amym1586

We've got a demo of the MaxQ on the way.  I'm kind of excited. 
I hate our cooler system now.

We remove a segment at issue with a unit number sticker.  The nurse disposes of the bag after transfusion.  We store the segments with the daily specimens and dispose of them when the samples are disposed.  

We remove a segment at issue with a unit number sticker.  The nurse disposes of the bag after transfusion.  We store the segments with the daily specimens and dispose of them when the samples are disposed.  

We use logsheets.
Scott

Me, too! I'll bet the company will wonder what's going on with the sudden interest

We too bought the MaxQ coolers and we are very happy with them  We use a plastic insert liner bag with each cooler so the blood units do not come in direct contact with the cooler  Ours are blue not yellow  Maybe each cooler size is color coded  
they are light weight and easy to handle  
PS we ordered a demo and they never asked for it back nor did they want payment for it when we actually made a purchase
i validated them for 24+  hours, however we do not let them out over 12 hours  usually we get our coolers back within 8 hrs
 

I got my demo cooler yesterday. Looks like its well constructed, weighs very little. I need to read the info that came with it. They also send a paid return shipping label with it so I can send it back if we aren't buying.
I asked specifically about using it for transfers by helicopter and they say that University of Alabama(? - someone in Alabama) is using them for that purpose. If one of these didn't come home, I'd be a lot less upset than if one of my Credo coolers didn't make it home.

We've got a demo of the MaxQ on the way.  I'm kind of excited. 
I hate our cooler system now.

We're doing this with Cerner, we started out with 14 days.  Then realized someone had gone in and shortened the time to 7 days.  7 days doesn't seem like it's even worth the time and effort. 
We can see the three answers that come across, but the only part of the answer we see is  1) Pregnant? 2) Unsure of History: (History of what??  I have no idea. yes you're sure? no you're not sure  *Shakes fist*)   3) Transfusion: yes/no      I have no idea if they are asking them if they've EVER been pregnant/ transfused  and what are they unsure about.    
 
Anyone else have Cerner with Pre op protocol ?
 
We just went live with this new system and decided to implement extending pre op T&S at the same time.   I'm starting an Audit   right now to figure out what is going on.

Good laugh to start my day!

I could not get my igloo coolers to maintain temps between 1-6 C.  I found these really neat coolers from Camp-Zero.  I am going to use the mint green for plasma and the pink ones for red cells.  2 Down falls 
1. The latches are meant to keep the bears out!  I figured it would probably keep the Dr.s and nurses out too, so I validated them for 24 hours with the lid closed, not latched. They maintain temps beautifully with the lid not latched. 
2. Stickers don't stick to the plastic very good, so I am gluing the stickers on.

Turnaround times for crossmatches...routine, ASAP and STAT.
Turnaround times for emergency release/mass transfusion protocols.
Patient blood management - track patient Hgbs vs transfusion rates, do peer comparisions (look at a specific group of physicians to see if they transfuse at higher Hgbs, look to see if there is an individual whose transfusion rate is higher than his/her peers, etc.)
Specimen labeling - how many rejected, how many missing initials/collection times, how many WBIT (this delays patient care)
Track transfusion rates for specific groups of patients - we monitor OB patients for transfusion if Hgb <8.0
Track ordering problems - duplicate orders, give order for nurses but no prepare order for Blood Bank - education needed for staff/physicians placing orders results in delay of care
Transfusion documentation - check patient flowsheets for missing information (like no 15 min vitals, missing donor #, no signed consent, etc.)
You could spend your whole life on stuff like that, so be selective. Don't just go through the motions with multiple graphs. Choose 1 or 2 things where you can have a positive impact on patient safety or quality of care. Once things are going smoothly with a project, continue monitoring as long as needed and add a new project. Hospital quality will love you for that because its something they can show inspectors from JC, the state, etc. (It can get the lab noticed in a good way!) One of our recent projects came about after receiving complaints about how long it took for us to send blood to the ED for traumas. We started out with what seemed to be a lab problem, but it quickly became obvious that it was much larger. We've now spent almost 3 years working on emergency release processes from order to transfusion, not just working on blood release times by Blood Bank.
Using a multi-disciplinary approach with nursing, we developed job aides, educated, and documented to drop our TATs dramatically and improve the entire process. Nursing staff now has a better grasp of what is expected of them in those kinds of situations and they know what we are going to be doing about providing blood products. Physicians are aware that there is an actual protocol. It makes for pretty graphs for Quality, but most importantly, it greatly benefits patients. As an added bonus, you can develop strong team relationships with staff from other areas. This has the potential to make tackling future problems much easier.
We are not a large facility. It sometimes stretches me pretty thin working on stuff like this, but its worth it over the long haul.

You may want to drop CT ratio since you implemented electronic crossmatch.     Generally, it usually drops close to 1:1 if you are not setting units up in anticipation of usage.    Your computer system will check to make sure that patient is eligible so that is probably not a good monitor.  I can't think of a thing to monitor for electronic crossmatch.

What immediately sprang to mind was, to be honest, get a different Lab Quality Manager if she has to ask you (it's her job, for which she gets paid, after all), but another thing is turn around time for non-complex samples - by that, I mean routine samples, with out-liers containing antibodies (particularly antibodies directed against high prevalence antigens or nasty mixtures).

Are you performing electronic crossmatches?  
 
How about autologous blood use/waste, corrected reports, FDA reportables? 
 

