Karrieb61

OK, thanks! I got what little info I had from the BioMed administrator for the corp that owns our hospital. Kind of wish he acted like he knew what he was talking about....

Hi, has anyone heard of RTLS (real time or radio tracking) location systems? I was told yesterday that our parent company is bringing this onboard and that it would have applications in the Blood Bank as a means of locating blood products once we release them. Anyone know anything about this? I did a quick Google and found nothing that was applicable to labs. Thanks!

Oh boy, not a thing. We have an SOP on the transport of products and the responsibility of the courier at the time of issue but nothing about education. This could be tricky which is why I am responding- we had a CAP inspection earlier this year and they nailed US on our lack of records of nursing education about administering blood. CAP held firm in their interpretation of the standard saying that it was the BB's responsibility to make sure all nurses where educated about blood administration!!! Needless to say we were not happy. The inspection team was OK however once we came up with (extremely poor documentation but that's another story) documentation through Nursing Education that the two nurses audited during the CAP inspection were annually trained in Blood administration. Watch out ladies and gents!

Me again, if JC expects lot to lot verification on ALL kits, how do we compare new to old kits for fetal cell stain kits? We make up our own positive control as instructed and would do the same thing for the new kit. So how would we verify a new kit? Either the control works with the new set of stains or it doesn't. Any ideas other than using the same exact control preparation on both the old and new kit?

Oh boy, add this to my to-do list. So happy I saw this! We had a CAP inspection a couple of months ago and they were extremely lax (IMHO) and didn't review basically anything related to QC so maybe we got lucky

No we don't. We use the FMH Rapid Screen kit and it contains a positive and negative control. If I am reading the standard correctly, it says you can use QC materials to validate the lot so I think we are good to go with the built in controls with each lot. Feel free to "argue" this with me if you think we would get a deficiency from CAP. Thanks

Got it AMcCord, as soon as I saw it later on I thought Daahhhh, Karrie, what the heck do 'ya think they meant. Slow brain cells that day

Oops, sorry, I didn't understand the term convalescent plasma- dumb me!

What does your emergency release protocol say about FFP, cryo, and platelets? Ours says to give AB plasma products in those cases so why not just stick with that? I also added in our "Ebola" directive that if we have a historical type on the patient which is absolutely confirmed by the ED staff, then we can give out type specific non crossmatched products. This is a gamble and hopefully it will never happen. I may end up taking that back. I'm grateful for your post as I had released the directive to our techs about sending over un-crossmatched, emerg release products to the ED for these patients but it didn't occur to me to address returned products. I'll do that now and will follow your directive. Thanks!

Maybe I am over reading this or maybe because its Friday but - if you are in the USA and are AABB or CAP accredited, yes, you are very archaic because nothing in these standards require a full crossmatch unless you have a history of antibody issues! My guess is that your institution is nervous about blood banking in general with such a low number of products going out the door and someone long ago felt that a full crossmatch on everyone insured the safety of the product for the patient? How's that for pop psychology? Do you have a medical director you can approach with changing to immediate spin crossmatches on patients with a history of negative antibody screens? I had to do this at a larger institution near Boston in 2000 because the pathologist had no blood bank background and was petrified we would kill someone. I had to show him all kinds of scientific articles that "proved" that IS was OK for many patients. Good luck!

Yes it does, thanks. I think that whoever wrote up the original SOP didn't see if it jived with the nursing form which instructs the nurses to assume there is a genuine trans. reac. with "severe" urticaria. I'll take it up with the Director of Nursing to start. I have another more open question but I'll post that separately.

I am trying to clear up a number of interconnected SOPs that related to various BB work-ups and see that our Transfusion Reaction work-up SOP does not match the Reaction form that our nurses are required to fill out. The primary issue right this minute is the Blood Bank's responsibility should the patients transfusion reaction symptoms be limited to urticaria only. Our current SOP says that we do nothing but the nursing form says to alert Blood Bank for follow-up work if there is "severe" urticaria. I have read references to considering transfusing washed rbcs only to patient's who present like this in the future but what do YOU do? Do you do a work up at all if the only symptom is urticaria, only if it's severe or what?? Thanks! (PS, we do not have a strong Med Director when it comes to blood banking so asking his opinion won't help me)

Just a quick update. We decided against purchasing the DAT on the Echo since it doesn't have the complement component most of our MDs are looking for. But yesterday, I had a strong cold panel on the Echo and followed it up with a "crossmatch" of the patient's serum and cells and it too was positive. Manual DAT was negative. As I made the "donor' cells I realized that their consistency was different from a traditional donor segment since it had no additive mixed with the red cells (other than the EDTA) so I added a tiny bit of saline to keep the cells somewhat fluid and the Echo seemed fine with that. I' m still thinking about the value of this but it was easy enough to do so I did it

Sorry for the delay in responding. I used to work at a much larger institution and I aimed for 3-4 per month. We always got 100% compliance but I still felt it was a way to keep the Blood Bank's face in front of the nursing staff. I monitor quite a bit of paper retrospectively and hope that it will be enough for the next assessment. Trying to get up to the floors here is difficult. Anyway, thanks everyone

My congrats also! Bravery is not always appreciated. Your new hospital is lucky to have you and my heart goes out to those in your former hospital who cannot bail out of what is a sentinel event just waiting to happen.

