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milesd3

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Posts posted by milesd3

  1. We have a form the Dr. must sign.  It includes the unit number/numbers, the Dr.s signature time and date, the tech involved signature time and date.  if the unit is O negative or type specific.  (We try to give type specific if possible and limit uncrossmatched blood to 2 units.. try)  We are a small rural hospital.  The ER calls the request to us.  on a rare occasion surgery will request emergency release blood.  same thing they call us.

  2. The issuing tech should have questioned the "O" plasma even though it was her boss.  Without pathology approval (at our facility) we cannot give inappropriate units knowingly.  I'm interested in what the pathologist is saying because at least at our facility, the pathologist is ultimately responsible. The "boss" at the very least should be counseled and or written up personally if this is the second blunder perhaps he should be gone.  The issuing tech should at the very least receive a verbal warning.  all my opinions..

  3. On ‎2‎/‎20‎/‎2019 at 12:57 PM, bevydawn1 said:

    Does anyone out there still do bleeding times? If your facility doesn't, did you just discontinue it altogether or did you switch to another testing method? 

    Yes we still do them on a rare occasion.  One of those archaic nearly useless tests that some doctors can't get away from. 

  4. On ‎1‎/‎3‎/‎2019 at 7:37 AM, SMILLER said:

    We have been using a Polymedco sedi-mat for a few years and have had little trouble with it, other than getting used to its simple menu.

    With only 10-15 ESRs a month I have to wonder why you don't just use the old-fashioned 1 hour manual test.  You need it as back-up anyway if I am not mistaken.

    Scott

     

    Thanks Scott,

    I'd be totally fine with the old manual test but we are a small rural hospital and the night tech is alone after midnight and if he/she is in the ER or on the floor when the hour is up it would have to be remixed and the process started over again thus making the ER Dr. upset.  I realize ESR is not an emergency room test but someone forgot to inform the ER Dr.s about this fact.  We also do CRP's but if "our" ER Drs order a CRP they seem to want the ESR as well.  In the 23 years I've been at this place, we've never had a backup for ESR and haven't ever had a need.  I suppose in the event that our analyzer was down, we would just send the sample to our reference lab.  If administration approves the purchase we have decided to go with the Streck mini cube.  If they don't I'm going to talk to our pathologist about discontinuing the test all together.

  5. Streck is discontinuing the ESR plus sed-rate analyzer and I was wondering what everyone else is using.  streck is recommending the mini-cube but I don't know any thing about the analyzer good or bad as I think it pretty new but is able to test directly from the edta tube eliminating the need for sed-rate tubes. we only do 10-15 per month so we do not need an analyzer that can test dozens of sed-rates at a time but something affordable and reliable.

    Thanks

  6. Are you saying that a specific parameter is consistently the same exact value each and every time QC is performed and for all three levels?  That would be amazing.  There are a couple non reportable items on our analyzer that stay pretty consistent but they are items that have to do with the operation of the instrument such as diff X and Diff Y.  none of our reportable parameters are steadily the same number each time...

  7. On ‎9‎/‎6‎/‎2018 at 1:52 PM, kimg said:

    Currently we are running our coag q.c. every 6 hours to ensure that we are not late. This is quite wasteful and we would like to run q.c. every 8 hours (as required). Any ideas on how to make sure q.c. is not getting run too late (after the 15 minute window). We use the ACL TOP 350's and I thought there was a way to hold results if q.c. had not been run but apparently I was mistaken. Any ideas would be greatly appreciated.

    When we had the Stago we ran QC every 6 hours but it was because we were able to utilize the QC material better that way.  I cannot remember how long the QC lasted (hours) maybe 24.  We are on our second Sysmex and allot of us set timers so we don't forget.  Occasionally though we are on the floor or ER and we end up being late.  We document that we were late and why.  Obviously not all the samples between the late QC and previous are suitable for retest so we look back at previous coag results on that patient if there is history and compare.  State health recommended this but I'm not sure what it proves. 

  8. 4 hours ago, SMILLER said:

    A simple standard to go by would be to use the same acceptable limits for correlation that you use for QC.  You cannot expect precision to be better for patient correlations than  you get for QC, and it should be at least as good.

    Scott

    Thanks Scott I'll take a look at comparing my data with QC ranges to see if that will help me.  I talked to a guy at JCAHO and basically they can't tell you anything or maybe won't would be a better term.  He did tell me though that there should be some individual limits and that our director has to decide what they are... He doesn't have a clue nor does our pathologist.  The problem with sysmex is that they make claims about the correlation between the modes but they don't elaborate.  On average we are aok but individually we are out on different parameters.  Sysmex went as far as to tell me if I'm running controls in both modes then we don't have to do it... JCAHO said controls aren't really patient samples and we have to do the correlations with patient samples.  So we just got inspected so it will be 2 years before we have to worry about it but I sure would like to know something lol thanks again..

