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Lcsmrz

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Everything posted by Lcsmrz

  1. http://hosting-tributes-24789.tributes.com/condolences/view_memories/89295193 My father passed away in an unfortunate mountain biking accident with my brother. Please post any stories if you have any. I would love to hear as much about my father as possible. He was a good man, a hard and dedicated worker, and the best dad I could have asked for. Thanks, Rebecca Smrz
  2. In my many years of blood banking, I've never used a full swinging rotor for serological testing, but there is no reason that you can't. I'd have to calibrate it and reteach my techs how to properly read buttons that aren't on the side ...
  3. We are 100% luekodepleted -- it's the only product that I can get from my blood supplier. The transfusion committee has sanctioned this. The physician can write anything he wants that's decipherable as a unit of RBC's. He's gonna get a leukodepleted packed cell, and the patient will get charged accordingly ...
  4. No ABO/Rh mistyping should be allowed - but they do rarely occur. It's important that you treat them as very serious errors and allow no excuses! Congrats on having a non-punitive QA system that the techs are comfortable using. I would have immediately determined a root cause for each and modified whatever was necessary to stop them cold, including reassigning techs who couldn't handle the pressure -- Micro is a nice spot for these techs, as is upper management
  5. We tie the crossmatch hold time to the specimen outdate. Sample and any reserved units on-hold expire at 23:59 on the third day.
  6. We also discard the empty bag will all attached tags after an uneventful transfusion. Only those with incomplete infusions are returned, such as reactions.
  7. Your Medical Records dept is a good internal source for equipment and procedures for scanning documents. I bet half of their job is doing that!
  8. "Eoin" makes a great point in not jumping to conclusions on hearsay evidence. The lab could have been an accident waiting to happen, and this tech was the unfortunate one to make it. I know of one tech who was rotated out of blood bank work for "errors" that he was never shown, and I suspect a personality conflict with the supervisor played an important part of that decision. I find that I make the most errors at the end of a double-shift, trying to keep a woefully-understaffed lab operational by working unwelcomed overtime. Since I know this, I am also the most careful at this time -- a younger, less-experienced tech may not be so introspective of personal limitations. Occasionally, labs will fire a good employee for being involved with a serious error, listing the corrective action as "employee terminated" when reporting to the FDA. While this makes it sound like it was negligence, it could have been a systems problem that no one bothered to address -- and it may happen again to someone else! My answer for this one? -- the interview makes it or breaks it for most potential employees!
  9. We have a mandatory result field call "History Checked?" that is answered Yes/No.
  10. We still have people using a relative's or friend's insurance info in ER. We require a current draw to confirm the Rh type, but issue RhIg before the rest of the testing is completed. An OB Clinic record would probably have multiple ABO/Rh determinations. They know the patient and her clinical history, so they may feel comfortable with that.
  11. We have a receipt log sheet for each reagent that specifies the incoming acceptance criteria for the reagent at the top, followed by the "prior to use" QC that is required. Our in-use and new lots are segregated on different shelves. I also record when ordered, when received, and when activated, along with the required information that is listed at the top of the sheet, such as insert checks, visual verifications, QC performed, acceptance (Y/N), and a comment section for quarantines. All historical information about the reagent is on the same sheet. Each type of reagent will have different acceptance criteria, QC, etc -- there is no remembering by the techs -- they just have to read what's written on the sheet. There is no defined criteria for reagents, other than running QC before use. You have to decide on whatever makes you sleep at night ...
  12. We are estatic to obtain any platelets when we have a need. We suggest RhIg if patient is Rh neg and donor is Rh pos. But in reality, only the younger females get it.
  13. We also use the charge-type test for charging Ag Typing in Meditech CS v5.64, but I add them the following working day when reviewing transfusions on the Patient Master Log. I charge an Ag Typing on each transfusion, unless we get some special units in from the blood center for one patient. We rarely screen shelf units for an antigen ...
  14. If the original sample becomes depleted, we redraw, reband, and start over from scratch with another T&S, etc. Our blood bank wristbanding system is a specimen identifier, not a patient identifier, so each sample gets a new wristband. The wristband number identifies which sample was used for the crossmatch.
  15. Partial units are returned in the hopes of detecting something we would want to know about: clotted units, nonreported reactions, and the like. We find the strangest things happen with these units ...
  16. Our "short draw" policy is for techs who choose to use a sample that is considered suboptimal and does not meet minimal requirements. We generally ask for a redraw, unless we get additional information that suggests another attempt is futile or clinically unwise (i.e., trauma).
  17. We consider a sample to include all tubes collected at the same collection event. Only one such tube needs to be tested for compatibility testing.
  18. She is not likely to develop an Anti-D so quickly. I would continue giving O Pos red cells, especially since there is no chance for another pregnancy. Some suggest that, once an Rh negative patient gets large amounts of Rh positive units, you should continue giving Rh positive for the short-term, with the hopes that the immune system becomes temporarily tolerant and does not form an Anti-D.
  19. We have minimum specimen requirements throughout the lab. Anytime the minimums aren't met, the tech has the option of using it anyway, but must complete a "suboptimal specimen" form as a QA monitor. Sometimes, it's all the blood you can get ...
  20. Our HIM dept -- formally called Medical Records -- says all forms posted to the chart must be white with black letters (among a list of other requirements). It has something to do with the ability to copy it without masks to produce certified copies for legal purposes. We can have one colored edge (bottom), but the change has to go through Admin (increased cost). If you were to include colors, I would keep them as standardize as possible. No need introucing an error potential when other options exist.
  21. You can spike a unit, let it sit for 3hrs & 59mins, then infuse it within 60 seconds -- and still be in compliance with my SOP. I don't know why you'd want to do that, though ... We ask the nurses to return any unit not totally infused to the patient (for our records).
  22. I vaguely remember a post from months ago, regarding a need to perform IS phase along with an AHG crossmatch. The posting had to do with some newsletter stating that CLIA demands a test for ABO incompatibility, to which an AHG crossmatch is particularly insensitive. If I remember correctly -- always suspect in my old age -- the discussion scientifically understood the rationale, but disagreed with the requirement. A subsequent article (somewhere) studied the ability of an AHG crossmatch to detect ABO incompatibility, and the numbers showed that (surprise!) it does a very poor job. Does anyone remember the AABB or CLIA commenting on this?
  23. The "Truth Tables" are located in the Calculations section of the BBK dictionary. We have two ABO/Rh orderables: one for adults and one for infants. The infant one has the Weak D fields, whereas the adult one does not. Each has its own truth table, and the former has a longer truth table to account for all the extra possibilities. We have alot of rules, too, such as "if Anti-D is positive, then NP" on all the Weak D fields. We call all Weak D patients as Rh positive (although you could set up a third Rh possibility). Cord truth table: "Anti-D = pos and Anti-D AHG = NP", then Rh pos. "Anti-D = neg" and "Anti-D AHG = neg", then Rh Neg. "Anti-D = neg" and "Anti-D AHG = pos", then Rh pos. The biggest problem with Meditech is that you have to become a local expert, since their tech support is relatively poor. But with the help of this forum, I can do pretty much what I want with the system ...
  24. Our setup auto-defaults the Weak D section of Cord Bloods to NP when a non-negative result is entered for the IS Anti-D field. The blood type calculation makes the interpretation, and the tech verifies before completing.
  25. I would also lean "yes". You issued two units that did not meet your SOP's "special testing" requirement without prior approval for the exception -- you would have not have issued, had you known that absorbtions were not done. "No harm, no foul" does not apply ...
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