Correct. That is incredible overkill. Sounds like you had an adverse transfusion event once and the partial-knee-jerk reaction was to retype everyone constantly? Sooner or later you have to hold the people who draw the blood responsible for what they do. One retype per patient to verify type/Rh then T&S only after 3 days to recheck the screen. If you aren' t the Supervisor who can delete this requirement, I would sure as heck talk to your Supervisor and the Medical Director and ask for the rational. Certainly not a standard/requirement/recommendation or anything else so how would they rationalize this?

Same as Dave and I bring up any new technologies or potential LIS additions that we might bring on. Our Trans. Comm wants the meeting over and done with in an hour so taking the time to present statistics about tests that require no action or even comment isn't worth the effort IMHO. So what you do now, with useful agenda items that require actions and decisions should be it I think.

No clue, but for what its worth, I have asked our Medical Director to approve a Blood Bank protocol that will say that if a sample comes into the Blood Bank and the patient is documented as a suspected Ebola patient, that we release uncrossmatched, emergency release O neg blood only. I am trying to avoid the issue of what to do with contaminated tubes and avoid contaminated fluids (saline from manual cell washings) being dumped down our sinks. We are a small hospital in a poor community which has a large population of people from various African nations. So there is the off chance that such an infected patient could walk into our ER after returning from his/her native country.

Yes, Immucor has some under their Learn web subsite (its under the Learning Center within their Customer Center). You probably have to be a customer to access these but maybe not. I like them a lot and you can earn PACE credits for most of them.

Zip! Our pathologist does not have a strong BB background so I think he knows his limits. We have a Trans. Medicine medical consultant available to us for those problem identification issues as well as a Reference lab close by too as backup. But the part-time Pathologist we have does not get involved.

HI all, if I put this in another section on the Forum, I am afraid I won't get any hits. So- I have the standards in front of me and don't interpret the section on Assessments to mean that we have to observe (audit) a transfusion directly. Is this your take on the standard 8.1 and 8.2? We got a deficiency during our last AABB inspection because we didn't audit annual competencies of the nursing staff (huh??) for transfusion but that's another story. In the meantime, I do a very active review of almost 100% of the returned transfusion forms to see what was documented. But does Standard 8.2 mean I am supposed to also audit transfusions in progress? Thanks

I have to chime in a little bit here to say that the advantage to gel is that as us babyboomers (37 years of marriage for me next week and Hubbie better not even think of retireing yet!) lose our eyesight and/or new students are subjected to 'subjective" eyes of other techs, interpreting a gel result beats interpreting a tube result hands down!! But yes, its still time consuming like using tubes. We are validating the Echo right now bringing my little lab up to the 21st century. Very different from the gel but since the majority of us squabble over tube interpretations, I hope to see a lot of that disappear including use of the gosh-darn microscopes. Good luck with overnight. It was great for me in college but now- no way!

Wow, you have your work cut out for you. First of all, with a BB that small, why on earth do you have a ProVue, and manual gel and tubes??? Provues were designed for bigger labs not little ones. Seems like a huge waste of money when you already have manual gel and tubes as a fall-back. Just an opinion As far as inspections go, dig out the last 2-3 previous CAP and AABB inspection records and see how well the lab did. That will be your first clue as to what they felt were deficiencies that both organizations will look for immediately. Both should send you pre-inspection documents so you will have an idea what they will look at. You should have a copy of the AABB standards which will be your new bible. You should receive checklists from CAP well in advance to your next inspection which will also tell you what you should have. The AABB standards will list what records you need to have and how long to keep each kind, usually a maximum of 10 years or forever for problem patients (those with antibodies or other unusual challenges). Your LIS records should include the validation done on the original systems as well as validation of any significant upgrades. Training records for all your techs should show training completed for LIS use. Others will surely chime in here about this. We are computer free right now so I haven't had to worry about this since I got to my small lab about 8 months ago. Your proficiencies (I assume you use CAP's PT system?) should be up to date in a binder and show that you do PT on every process. This is one reason why it seems like you have super overkill in your lab in terms of instrumentation. You need to have proficiency on all three methods and twice yearly method comparisons between all three. That's a ton of work!!! Feel free to send me a private message and I can share more ideas if you like. Gotta head back to the lab now.

OMG, what kind of Lab Director is this?? Who in her/his right mind would think that it's OK to work anywhere without training or retraining. This is a scary person

thanks again everyone!