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Everything posted by Jane
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I would advise having someone "higher up" on your committee as well if possible. That way if you do have any problems, they can help you solve them a little faster. I have had the VP that is over the laboratory on the Blood Utilization Committee for that last few years and that has proven to be a good thing.
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The nurse is supposed to call the physician at the first sign of a reaction and then the blood bank. We have certain criteria that make a workup mandatory but the physician can request a workup for any symptoms.
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When we did antibody screens using a tube method, we rarely picked up RhIg. Now that we use Ortho gel, we almost always see a positive screen from RhIg so it may be the method that you are using. Just a thought!
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Hi All- I was wondering if anyone uses the Dinamap 9300 for checking BP and pulse? We have aquired one from our OR to use with our donors but they did not have an operator's manual and I can't seem to find one on the web. Any ideas? Thanks!
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To Use a Unique Blood Bank Identifier or Not...
Jane replied to Laurie Gillard's topic in Education / Quality
We use the Typhenex armband and the nurses have to bring the armband # when they come to sign out blood. The only place they can get the number is from the patient's arm. I do feel like it gives another layer of security. -
You can order complement control cells from Gamma. We use them to QC our anti-c3b, c3d reagent from Ortho. Hope this Helps!
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Welcome Urvashi! This site is a great resource for help and ideas from our peers. Jane
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I would think as long as the bench tech can access them that would be fine with any inspector.
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We pay 231. in NC.
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We wouldn't know either unless a DAT was ordered separately. Our policy for the crossmatch through AHG just applies to patients with antibodies (past or current).
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Do any of your facilities' informed consent forms require that the physician sign them? Ours currently does and administration is wanting to remove it to end a compliance problem (forms don't end up getting signed). I know that it is not a direct requirement by anyone that we have this. One of the docs wanted me to get a feel for what others do. Thanks for your help! Jane
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Have you considered antibodies that aren't listed on the panel. We recently had a patient (prenatal) with a postive antibody screen (1+ in one cell). When we did the panel, we had 3 positive cells but were able to rule out all the clinically significant antibodies. If this had been anything but a prenatal we would have probably quit there with negative crossmatches through AHG. But with the prenatal we sent it off to the ARC ref lab. It turns out to be an Sd. So you could always have something on the cells that is not listed on the panel sheet. Also, I would never go by results gotten after respinning the cards. This is a lot like respinning and rereading tube reactions- never as good as the first time. I would repeat the screen and make sure pos and neg controls with all 3 screen cells were reacting correctly just to make sure nothing was contaminated. Probably not the case here since you got positive panel reactions as well. just my .02
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Selecting a new computer system
Jane replied to QDeb's topic in Computer Systems / Software / ISBT128
Our entire lab including blood bank has been live on Misys since April 2003. Prior to that the lab used McKesson Advantage and the blood bank used Western Star. Using Misys and using only 1 system has been a huge improvement for all of us and especially for all the folks that are cross-trained. I would be glad to answer any questions about Misys that you might have. -
We also require everything except Kell be ruled out homozygously. If we can't rule out something then we will give units that are antigen negative for whatever can't be ruled out. A new tech actually missed an antibody last year by ruling out with 3 heterozygous cells. No harm came but it was a good reminder that ruling out heterozygously can get you into trouble.
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We do the same thing you do Mary. It does occasionally confuse the nurses but we also put on our blood bank form that an armband is only required for blood. There aren't too many questions but we do get one now and then.
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We definitely add overhead. This covers all the stuff we can't charge patients for anymore- courier fees to get platelets/special products, special orders not used, units mismanaged by nursing, etc, etc etc.
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Our OR is responsible for the tissue but it is stored in one of the lab's (not blood bank) freezers. I hope no one decides this would be better handled by lab. In fact, during a recent JCAHO survey, we got asked a lot of questions about tissue even though we don't order, issue, track, etc. I would like the OR to get their own freezer and move it away.
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We also perform a second type on all patients with no historical type. I am trying to avoid the second sample for all the complexities that it will bring. We currently have lab personnel draw all samples for blood bank and use a Blood bank armband.
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Thank you both so much for your help! I also found a lot of other good stuff in the commendable practices section on AABB.
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Would anyone be willing to share their procedure for critical materials and reagents with me? I am having a terrible time getting this procedure started and I hate to reinvent the wheel. Thanks!
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We get these sometimes and we use 24 hours for the expiration once the 2 bags are pooled.
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We were doing the clerical check, post DAT (unless post was positive, then we added the pre), check for hemolysis. Because of a CAP standard in the Dec 2004 checklist (TRM.41850) we are adding the post ABO/Rh as well. I have pasted the revised standard below. **REVISED** 12/29/2004 TRM.41850 Phase II N/A YES NO Does the immediate investigation of a transfusion reaction include all of the following? 1. Examination of patient identification, blood unit labels and all pre-reaction records for possible errors in patient or blood identification at the bedside and in the laboratory 2. Visual examination of post-reaction and pre-reaction (if available) serum or plasma for evidence of hemolysis 3. ABO/Rh and direct antiglobulin test on post-reaction patient (recipient) blood sample Hope this helps! Jane
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I agree with the other posters. We do not routinely perform DATs on donor units either. I can also speak from the experience of being a new supervisor (3 1/2 years now). You will probably discover a lot of things that need changing and the best way is to do exactly what you're doing. Just slowly make changes and chip away at all the old ways until you have them up to date. Good luck!
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Ok- here is yet another question about validation. Mine is a little different. We are planning to switch from the BD pink top tube (plastic K2 edta) to the Greiner Bio-One pink top (also plastic but K3 edta) due to significant price differences. I am planning to do a small parallel study as the new tube has FDA approval for the testing we will be performing. My question is what tests should I do for the validation- we use this tube for most everything in the blood bank- ABO/Rh, DAT, Antibody screen and ID, crossmatches, etc. Will just doing tests with similar methadology be adequate- antibody screens and ABO/Rh on all the samples? Opinions please!
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Yes- If you have the book from Ortho titled, "Interpretation Guide" it has pictures of samples with rouleaux listed under that and under haze. If we have a patient with rouleaux (verified by hematology or by us looking under the microscope) we do the tube antibody screen. After washing and adding AHG, rouleaux shouldn't be a problem anymore. Hope this helps!