Darren
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Posts posted by Darren
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Does anyone have a policy to share on delta check intervals? In our system (meditech) we have the hours set pretty far back and it stops outpatients for ridiculous things like a1c% and differential values and various chemistries. Personally I think delta checking differentials at all is a bit worthless, particularly on an outpatient whose last value was a week or two ago. And nearly daily at least a few inpatients will have differential delta checks.
I'd like to whittle down our delta checks to try to make them actually helpful and optimize our TAT with more autoreleased results.
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Anyone have a 7600 from ortho? Have they updated the software in them at all? Seems like all they did was change the color and put in the digital camera and dual test slides. The software of the 5600 is dated. Wants you to print everything rather than offering to save to usb or a network folder or have an email option. It would be nice to be able to use a network printer as well.
I've heard that they have a hemoglobin A1C microslide coming out this year. That would be better than the supply 3 test. Hopefully. If it works well.
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On 1/11/2022 at 4:14 PM, PORTAGE said:
Thank you for posting this. I am trying to create an automatic retype order for when the patient doesn't have a history in meditech. I have attempted to use this rule but it won't pull the result on its own. Do you have to manually enter ., AP,AN etc? I have it set up as a PRE rule and was not sure what else I might be missing. Please let me know if you have any questions. Thank you.
No, we don't have to type in the period. The period is put as the auto result spot on page 3 of the test dictionary. Then on page 5 you put in a period as a result code with No History\FV as the result text. You have to have an Order Group built that you attach to this response to trigger the reflex type. If any other result appears like ABN or OP or whatever you have each built as a result code on page 5 and for the result text put History On File or whatever with the \FV after it. But that will not get any reflex order groups.
I'll try to keep a better eye on checking this site if you have any other questions.
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On 5/20/2021 at 9:22 AM, John C. Staley said:
Wow, just wow. I can't even imagine a blood banker in the US considering this as acceptable. Our usual assumption has always been, if we didn't do it then it's probably wrong. Our paranoia runs deep and swift. Now, before anyone gets too upset with me please know that I was one of you for 35 years so I can play the what if game with the best of you. I'm just noting what I observed over many years. If anyone in the US is actually accepting the results from other facilities at face value and acting on them, please let me know, I would love to be wrong.
I would love a national medical record so we could all have access to the type of anyone that walks through the door and has a history.
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On 5/3/2021 at 2:59 PM, Malcolm Needs said:
And if the blood in the tube was taken from the wrong patient?
Then a phlebotomist is in deep doo? We do a two person witness on BB collections. Something I guess.
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We run our panels on the Vision analyzer and result them all in the LIS. I do not scan the antigrams. I keep a network folder of PDFs of all of the lots we use for referencing back to. Which in years and years we've never had to do.
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I have a calculation built in Meditech that if the patient has no BB history then it will automatically add a second type to the order. Forward type only. Currently we just run it on the same tube.
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We use the Transfusion administration record in Meditech. Barcode scanning in the BB on issue and at bedside by nursing. Nursing brings a form with the patient account number to pick up the unit. We scan that to bring up the patient and then scan out the blood.
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We use the TimestripPlus BT-10s. We also have a tiny infrared thermometer and there's always the certified thermometer that we can wrap around a unit and take a reading. We don't often get returns or have to mess with coolers so it's not that big of an issue for us thankfully.
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We'll be migrating to Epic in the next year or two. Probably with Wellsky or whatever HCLL is called. I know it probably depends on the organization, but is there much building to do with Epic or does a lot come standard with no customizing? We're currently using Meditech 6.0.
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Hello all. Am I the only one that doesn't get hemocytometer controls. We run a liquid control when we do them, but it really seems that manual counts should be an issue of competency with a validated hemocytometer, not a qc issue. Even if you get a manufactured disposable hemocytometer with multiple counting areas you're only running qc on two areas that you don't even use for counting the patients. So it seems that QC is assessing the tech performance rather than the hemocytometer. Particularly if using an old glass one with the same coverslip over and over.
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Hello all. I have Vision and we have two of the Ortho Sera reagents that we use, the weak D and anti-K. The problem with doing antigen typing for us is that we don't do enough of it to get the Ortho antigen typing cards. If we got one sleeve of Anti-E cards we'd probably have to throw some away at the expiration date. Same with any of the other Rh cards they offer. What would be ideal for us and probably a lot of places is Ortho Sera for Rh antigens because the antisera has a much longer expiration date - 18 to 24 months I think. I asked our rep if they planned on producing those and he said that right now he didn't see anything on it. BUT if customers start putting in requests for it on the hotline they would consider it if they got enough requests. If enough of us Vision users flood them with requests then maybe we can get them moving on it. So the next time you have to call in to service for something request Ortho Sera for the Rh antigens! You can even call the service hotline just to make the suggestions. I think it'd be a great product for practically everyone that uses the Vision.
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Okay! Here's the deal. Cytotherm has gone under. A former employee has taken over the service parts and started his own business that hopefully lasts as long as the thawers do. We ordered 2 bladders from him and got them the next day! The website is called Cytosupplies. https://www.cytosupplies.com/
First purchase is via credit card and then after that you can get set up in his system for POs. So spread the word to get this guy some business so we don't have to fork out a bunch for all new thawers.