  9. I've been performing open vs closed comparisons on our Sysmex for a couple years but had the expected limits  wrong.  I was using instrument vs instrument numbers but actually found the correct data accidently searching for something else.  My question is:  Does each individual sample comparison have to meet Sysmex claims or is it on average.  I couldn't get a straight answer from sysmex at all in fact they claimed that no one was doing that and that if we were testing controls on both modes then it was all we needed to do.  I finally talked to someone that told me that the average was ok and that I should always use a normal sample for this but they could not provide any documentation on this other than what I already had ( one paragraph and a table of limits).  I also spoke to JCAHO and they told me that it should meet claims on average but that there should also be some individual limits as well.  When I asked him where do I get these limits he said the typical JCAHO response "you lab director must determine this".  I spoke to our director as well as our pathologist and neither had a clue on where to look for this.   On average we are fine both % difference and/or less than some expected actual number and the regressions all look good (even Basophils) but individually there are failures on everything platelets being the worst.  What was suggested several years ago by a JCAHO inspector was to do this testing every Monday and crunch the number every 6 months.  I quizzed a friend at another hospital but they use a Colter and that information is provided by Colter in their documentation which consists of running ten samples each in triplicate (averaging the triplicate results) and using that average results to crunch the numbers.  What is everyone else doing along these lines.  We just finished our JCAHO inspection in May and had a state health validation inspection last week but neither looked at this information this time. 

    Thanks

  10. On ‎10‎/‎19‎/‎2017 at 12:18 PM, hippie_chick67 said:

    Bio-Rad Serum Volatiles. Level 1 is negative. Level 2 is positive. We run them daily. We only do serum ketones.

     

    Cool I talked to them sometime ago and they told me their control was "not" acceptable for use with the tablet because it makes a speckled pattern on the tablet rather than the solid purple that serum does on the tablet.  Have they reformulated the control?? Thanks

  11. We haven't had the 2120 for 5 years but yes, unless something has changed with that analyzer, all three modes have separate pathways thus the comparison between modes is a requirement.  We also had to run controls on all three modes as well.  That analyzer was a bear.  I hope you have better luck out of yours than we did... very needy..!!

  12. On ‎6‎/‎21‎/‎2017 at 9:23 AM, Moyer said:

    We have been using K-check tablets since the Acetest tablets were discontinued.  We had been using MAS Urine controls for the Acetest and back then, MAS did not have ranges for the K-Check.  I did a study between the two methods as they recommended.  Now MAS has ranges and we still use those controls for the K-check and acetone testing.  We have always used urine controls and at not point did we use serum controls.  We mostly do serum acetone testing as well.  There is a procedure in the K-check package insert for making a positive control but it does not indiciate that you need to use serum for controls.  Hope that helps :)

    Thanks Moyer yes I read the insert and actually talked to a nice gentleman there about the same thing as the instructions in the insert basically are what the urine control would be.  He told me I could experiment with different volumes of acetone in ketone free serum and develop my own control  but that seems like a lot of work and extra use of the tablet.  Our pathologist just said to wait and see what JCAHO said if they indeed say anything. 

  13. Has anyone found a QC material to use with the K-check tablet?  we are currently using urine controls but the bulk of our ketone testing is on serum.  Bio-Rad makes one for use on some chemistry analyzer but when I talked to them about it they said it was unsuitable for the K-check tablet stating that it made a speckled pattern on the tablet rather than the solid purple a positive patient would leave.  JCAHO seems to be concerned about "matrix" as we found out 20 years ago when we were only using urine controls for pregnancy kit tests.  Thanks

  14. 17 hours ago, LaurelMae said:

    I have worked with the CA1500 for 12 years now.  It will handle your work load just fine but it is an archaic instrument and the software is horrible.  Just a couple of examples: You have to manually register all your reagents (it comes with a barcode reader but it doesn't work for the reagents).  Also you can only have one lot calibrated at a time so you cannot get the new lot ready when it is convenient (D. Dimer and Xa).   I have always wanted an IL Top, I think they are the best in Coag right now but if you are limited to Siemens I would go with the new CA2500.

    I was upset when we received our 660 because there is no way to save data so all of our QAP data has to be entered by hand.  Plus what LauraMae said above..

  15. 13 hours ago, Joseph said:

    Anyone have any knowledge or experience with the Siemens/Sysmex instruments?  I'm looking at the 1500 vs. the 2500.  Daily volume is about 200 PT, PTT, Fib and D-dimers mixed.  We will soon add Xa.  We have been using Stago for 20 years.  Thanks!

