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Andersli

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Everything posted by Andersli

  1. When we switched to Gel methodology we changed our XM grids. For all patients, only the IS XM grid populates our TYSC orders. If the patient requires a Gel XM or XM by another method (PeG, LISS, PW, etc.), then we add the additional grids, which also have the IS phase. Therefore, we have to result the original IS XM grid with 'CE' or 'IE' for compatible/incompatible by enhancement. May not be the best way, but it works for us. You can charge separately for each of the phases. Unfortunately, I do not do the maintenance in SQ but I can give you a contact for one of our LIS people if you would like. I do know that for patients that only require the IS XM, the charges are based on the number of units that we put into the UO field. If the tech does the IS XM but does not update the UO field, no charges go across. But once that field is updated, the charges drop. When we add the other crossmatch grids, the system is set to charge based on the phases performed. For instance, our Gel XM grid has an IS phase and AHG phase. When both are resulted, charges drop for CPT 86920 (Compatibility, IS) and CPT 86922 (Compatibility, AHG). If we were to do a LISS XM, then a charge would also drop for the 37C phase. It took some time to set-up and validate everything, but it is much nicer than having to complete the full grids. Lisa A.
  2. If your computer system is being moved to a new server (AIX) that is the same operating system but an upgraded version with faster processing, would re-validation of the BB system need to be performed? Not sure if a new server would be considered a "hardware" change? And if re-validation would be required, is a full re-validation needed or would a partial validation check be sufficient? We have reached out to our vendor and they are telling us that re-validation is not necessary. Any thoughts/recommendations would be appreciated! Thanks, LA
  3. As referenced by 'goodchild', if we do a LISS crossmatch, say for an autoantibody patient where the auto is not demonstrating in LISS, we charge for all 3 phases (IS, 37C and AHG). Otherwise our primary method for an AHG crossmatch is Gel so we charge an immediate spin crossmatch and an AHG crossmatch. Same would hold true for a PeG crossmatch. Lisa
  4. Thank you Liz! This is very helpful!
  5. When we switched to only receiving pooled cryo from our blood supplier we created a new thaw code in SunQuest "PCRY5T" because some of our sister facilities were still using single cryos. Our pooled cryo "E3587" is put in as PCRY5 and is thawed using PCRY5T to "E3591" Thawed Pooled Cryoprecipitate/None/XX/rt.
  6. We are in the process of changing our ancient form feed printer (that jams with every print) of 2 part forms to using a laser printer to print our transfusion bag tag forms for tagging units. Are any other SunQuest users currently using a laser printer? If so, would you be willing to share your process/form? Our current form has a removable sticker that we place on the back of each respective unit and we would like to use a similar process/paper. Thanks, Lisa
  7. I agree with you that if the sample you have doesn't have any matching identifiers to the current name and MRN, then a new sample would definitely be needed. I have heard our nurses in the ER complain about not being able to see previous records when the patient is currently admitted as an Unknown. Even once they update the name though, they still have to search by name to get all the records because we do not merge until the patient is discharged at our facility. Lisa
  8. I may need more clarification on what you mean by "merge". Our system has a group of trauma names that are 'pre-registered' with an account number. When a trauma patient presents, our admitting department (PAS) quickly assigns the patient a MRN with an alias name (i.e., Athens, Athens; Evans, Evans) are a few of the ones we had yesterday. Once they obtain a 'real' patient name, PAS is given the ok to make a name and DOB update. This MRN stays with the patient for the entire length of stay. Also, there is an audit trail that captures the alias name in the hospital system and when the lab is made aware of the change, we also put the alias name in our system when we update the name. For our blood bank samples, we use an additional blood bank armband with a unique number so we really have 3 identifiers (i.e. Name, MRN and R#). So when the name changes, the MRN and R# that print on the transfusion forms match the blood bank armband and the sample collected. In addition, once the name is updated, nursing replaces the hospital armband with the new name so that band is checked against the transfusion forms if the name has been changed. The blood bank armband is not removed until another sample is required or it expires (72 hours). For the merging of records.....so if the trauma patient already had a previous MRN in the hospital system, these 2 records are not merged until the patient is discharged. Once discharged, then the merge occurs and we can track this in the system. They are not to merge anything while the patient is still in house. Hope this helps! Lisa (PS - edited for font size)
  9. Our process for MTPs involves using a manual "Emergency Release Form" where documentation of the physician ordering the emergency release of products signs as well as capture of transfusion documentation (Y/N and start/end times). If products are returned, we have a statement at the bottom of the form that states "I certify the returned units have been maintained at appropriate storage temperature as packed by the Blood Bank and are safe to reissue for transfusion."; which is signed by an individual that was in the room during the protocol. As long as this is signed, we will return the plasma for use but we still take a manual temperature of the products upon return just to be sure and use some judgment. For instance, if a cooler has been out for hours and the plasma is still warm, then that gets quarantined and discarded. We are fortunate as well that we keep approximately 12 units of plasma thawed at all times and generally the first 2 MTP coolers issued have plasma that has been in the refrigerator and already at appropriate temperature. Lisa
  10. Same as David for 1 & 2. 3) During a massive transfusion, we only give type O RBCs emergency release. We do perform the crossmatch post transfusion, but only on the first 10 units given. After that we put in a comment that crossmatch is not required due to massive transfusion. 4) For our neonates we perform a type and screen usually on admission. If we detect anything, then we would use a sample from the mom to ID and order antigen negative blood and crossmatch. Majority of our neonates have a negative antibody screen and we only give type O RBCs, unless we have a directed donation. In those situations where the neonate is type A, B or AB and the directed donor is not type O, we do perform compatibility testing prior to the transfusion of the first aliquot. Lisa
  11. We have recently purchased one of the Genesis Plasmatherms and I am in the process of writing the validation plan. It seems as there may not be many out there using these devices but I want to ask what others have included in their validation plans to make sure the device is properly functioning, other than the general temp/time check and water filling, etc. Did you include thawing a certain number of plasma/cryo prior to putting it into use to validate function/time? Any input provided is appreciated! Thanks!
  12. My facility is also looking at TEG and ROTEM. Our trauma program is relatively new (Nov 2011) and as we bring in more trauma surgeons they are pushing for one of these. It has been mentioned that our CVOR program actually purchased TEG many years ago but never put it into use as it was difficult to interpret at that time. Our trauma committee is in the process of setting up some inservices to see which one may be more feasible for our program.
  13. We do a blood type each admission for inpatients. For our recurring outpatients that are getting therapeutic plasma exchanges we do the blood type each month with the new monthly admission.
  14. Oops...yes we also require the pretransfusion vitals to be recorded.
  15. Hi All, I am new to this group and have enjoyed reading previous posts on the various topics. I now have a question for the group to see what others may be doing. We have been tasked by QA administration to look at the process for nursing related to blood administration and documentation of vitals. Apparently they are not very happy with all of our reports of incomplete documentation we are discovering when we perform the chart audits.... The current process is to document vitals at 15 minutes after start, every hour (1 hour, 2 hours, etc) during the transfusion and then 30-60 minutes post transfusion. Their feeling is that this is too much. We have looked at the standards, checklist items, technical manual, circular of information, etc., for guidance and have not found anything as specific as our current process. We of course have our concerns of changing this process...especially for units that hang for 3-4 hours. If you are willing to share your process or have any comments, I would appreciate your feedback. Thanks, Lisa
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