Lcsmrz
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Everything posted by Lcsmrz
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We use a rubberband looped through the hole of our tag, which is almost impossible to remove without scissors. Prior to that, we used a looped rubberband through holes in the form, but it was too easy to just rip off the form, then "reattach" it somehow. We plan on going with a label on the unit and an electronic Transfusion Administration Record by the end of the year.
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We also require a call, since our pathologist needs to OK further transfusions.
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I define "moving" equipment as the need to unplug. Once moved, I requalify it by performing a set of function and performance checks, and document the exercise for posterity. For serofuges, I checked the RPMs, timers and spin cals. For cellwashers, I changed tubing and rechecked the dispensing and button formation.
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We also use the 1hr post vitals, but I was unable to find any reference for that when the policy was last revised. Computerized transfusion administration records have a hard time complying with a vague time, so it's up to the nurse to remember -- it's rarely done, on audits. We have a post-transfusion information form for our non-inpatients, and it's documented with the discharge nursing instructions. Most of our outpatients are oncology patients.
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We recommend (via nursing policy) not transfusing until the temp in under control, but the transfusion necessity arises even when the temp is elevated. Our pathologist is consulted if there is any questions.
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I use expired panels to select cells to increase my rule-outs or my confidence in a specificity. I would not use them as a sole determinant in a transfuse / don't transfuse situation. I run "QC" on an expired panel for my own comfort, so I can sleep better at night, not because it's required.
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Using w2t would be great process control in component preparation, rather than setting time and RPM. But few of us understand how it would help us make better, more consistent products. There would be a certain learning curve yu'd have to get over to make it a marketing enhancement.
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My problem is always "how accurate is accurate enough?" In Blood Banking, the standards read in integers, so we'd like to verify with something to the next decimal point (+ 0.1 C). However, when you start looking into LIG, infrared and electronic thermometers for bench use, you find that the accuracy does not approach 0.1 C, esp with most LIG thermometers that come with "certificates of accuracy". And we haven't even discussed other measurement variances yet ... It almost seems like most of what we do is a low-leveraged activiy of borderline utility, done only to show an inspector that we're doing something!
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I've worked at facilities that use a separate consent and some that don't.
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sample size per aabb standards
Lcsmrz replied to durantee's topic in Tissue, stem cells, and bone marrow
I don't believe the AABB has a sample size requirement. It would depend on your facility's population and its acuity. Some hospitals that I've worked for choose 4 random transfusions per month. -
Collection dates... where are they going?
Lcsmrz replied to spavlis's topic in Computer Systems / Software / ISBT128
Blood centers have a highly-automated labeling process. The chances that an expiration date is incorrect is very small. I haven't had my techs check the collection date in ages, only the expiration date. Our blood center writes the collection date and time on the bag label at collection, which is verified just prior to overlaying the ISBT label during labeling. -
We are planning to start using it in December, when our TAR (Meditech v5.64) becomes activate. I'm told it works, but I haven't tried it yet. Larry
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We require informed consent for blood products only. RhIg is a blood derivitive, as are Alb, PPF, Ig, etc. The disease risk for these products are exceedingly small.
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I think the AABB has a book about informed consent
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What does Biotest say to use as a negative control?
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There seems to be several "standards" for temp monitoring: one for storage of blood products, one for reagents, one for coolers, etc. Personally, I think there is only one -- you must be able to prove that you stored any critical material within the temp range specified by the mfr, the FDA, or your own SOP/QP, from receipt to final use.
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Same here ...
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At our facility, that is correct. We don't have MLT's working in Blood Bank, so everyone is under the same job category and has the same responsibilities. But each institution defines things differently -- the official Job Description will document your facility's definition of the difference (if any) between MLT, BB and MT. If unionized, check the work rules, also.
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We consider the BB categorical with a BS/BA to meet our definition of a Technolgist. At one time, an MT working exclusively in Blood Bank was encouraged to take the BB exam. If you need some more evidence, I would check the BOR website for a definition of the exam and the required Body of Knowledge. But every facility makes its own decision, as long as they document it in their job description .
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I vaguely remember a scientific study from years and years ago about estimating blood loss using various methods. The most accurate was the guestimate by the Anesthesiologist looking over the drapes and saying "looks like about xx units to me." OB/Gyn docs are notoriously frugal with transfusions (even with large bleeds), whereas Internalists dealing with old, frail patients with multiple morbidities seem to be the most liberal. All clinicians can produce literature supporting their transfusion strategies, since there is a distinct lack of censensus among the different specialties. I've always used 1 g Hgb per unit as a ballpark figure.
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DIFFERENT Poll on "When does the Clock Start"
Lcsmrz replied to Brenda K Hutson's topic in Transfusion Services
Although we use use receipt-in-lab to start our stat TAT, I say choose something to measure that will provide meaningful feedback for your site and consistently try to meet it. If your facility's phlebotomy team is lab-controlled, order-to-verify may be an appropriate process measure. But if you rely on nurses to draw and transport, then receipt could start the timer, since they are notoriously lax on lab-related activities. I've heard it said that the clinician's personal TAT starts when he/she THINKS about ordering the test ... -
By "electronic issue", do you mean electronic crossmatch? Most US transfusion services are computerized and keep their records online, so there is an electronic verification at issue. There may be some small rural sites without a computer that still have a manual system. We are working feverishly at computerizing the nurse's transfusion administration record, so we can eliminate the last vestige of blood bank paperwork throughout the facility.
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If you are a high-volume blood bank, you probably have a computer system that has built-in historical checking of all patients at results entry. We acknowledge that we viewed the history (usually blank) by resulting "yes" in the History Checked? field. If a flag appears, we view the history file information and respond accordingly. Our main problem is not antibodies, but Weak D's. While we call them Rh Neg now, a previous history may show them as Rh Pos. We also have a rather high percentage of OB patients using someone else's insurance, so there is the occasional ABO/Rh discrepancy.
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I believe in the AABB's mission and help support it with my individual membership. The newsletters are very informative, and I find that I don't always get my institutional mailings.