[Review of Crossmatch Cards]

Almost all places I've worked does a "completeness" check of the returned document: signatures, vitals, "no Rxn" box, etc. (Quite a hassle getting them to correct them in retrospect, and it's part of our CQI program.)

But other than some parameters on temperature or calling a code, an audit of the values themselves without the chart or knowledge of the patient would be guesswork. A "significant" change in vital signs is subject to the professional judgement of the transfusionist and a complete knowledge of the patient. We require consultation with a physician before a transfusion reaction workup is inititiated, which implies that the nurse had a concern in placing the call, too. Maybe your transfusion committee can discuss the issue and render an opinion regarding the appropriateness of the current policy.

Once, I performed a reaction workup on a patient anxious about getting blood, and had an immediate and significant change in vitals as she watched the blood flow down the tubing toward her arm !! I get as irritated today with the waste of time as I did years ago when it happened ...

Given the HUGE variety of patient types and acuities you deal with, your current policy seems quite reasonable. Did you happen to ask the inspector how he defines "significant" change in his insitution and what he does about it when he finds it a day later? Makes me wonder if he charges for a reaction workup ...

Larry

[Blood Warmers]

Not aware of any need to record temps while in use, once the warmer is validated and periodically checked thereafter.

Larry Smrz, MBA, MT(ASCP)SBB, CQA(ASQ)

Indianapolis, IN

[Quality Representative Poll]

Hospitals are playing catch-up in the Quality field, spurred on only by the 2001 IOM report, Leapfrog, and various raised eyebrows in regulatory, accrediting and political bodies. Unfortunately, the new hospital positions seem to be filled with RNs that took a quality techniques class and are now the "experts." Their initiatives resemble non-statistical psuedoscience -- as I call it -- and input by MTs, who have been "doing" quality for 30 years, is usually ignored as irrelavent.

Quality plans in Blood Banking are almost 15 years old now. Think how long it took us to catch on, and how much progress we've made !!

But the rest of the quality field, esp in manufacturing and high-risk fields (ie, nuclear, aerospace), has progressed to where quality has been pushed down to the worker -- exactly where Deming said it should be !! And quality departments are declining ...

Larry Smrz, MBA, MT(ASCP)SBB, CQA (ASQ)

Indianapolis, IN

[Color Comparator]

Years ago, I found a pathologist at Wishard Hospital (now part of Clarian) in Indianapolis, IN, that published color charts for interference detection in Chemistry tests, I think for the Kodak EktaChem (now J&J Vitros). Although they show mocked-up samples in 12x75 test tubes for hemoglobin, lipemia and icterus, they were used in our BB for post-glycerolization comparison.

It would be fun to see if the serum indicies on modern chemistry analyzers would work as well ...

Larry Smrz, MBA, MT(ASCP)SBB, CQA(ASQ)

Indianapolis, IN

[Computer records as "copies"]

I've always assumed downtime records were "temporary" copies. We enter our downtime data into the computer system, then audit them for accuracy before filing the papers for a year; the computer record is our permanent record.

Larry Smrz, MBA, MT(ASCP)SBB, CQA(ASQ)

Indianapolis, IN

[Quality Representative Poll]

I think the trend throughout the US and in all industries has been to reorganize quality positions out of existence. In a way, the quality industry has always said that they want to push quality management down to the process level in the interest of getting real-time feedback. I appluad the effort of quality personnel to educate everyone in quality techniques.

The only downside is the loss of oversight independence, and we're reverting back to a single gatekeeper of all data coming out of an area, usually a supervisor who is already overworked. So, I have to question the quality of the data being collected and analyzed.

Are quality positions really redundant, or is this just an excuse by upper management to cut positions ???

Larry Smrz, MBA, MT(ASCP)SBB, CQA(ASQ)

Indianapolis, IN