored at room temp rather than the refrigerator. The thing everyone likes about it is the lot number and exp date that we write on the irradiation log is actually a sticker on its own that you peel off and attach to the log. As far as a making doses from the parent bag we use a ISBT based label that has irradiation printed on, like Malcolm's.

6 rbc/6plasma(usually liquid)/1 pphl every 15 minutes(we try). If it is a OB one of the rounds also gets a pooled cryo.

We do have a rotem but it is used mainly for trauma surgeries. Surgery is in charge of the running of the cell saver although the BB does review their QC, put it in a spread sheet and then transfusion committee reviews it. The standing order is 3 red cells on the fresher side of expiration. And although it isn't order at the onset there is pphl on hand in the event it is needed.

Last Aug we stopped using the Quick Release sheets where we documented the T & S, wrote all the units down, document the dispense time; and initials of who listened, read and picked up. Now for dispense documentation we use the regular dispense log where the patient's label is place, the number of products that went out and what type, also the initials of involved. The dispense log is reviewed the next day for accuracy and usually there hasn't been any discrepancy. The ones we had were able to be figured out.

We use plain old plastic ziplock bags. Not so much for the safety of the transporter but in the event they drop the bag and it happens to break.

I have been told by the BB leadership that antibody workups need to be kept for ever per either AABB or CAP(don't remember which was they said). This doesn't make sense to me as the results are in the computer unless they believe the workups would be subpoenaed if sued. Anyway since our file cabinet is bursting at its seams so I am in the process of removing the workups of anyone born before 1940 and haven't seen in 5 years and moving them to long term storage

What a timely question! My hospital also is a trauma center and we have a pretty good adult protocol for MTP in place. But currently trying to have a good one for peds which as we are finding out there is no real good studies or whatever you want to call it. Currently if the child is 10 or older we send the adult mtp pack which is 6 rbcs, 6 liquid plasma(if not available fp) and a platelet. If under 10 we send a RBC and FP with a filter syringe and let them push it(this has worked well in the pass). As for the platelet portion we aliquot based on the patients weight. I will be interested to see what others say on this post

365 bed trauma center that pulls staff from the other departments if needed although during a massive the hem/coag needs to be staffed too. If another body is needed a call would go out to someone close to the hospital and works in the blood bank. Fortuanately, we have not had anything the staff couldn't handle and not problem in the rare occassion to get a body in.

We use the cells on from the panel with the @ as long as we know the patient has received rhig. Also it is documented in the Blood Bank Patient History that you can not use this work up for transfusion purposes.

Patient medical record# and their own id(not all nurses have been trained to access the refrigerator)

Midnight on the 3rd day

OR staff, usually the anesthesiologist

1. There are two in separate cores for the OR. The OR techs take the temperatures daily which the BB reviews at the end of the month and keep with the other temperature records. A circular graph is also connected to monitor peaks and valleys 24/7 which is changed weekly. The refrigerators are also connected to alarms that sound off at the OR desk, facilities and BB. Blood that has been crossmatched for patients that have a high chance of using is picked up in the am by a OR runner, They are sent in and store in separate containers to prevent a mix up. 2. There is also refrigerator with uncrossed O+ rbc and A low titer liquid plasma. Which only can be opened by a trauma RN who has the MR# of the patient that the blood is being given to. When the refrigerator is opened there is a large screen in the BB that flashes that the blood is being removed, which units and the Patient's MR#. This refrigerator temp is also taken daily and connected to an alarm.

I don't understand this question? What do you mean by platelet bag?