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Anyone else have a cytotherm thawer and find it impossible to get the replacement bladders? I've tried all of the numbers and email and gotten no response. Have they gone under? I even tried calling the fax number and a fax machine picked up. It's a mystery.
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We just went live with doing weak D on the Vision with Ortho Sera. I also got the anti-K set up as well, but haven't rolled that out to everyone.
On the Provue we ran some antigen typing using the IS XM and IgG XM to cross the antisera to the unit cells. I have figured out how this can be done on the Vision as well. The question is, as long as I do a validation, can I proceed with using it? I would be using another company's antisera barcoded to run on the machine. Ortho has made a big deal about their new Ortho Sera being specifically for gel, but I know people have been using antisera in gel forever. I'm just wondering if there's any prohibition against this aside from Ortho preferring that you buy their stuff.
As for the meditech portion of this, those of you with interfaced analyzers know that at least in version 6 of meditech (and probably expanse) antigen typing doesn't interface and neither does crossmatching. Just thought it might be a good time of year to remind meditech that they need to add that functionality to the interface. Let's all spam them with it!
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On 6/21/2018 at 7:35 AM, ANORRIS said:
I scan them into a folder on my PC and throw away the paper copies
I do this as well and put them into a network folder where we'll probably keep them for 10 years. Maybe. I only scan them once a quarter on a big copier that can do them all, then it emails me a pdf. Sometimes the files can get big so at the end of the year I use a compression program to shrink them down and save server space (7-zip).
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10 minutes ago, Texas Lynn said:
I interpreted it that they added that it had to be stored in it's original vial and stored appropriately at the recommended temperature.
I would think that if that were the case it should say:
"Once the product vials are opened, the reagent's performance characteristics are maintained for seven days when stored at recommended temperatures and within its original vial. Do not use this product after seven days of being opening."
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23 minutes ago, SMILLER said:
I would think that the rephrasing was to emphasize that is is the reagent in the vials (not just the vials themselves!) that expires after 7 days. I think it is clear that they are saying they claim the reagent is stable for 7 days after opening. If I were an inspector, I would interpret the new phrase as indicating that the "performance characteristics" end after being "maintained" for 7 days, which would mean that you cannot use a vial after that time.
Scott
This is the problem with peer to peer inspections, I interpret it differently and unfortunately the wording is less precise than previously and open for interpretation. Interpretation, though well-informed, is still opinion. The new line doesn't say that the performance characteristics end or that it cannot be used after seven days. It would seem that a lab could validate them for longer use as long as they did a decent study and include things like examining for hemolysis, reactivity strength over time, etc. So far I can't get the updated PDF from the Quotient website.
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I recently received a notice that Quotient has updated the IFU for the AlbaQ's.
They removed the line: "Once opened, vials can be used for seven days."
They replaced it with: "Once the product vials are opened, the reagent's performance characteristics are maintained for seven days when stored at recommended temperatures within its original vial."
To me this opens up the possibility of using them until the reagent expiration date. Of course that would depend on a validation study. I've kept old ones around and they seem to never lose their reactivity. Even to the point that they rarely suffer from lowering grades as they age.
Thoughts?
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We very rarely resort to running manual gel so I gave up doing the controls on it daily a few years ago. We run them if the Vision is down, but of those rare times we have to run manual stuff the reagents have been QCd on the Vision already that day. It makes me wonder if you took the reagents off of the machine to use manually in that case, could you then just do some abbreviated QC. All you'd really be checking is the pipette, incubator, and centrifuge (which work as expected 99.9999% of the time). So I wonder if just running a positive and negative DAT would suffice.
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I "review" everything. I put it in quotes because it's actually done automatically thanks to my girlfriend being a SQL report writer in IT. If you have a SQL writer you can have them whip up a report that does the reviews for you and you just stamp it reviewed and take whatever corrective actions you need. I guess this also assumes that your facility is using a TAR system for nursing to enter vitals and whatnot.
It's really baffling why we don't see LIS systems taking more into account the regulating agencies and tailoring their software to it. So many things that are manually looked at could be done in the background.
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On 1/25/2019 at 10:54 AM, Cliff said:
- If > 0 but < 2+, interpret as Rh neg and perform Rh molecular testing. Notify a supervisor to have molecular testing performed.
Why interpret it at all until the extended testing is done? It seems this would create confusion among doctors. "It was negative and then it wasn't!"
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Officially we say "females less than 50", cheeky man.
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Is that 16% all Rh neg women or just ones with FMH? If it's just FMH patients then the overall number of people developing anti-D would be very low. To conserve Rh negative we often give Rh pos instead to anyone except women in child bearing years and I can think of 1 in the past two or three years that actually made an anti-D. I've seen more anti-E and -K develop than anti-D. Allergies, man. Some people get them on the first dose and some never do after twenty.
Cyber Attack
in Transfusion Services
Posted · Edited by Darren
My hospital was cyber attacked and we've been down for about two months now. The end is in sight and it is the opinion of my boss that we will be manually entering all results from those two months into the LIS. Everything. Lab, Micro, path, BB. Thoughts? My thoughts that it is horribly unsafe and that all results should be scanned in and manually charged has fallen on deaf ears.