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Posts posted by Maureen
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I was in your position a few years back, attempting to update an outdated microbiology procedure, and now follow the procedure from the AABB Technical Manual. I considered discontinuing this infrequently ordered test and sending the orders to our Reference Lab, however they offered to send comparative samples for PT, which we implemented. My most recent AABB/CAP assessor was pleased with the process and outcome.
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We use the Thermo Clinifuge, spin for 5 minutes, which we reduced from 10 a few months ago. Specimens are routinely tested on the Immucor Echo analyzers. We're in compliance with the vendor/manufacturer's requirements.
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AABB has published Standards for Perioperative Autologous Blood Collection and Administration. Our Surgical Services and Txn Med Quality Committee found these standards helpful when updating our interoperative processes. Similar organization to Txn Med Standards, including labeling, process control, documentation, and QC measures
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I have a 'Supervisory Review' form, one page per month, which has check off columns for specific tasks (and a corresponding SOP).
On this form I record the ECHO batch # of each QC run when I (or a designee) review them. I track the RS3 & Indicator cells for my own purposes.
I don't print them out, but they are archived with the patient data, so I can retrieve it when requested.
I include the 'Supervisory Review' form with other QC documentation for retention and retrieval. I've attaché d a copy of the spreadsheet.
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If you are an Immucor customer, with your customer number you can access their LEARN online modules. Most provide PACE credits. Our lab techs find it can be challenging in the beginning to get access to their website, but the learning modules are very good.
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Enjoy a fantastic retirement ~~
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On 8/30/2017 at 11:27 AM, Malcolm Needs said:
I do so agree with you mollyredone. Sadly, in the UK, it is usual to have to perform a serological cross-match, using group O red cells if there is any hint of a mixed-field (even if the patient has, for example, been typed as group A for a decade, and a unit of group O blood was transfused the previous day). This pathetic attitude to the professional ethos of the laboratory personnel is insulting in the extreme, and, because the "mixed-field reactions" will be "reinforced" with each transfusion of group O red cells, if the patient requires frequent transfusions, the "discrepancy" will never be resolved, and precious group O units (in particular, group O, D Negative units) will be wasted unnecessarily.
Worse still is when the patient has an alloantibody, such as an anti-Fya, when group O, Fy(a-) blood has to be selected for the group A patient (in my example), when group A, Fy(a-) blood may be readily available, leaving fewer group O, Fy(a-) units readily available for a genuine group O patient, with anti-Fya, who may require it in an emergency.
Worse of all is when the patient has a complex mixture of common antibodies, or an antibody directed against a high=prevalence antigen, when there are only a certain number of group O units available in the country (and less donors, as numerous cryopreserved units may come from the same donor) and these units are wasted on patients who are patently not group O.
RANT OVER - FOR NOW!!!!!!!
Hello Malcolm - from your text it seems that the 'usual UK practice' needs to shift. Fortunately the proposed CAP reg does not require use of type O, only requiring a serological crossmatch. Re: preventing a LIS from permitting an electronic/computer crossmatch I suggest creating a placeholder 'antibody' for the requirement, which can be set to disallow. This antibody could be deleted when the requirement is resolved (awkward but possible).
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On 8/13/2017 at 7:45 AM, AMcCord said:
I like the idea of your verbal order verification.
Our Lab has a 'Documentation of Verbal Orders' - policy and form (available as Log Books), which the blood bank techs follow as needed. Like most labs we strongly encourage transfusion orders to be placed by the provider, nurse or trained patient services personnel, but we will accept and order as necessary.
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In Cerner there are two Computer Crossmatch options. One requires you 'order' a crossmatch, then 'result' as a computer crossmatch which updates the rbc status to crossmatched and generates a crossmatch tag. We don't use this option, except for scheduled downtimes. Our preferred process is, as described previously by pbaker to computer crossmatch dispense in one process, capturing the all required information in real time (but we don't have the tools to scan employee badges, so we type). We now have a customized Transfusion Tag, on which we record the date & time dispensed, and sign. The transporter signs the tag when they handoff the blood to the transfusionist.
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Thank you Malcolm, for traveling so far and sharing your expertise with us, and thank you to Phil as well ~~ it was an excellent convention ~~ Save the date, the 2018 70th Annual Convention is April 24th through the 26th ~~
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We’re excited ~~ the 69th ASCLS-CNE Annual Convention’s speaker program is now available on the web ~ the site is open for online registration
Providence is a great city to visit in the spring – and this is an excellent opportunity for networking and learning.
Feel free to share this link www.ascls-cne.org/annual-convention to view the program and register!
- Malcolm Needs and gagpinks
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We do not repeat the Type or Screen post delivery when it has been done on this admission. We do perform the Fetal Screen (Immucor FMH RapidScreen/KB if indicated).
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Before we implemented electronic crossmatch we changed our retype protocol. We perform a full front and back type when we perform a patient Retype.
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Thanks for letting us know ~~ I noticed them, but didn't realize it could be a game ~~
- Malcolm Needs and Cliff
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I have gone to our off site storage facility and retrieved paper records. Fortunately it hasn't occurred frequently.
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The FDA states to report adverse events.
We are notifying the ordering providers of transfused patients, with a request to let us know of any unexpected clinical events have occurred subsequently, which could be related to this transfusion.
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WE use the Sure-Tech kit and ~ 2 specimens per month are tested. The test is time and technique dependent, but competency is not an issue in our lab. The patient specimen results are usually clear and easily read by the techs.
The positive CAP survey specimens are not easy to process, and the Limits of Acceptability are quite wide - attesting to the challenge of this survey.
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This is our version - it's long because of the flowchart and examples
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We are part of a multi hospital system. We use LIS test patients which match the ABO/Rh and antibody status for the CAP 'patient'.
For the CAP XM survey I generate a random ISBT DIN that will not ever exist (collection year <2007) which I substitute and crossreference for the CAP supplied DIN.
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Our LIS terminology is 'Antibody not identified'.
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Issuing plasma based on historical type
in Transfusion Services
Posted
5.16.2.2 only applies to crossmatches.