Lcsmrz
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Everything posted by Lcsmrz
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Looking for Meditech Magic Users...........
Lcsmrz replied to Skinrash's topic in Computer Systems / Software / ISBT128
I'm on Meditech C/S v5.64 right now, with a move to v6.0 planned for early next year. It was my understanding that TAR is not functional until then. There are a whole bunch of Meditech users who monitor this board, some are quite knowledgeable about using rules and the actions of various settings. We all learn alot from the postings. I would ask away ... -
We would probably give none to an Rh neg MALE who received Rh pos RBCs.
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John: Is it not sacrilege to propose that the Blood Banking community overdoes validation -- or any other thing, for that matter? "It's for the children ..."
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Immucor does indeed sell racks! They have the rubber "grippers" so if you bump the rack, everything doesn't go flying, as can be an occurance with the MarketLab ones. I bought them because of their low profile; the two-tier rack filled with 10mL vials fits on my BB refriig shelf without scraping the stoppers of the vials in the top tier when closing the drawer. A set of two costs over $150, though. Disclaimer: I am never been employed nor hold stock in Immucor/Gamma.
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"Ruling Out" has a higher predictive value -- if the serum does not react with one or more cells containing an antigen, then the probability of having the corresponding antibody is very, very small. One would hope that, after crossing off, that the remaining pattern fits the antigen that was not crossed off -- I've been fooled before!
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Indiana Blood Center in Indianapolis also provides it.
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You'll notice in the credits that the medical consultant is usually a nurse ...
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As one rapidly approaching retirement as well, I wish you the best ... Thanks for passing on some of your wit and wisdom to us Blood Bankers. I hope "artificial blood" hits the market before our knowledge disappears -- I see few new MT's interested in spending their careers hunched over a viewer shaking tubes like we did.
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The AABB has a billing guide on their site, under Programs and Services
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We've gone back to our old MLA's. The techs seem to like them better ...
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You are not alone! Many facilities are located in old parts of old buildings and have old equipment, making for very few options. Money is generally very tight all over ... Documentation is the only potential solution, converting all problems to a dollar amount -- the language of administration! There is a cost of moving inventory, taking additional temperatures, servicing, potential loss of expensive products, etc. The cost of the status quo frequently exceeds the cost of a new refrigerator & alarm system. Just stating "compliance problem" is no longer enough to loosen the purse strings. I have had sites request that I cite them for ongoing space and equipment constraints, as an additional leverage tool. I start requesting new equipment as they approaches their end of useful life, and usually get it replaced before they die completely.
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The weekly drain-and-refill of Helmer thawers has more to do with keeping down growth of contaminating organisms, rather than usage. Even if never used, we follow the mfg recommendation of weekly cleaning.
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You don't mention if you're a transfusion service or a blood center. I know, I know, it doesn't make a difference, but in a non-registered hospital, a Medical Director is allowed more professional judgement than in a licensed facility. In the latter, I would discard the entire inventory ...
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Transfusing blood and meds at the same time.
Lcsmrz replied to BUGGIE's topic in Transfusion Services
Having been in surgical suites on multiple occasions, I can tell you that they routinely piggyback blood products into lines running drugs, Ringers, etc. They justify it by saying the flow rates are quite high, so the intermix time is low. My opinion is that anytime blood and something other than saline is in the tubing at the same time, it's bad ... I once was called in to check a "clotted" FFP bag, only to discover that the calcium in the Ringers was causing the plasma to clot before reaching the patient! Their response was "Oh ..." -
Same here
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We use Meditech, and the system automatically backs up the historical file to a local hard drive. If the network or computer goes down, we can access it as an off-line PC. If the computer, network and local PC is down, we have a total electrical disaster and we couldn't do any bench work anyway ...
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We document these special conditions (once a year, or less) as a "deviation from SOP", with the advice and consert of our Medical Director. SOP manuals should have procedures for expected conditions, but not every imagineable possibility. MT's are very creative people, and my manual is already too big ...
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We like to see FFP given to patients with an INR > 2.0 and an immediate need for coumadin reversal, like surgery or acute bleeding. Otherwise, given Vit K and wait a day ...
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It could be that the patient had an Anti-E all along, just below detectable limits. Any contact with an E postiive cell (RBC or PLT) may have caused a quick amnestic response. Also, with many trauma patients, they are rather diluted out with crystaloids on arrival, and the "diluted" sample may have dropped a weak antibdy below detectable limits. Because Anti-c and -E tend to go together, many sites give R1R1 cells to patients with either. Inteeresting case !!!
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Sgt Dave: Thank you for your service to our country ... The R Set (we call it a minipanel) is used to exclude all antibodies other than Anti-D. Ortho Panel A has 3-4 cells marked with an "@" in the righthand column that can be used for this purpose, although some sites just do a complete panel. It's at the discretion of the BB Supv and Medical Director. We report it an "Anti-RhIg" with a comment that the identified Anti-D was consistent with a patient who recently received RhIg.
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Personally, I think forms completion is a nursing thing, but the BB always gets stuck with it. It gets easier when on-line nursing documentation is implemented. We're a small place, so I get to do 100% every month.
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Our ER Release procedure contains a history check (if the name/MRN is known), but I'm not sure the outcome would have been any different. If blood is needed now, it's needed now. Death by exsanguination is not an option. At least the clinician and pathologist would have been making knowledgeable decisions about limiting transfusion of incompatible blood and proper monitoring afterwards.
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My manual says we define periodically as after 30 days while in use. Since we get a new panel every 4 weeks, we just activate the new one and deactivate the old one. So we never run QC on panels, unless we're using a panel cell from the expired shelf. I think the statement is in there as a CYA from Ortho. Unless they can tell me how frequently and give me an example of which antigen they found to be the first to degade during storage, I will do what I do -- and I can sleep soundly at night, knowing I met the regulations.
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There are some general equipment standards: must be validated for use, must be calibrated, must be maintained according to mfr instructions, functions must be periodically checked, etc. The only specific one I can think of is the 30-37 C range for thawing plasma products.
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No donors at this small rural site, but we were talking about patient cards. Meditech can handle the donor side, too, and almost all of it without paper. The little paper that is necessary, such as donor cards, would be scanned into its document system. Again, you have to make the jump to embracing the technology that already exists -- but only if you're comfortable enough with it to sleep at night! Our entire facility has an EMR, and we're just a small fish in a very big technology pond. It would be too expensive to do this on our own.