We're upgrading our computer system and they didn't build the ABO slide "bedside check"  so they are telling us we aren't doing them anymore. 

Why is the bedside type "going away?"  We do that and have for years (decades), which has saved us on several occasions.  It's cheap, easy and quick.  Just curious.

Double yikes!

5.16.2.2    ~~~~~~~~Second  ABO by one of the following:
a) testing of a second current sample;
b. comparison with previous records; or
c) retesting of the same sample.
 
In the case that there is no other sample, there is no history and Retesting the same sample is not an option..  Where do you get your second sample?  
This happens to us daily in the ER and our Outpatient transfusion clinic.  Currently we carry the first blood product around and do a bedside finger stick and test the ABO.   We're being told that is going away.    
How does your hospital handle this situation ?  

We never retest the same sample. If we don't have a second sample we crossmatch group O neg. We require a second type to switch blood groups and rh.
In an emergency, we'll switch to rh pos for adult males or women >55.

BSH Guidelines say that it has to be a sample taken at a different time and, ideally, taken by a different person.  I agree with this, because, firstly, if the sample was taken from the wrong person in the first place, testing two samples taken at the same time will not identify a problem, and, secondly, if the sample is taken by the same person, they may not be as "good" (or professional) at identifying the patient properly, as "they already know who is the patient".
There, you see, I do agree with some Quality!!!!!!!!!!!!!!!!!!!!!!
Sorry, didn't see Carrie Easley's post, which says virtually the same thing.

Retesting of the same sample will not catch a wrong-blood-in-tube.  If performing a computer crossmatch, CAP states that you can only use same specimen if specimen was drawn using a mechanical barrier system or digital bedside ID system.  I believe there was an other thread regarding Typenex/Hollister no longer meeting the requirements of a barrier system.
We will use a hematology specimen for our verification if it was drawn on a separate phlebotomy event.  The blood bank can order the verification per protocol if another specimen isn't available.  If blood is needed in the interim, we issue type O.  It's a hard stop in our BB system.

We give group O.  If it is a female of child bearing potential (horrible phrase), which, in the UK is 50 or younger, we give D Negative.  If it is a male or a female of 51 or older, we give D Positive.
This is enshrined in the British Society of Haematology (formally the British Committee for Standards in Haematology) Guidelines, so, if we go against these, we have to either have a very good reason for so doing, or we get our knuckles rapped in a big way (including, possibly, being taken to court).

Cool.
 
Crossing it off my list of things to care about!

At my hospital, we split out our Blood Utilization monitoring like this (below) to cover each of these 10 AABB requirements:
1. Ordering Practices: C/T Ratios (Total and by Service), Uncrossmatched Blood Requests, Compliance with MD signature completion on "Release of Uncrossmatched Blood" forms
2. Patient Identification: Any Patient ID issues identified are reported
3. Sample Collection and Labeling: BBK Specimen acceptability report (outliers are detailed)
4. Infectious and Noninfectious Adverse Events, Incidence of Mistransfusion: Transfusion Reactions, Recalls, Notifications
5. Near-Miss Events: Anything identified would be detailed along with root-cause, corrective action
6. Usage and Discard: Units transfused, Units discarded
7. Appropriateness of Use (for all Components):
QA Audits performed by Medical Director, report pulls 100% products transfused (one type of product per month) and the most recent related lab data to when the product was issued. Outliers are investigated by the Medical Director. MDs receive follow-up letters on questionable transfusions.
Jan/Apr/Jul/Oct = RBC compared to most recent Hgb/Hct
Feb/May/Aug/Nov = PLT compared to most recent PLT count
Mar/Jun/Sep/Dec = FFP and CRYO compared to most recent PT/PTT and Fibrinogen
We also review any Autologous transfusions, Peri-Op Collection/Reinfusion (Cell Saver, Hemodilution, ECMO) and Therapeutic Apheresis and Phlebotomies performed during the quarter.
8. Blood Administration Policies and Practices: Our QA department performs random audits on 75 transfusions per quarter (coordinated with the RBC, PLT, and FFP/CRYO schedule above) and audits for MD Order to Transfuse, Issue Checks Performed, Bedside Checks Performed, Vitals Recorded. Since we are using TAR, all transfusion data is now entered into the computer so this audit can be done using computer reports. We also audit 100% of all transfusions for "Duration Less than 4 Hours" by running a computer report. We also report on Bedside Blood Administration Audits which are performed by the blood bank techs (minimum of 16 per year) and Blood Warmer QC which is performed quarterly by Biomed.
9. Ability of Services to Meet Patient Needs: We do Turnaround Time studies (Type & Screen, DAT, Crossmatch, Newborn Workup), report on any Customer Complaints and Cancelled Treatments. We also have a Bloodless Medicine and Surgery program so we report on the number of patients enrolled in the program who were treated without transfusion.
10. Compliance with Peer Review Recommendations: Letters Written/Sent to Phsyicians from the Medical Director and/or Blood Utilization Committee Chair, and Responses Received
I know, some of these do overlap somewhat, but "Ordering Practices" would be looking at how many and what kinds of products are doctors routinely ordering for various things (i.e. are they over-ordering or under-ordering for certain types of surgeries/procedures, do they order uncrossmatched too often because lack of ordering in advance) and "Appropriateness of Use" would be looking at whether they make the decision to actually transfuse those ordered products to their patients based on appropriate criteria (lab results, patient symptoms, etc.).