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April 2024 Challenge

Sophie1210

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Everything posted by Sophie1210

  1. Sophie1210
    When we pool units (plasma or cryo) with both Rh pos and Rh neg the new label that prints out from our LIS system says Pooled Rh on it. When we give it out we just explain to the nurse that it means it has both Rh neg and Rh pos.
  2. Sophie1210
    We are a level III and don't keep platelets in-house and our closest supplier is a hour away. The reason being is that we don't get many traumas and we don't transfuse many platelets. The price for platelets would be out of the lab budget and not the surgeons who wanted us to have platelets on hand. I figured out it would cost us about 18,000/yr in wasted units, so our lab director said no platelets. We do have a level II trauma center 3 miles away, so that may be why we don't get that many traumas.
  3. Sophie1210
    Unfortunately for us our LIS was built considering anti-M to be clinically significant when identified (no matter what phase it's reacting at) so we have to give antigen negative units.
  4. Sophie1210
    If we get question marks on the Echo and negative in tube, we'll call it negative. However, if we get a positive on the Echo that doesn't work out on the panel and negative with PEG we result a positive screen and put in a comment that it was negative in tube and no clinically significant antibodies were found. We also result an Unidentified anybody to get a hard stop so that patient can't ever get an electronic crossmatch (if at a later date the screen is negative, then our system would allow one if there were no antibody in there). We had a patient where this occurred and there was no clear cut answer on the panel and everything significant was ruled out. 2 weeks later the patient had a clear cut anti-C. Looking back the only cells that reacted were C+, just not enough and not in the correct pattern to identify. Yes, the Echo is overly sensitive but sometimes it picks things up before anything else.
  5. Sophie1210
    We get a few equivocals (question marks) every month called by the Echo. If the Echo calls the screen negative then we call it negative. If it gives us a question mark then we take it to the bench for a tube screen using PEG.
  6. Sophie1210
    We don't weigh our units at all. We only record volume and our computer system defaults to 350mL for RBC's and then we put in the volume found on the bag for plasma and platelets. Why do you weigh the units?
  7. Sophie1210
    We store bone/tissue for surgery and track it. However, if there is an adverse event dealing with infection we have the Infection Control officer do all of the reporting. We have in our procedure that they will deal with anything and we can provide documentation that the bone/tissue was delivered at proper temp, stored at proper temp, etc.
  8. Sophie1210
    Except that the Transfusion Checklist has a separate item about rare antisera. The question is - do expired panel cells fall under that checklist question? We once got cited for not having a policy defining rare antisera. So we wrote one that defined it and included expired panel cells for rule outs in that procedure. Our last CAP inspector said we were fine for that. I would think that the area specific checklist trumps the all common checklist if there's a discrepancy between checklist questions.
  9. Sophie1210
    We've never had an order for it, but I know my local reference lab offers it as test if we needed. As far as I know that's still the definitive test.
  10. Sophie1210
    We will allow a patent to use the same blood bank armband number and specimen for outpatient platelets/plasma as long as they stay under the same encounter number. So our outpatient cancer center gives patients a financial encounter as recurring that lasts for a month. As long as the patient doesn't receive any red cell transfusions, and hasn't in the last 3 months, and keeps their armband on we will just do one blood type at the beginning. If they receive red cells then we're at 3 days or if they get officially discharged in the system and a new encounter started we will redo the blood type.
  11. Sophie1210
    We have in our policy that we can use expired panels for rule-outs if QC is run and is acceptable. We've never run into a problem for having this policy. There may be a cell on a panel that could help identify or rule out an antibody that isn't available on the current panel. We QC the panel by antigen typing the cell or cells we're using with anti-sera for the rule-outs we need.
  12. Sophie1210
    We are concerned with billing because we are a small hospital and can't do DAT investigations, elutions etc. We have to send to the reference lab. If we don't have a specific order from the physician then we eat the cost of that reference lab workup. In terms of the regulatory agencies we have to work them up if they're suspected. It doesn't say that the blood bank is responsible for suspecting them or detecting them. If you have one tech (generalist) in blood bank on day shift and 1 covering heme/blood bank on evenings and nights, chasing these down ourselves is not possible. If a doctor suspects it then they can order the workup. That's what our policy states - transfusion reactions are called by the nurse or physician and not the blood bank.
  13. Sophie1210
    We do not automatically perform a workup. We only perform a transfusion workup if ordered by the physician, because that's only way we can charge for the work we've done. We also don't have the time or the staff to chase these down and try to figure out if they're reactions or not. If the patient is stable and not showing adverse signs, except a drop in hemoglobin, then it seems more academic than anything else. Unless it would change treatment I don't see the point in doing all of that work.