    We had the stago compact.  superb instrument..! We replaced it with CA550 Sysmex and have since replace that with the 660 Sysmex. I'm not familiar with the 1500 or the 2500 but we stepped down in my opinion from the stago.  We don't do near the volume you guys do but I feel the 660 would be taxed at that volume of testing..  we don't have allot of problems with the Sysmex but we have had some problems with reagents specifically  Actin a few years ago. 

  16. On ‎4‎/‎5‎/‎2017 at 6:00 PM, BenchTech said:

    How many places spin their urine QC and perform a microscopic exam? Do you do it daily? weekly? monthly? 

    My big question though is this a CAP requirement. I can't find anywhere where it states that it is a requirement. I recently took over as supervisor and I don't know if we are doing this every day because we always have or because it's required. 

     

    Thanks

    We are JCAHO inspected and we do microscopic on QC daily and we have for at least 21 years..

  17. On ‎1‎/‎3‎/‎2017 at 3:33 PM, mollyredone said:

    I had this question asked by my staff and I wanted to get some other opinions.  An inpatient had a blood bank sample drawn.  A unit of PRBC was issued on this patient before the patient sample expired, but the transfusion was not completed until 12 minutes after the sample expired.  The patient had received three previous units of PRBCs, starting 5 days prior.  When they wanted another unit we got a new sample.

    My feeling is that if the unit was started before the sample expired, it was still okay to issue it.

    What is your policy/process for this situation?

    Thanks!

    Unless I'm mistaken AABB changed it wording on how good a sample is good for.  Years ago it said 72 hours but that was changed to read 3 days so if the unit was given within those 3 days there is no problem.  Might be a grey area after midnight since technically its a new day. 

  18. 21 hours ago, SMILLER said:

    You might be safe with what the insert recommends for a positive control, as long as it also states that the test can be used for serum.  I would call the company to ask for advice--they may know of a serum control supplier.

    A few years ago, when the Acetest supply ran dry, we switched to an automated B-hydroxybuterate test, which is both more specific and sensitive and easier to run than the old titre-an-acetest-tablet.  Our platform is an Ortho Vitros F.S.

    Scott

    Thanks Scott, I called the company 1st for advice and he referred me to BioRad and their "Volatiles" control.  I called BioRad and they said their two level control was designed for a quantitative methodology and both levels have Ketones in them but she also stated that when using them with the tablets resulted in a speckled pattern and not the steady purple one would expect to see with a positive patient thus FDA would not verify their use for qualitative testing.  She did tell me they were trying to develop QC for the K-Test though but didn't have a time frame for when it may be available.  I think they are still talking to the manufacture at this point.  Here is the section regarding QC its rather vague (not as vague as the answer I received from JCAHO when I inquired though..):

    Quality Control: Use known positive and negative controls as recommended by your Institutional guidelines. This could vary from daily to weekly quality control. At least a positive and negative control must be run each time a new bottle of K –Check is opened. A positive control can be prepared by diluting 50 microlitres (one drop) of acetone to 40 ml of distilled water. The preparation should be comparable to “small”on the color chart.

    We don't do allot of ketone testing at our small rural facility and I'd say that almost all the tests are from the ER   I'll check with Siemens to see if they offer  B-hydroxybuterate test but at $24 a bottle of 100 tablets and the Dr's used to the semi quantative (small, moderate, large) result from the tablet, I think it would be a hard sell to our administration.  I thought about trying the homemade control only use serum instead of DI water but I'm not sure how to validate it. 

  19. I know this is an old thread but I thought I'd revive it with a question and a concern.  I recently found out that ketone testing on the K-Check tablet is now moderately complex.  We have been using biorad urine controls for a very long time on the acetest tablet and since we started using the K-Check tablet a year or two ago.  Biorad said they didn't have anything yet for serum/plasma so my question is since there is a matrix effect on the tablet, I'm guessing controls with a similar matrix should be performed with the patient testing...? I called Quest (our reference lab)and they said they couldn't even talk to me about the question.  I spoke with a few other labs and no one is even aware that a change has been made.  Years ago we got ourselves in a little trouble with JCAHO over qualitative hcG testing and only using urine controls so I'm trying to not have that problem with ketone testing. Does anyone know of a control available for serum/ketone testing?  The insert says you can make a control with 50uL acetone and 40mL DI water however that wouldn't be the correct matrix. 

  20. 14 minutes ago, nziegler said:

    It would be surprising if that were actually true. But I live in NYS, so even if JC gets rid of it, NYS never will!

    Regarding Fib cal verification - we use the TOP500, but I'm pretty sure there is wording in the regulation that states if it is a clotting based test (versus chromogenic), you don't need to do the cal ver.  Just like you don't have to do it for PT or PTT...

    Yes our director mentioned state requirements are sometimes remarkably different from JC requirements.  I have sent a note to our sysmex rep about the fibrinogen but so far not reply. 

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