  14. Sophie1210
    Had she received any blood product? We've had 2 patients that typed Rh neg on the Echo, but had history of them being Rh pos. On the bench in tube they were 3+. Immucor claims it was because they'd both been transfused Rh negative blood in the previous month. I'm not sure I buy their explanation. I've also noticed that the Anti-D Series 5 stops reacting as well when it gets low in the bottle and sometimes comes up negative when the Series 4 is 2+.
  15. Sophie1210
    Our computer system has an Emergency Dispense selection. We can type in the patient name and medical record number or trauma name and trauma medical record number, then we scan in the units, hit save, and tags print. We then tag the units and send them in a cooler. We usually have them in the cooler before the runner hits the blood bank for them. After everything is over, we do all the paperwork.
  16. Sophie1210
    We monitor the low temp on our freezer where we keep tissues, but the alarm testing on that is really easy. It's on the program menu and you just select low alarm test and it runs and then it's done. On our freezer that we keep just plasma in, we only do the high alarm test and we have in our procedure that just plasma and cryo are kept in there.
  17. Sophie1210
    If we have a patient with an anti-c or anti-E we antigen type them for both c and E. If for example they have anti-c, but have the E antigen then we wouldn't worry about it. If they're negative for E and we can rule it out then we don't worry about it; if we can't rule it out then we would give c-E- units.
  18. Sophie1210
    At my facility when we thaw plasma in the computer we automatically change it to Thawed Plasma, because our system won't let us convert it after 24 hours. Technically, we would be using Thawed Plasma to reconstitute but we would use units that are freshly thawed or less than 24 hours old.
  19. Sophie1210
    Anti-A1, natural or allogeneic, is not considered clinically significant unless it's reacting at 37C. The vast majority of patients with anti-A1 only react at IS. In my opinion, this is just like any other patient. We don't worry about their phenotype and what antibodies they could form until they form one. If this were my blood bank, I would tell the techs to continue to transfuse AB or A blood to the patient.
  20. Sophie1210
    nick7791 - I'm actually from Colorado, but my program is online (UTMB) and I wanted something in person and Southwest was having a fare sale. tbostock - I'm not sure what the deadline for Indiana Blood Center's online program is, but it starts in November of each year and they use the same modules/program that UTMB does.
  21. Sophie1210
    nick7791 - I'm also attending the last chance review! My former blood bank supervisor did the same online program as me and also attended the review. He said it was really good and it really helped him focus on what was important and not. He took his exam in May (2006) and passed the first time.
  22. Sophie1210
    We will be going live with electronic crossmatching on April 1st. I've validated it and will begin training staff soon. Crossmatching takes place in Blood Bank Result Entry. You should be able to select Computer Crossmatch (instead of Serological Crossmatch). You barcode in the units like you do for serological crossmatches and then instead of putting in results, if the unit is compatible with the patient it will automatically fill in as Computer XM OK. You'll hit verify and that should be it.
  23. Sophie1210
    We use only a computer system and there is no check by somebody else. Our automated system exports results to the LIS, but our manual tube results are entered as they're performed and nobody double checks it. The LIS contains truth tables that will not allow incorrect entry of results. For example, if the reverse type doesn't match the front type an error box will come up saying there's an ABO mismatch. The tech then has to re-enter the results if they were entered incorrectly or if there is an ABO discrepancy to result an Indeterminate for blood type. That ABO discrepancy result will appear on an exception report. As long as the techs are looking at the results before hitting verify (not just blindly hitting verify) and there are truth tables set up in the LIS, then you're in compliance with regulations.
  24. Sophie1210
    I agree with everyone else, there are so many variables and you have to consider each system/antigen separately. At my hospital we require 2 homozygous cross outs for Rh, Duffy, Kidd, and MNSs. However, I've told the techs that with M and N, heterozygous cross outs are fine if there are more of those since M and N aren't necessarily clinically significant. K, of course, usually presents a problem because finding K+k- is almost impossible, so I also allow the techs to cross out with heterozygous for that one (we have 62 panel cells at my facility, with the 3 Echo panels and 1 20 cell tube panel, and usually only 1 cell is K+k-).
  25. Sophie1210
    This is how they order in our system: Under Transfuse they select which product they want. The Nursing to Administer is automatically selected along with 0.9% NaCl. They then have to check the Set up [Product] and put in if it's stat/routine, how many units, the reason why. Then the order is electronically signed and submitted. When this happens Nursing gets their order to transfuse and Blood Bank gets a requisition printed to set up whatever product they ordered. The problem we encounter is that the doctor's forget they have check Set Up so Nursing gets an order, but Blood Bank never does. Then Nursing calls asking if the blood is ready and we reply "we never got an order." So we've had some delays in patient care because of that.
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