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milesd3

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Everything posted by milesd3

  1. We were recently JCAHO inspected and the surveyor mentioned that calibration/verification was going away for hematology (maybe retics as well but he wasn't clear) Has anyone else heard this. I've done those so long now I'm almost afraid to stop. My director said the same thing. BUT he ALSO said we should be doing calibration/verification for fibrinogen. when we had the Stago we di do that with a high patient sample but the instrument did all the dilutions and calculations. Is anyone doing linearity for the Sysmex CA-660 instruments? If so what is the procedure? Thanks
  2. We run 2 levels per shift on the auto mode plus one level per shift open mode. we were running less until state inspected us and dinged us for not running enough controls. JCAHO's next inspector asked why we were running so many controls. My answer is because state said we had to State can shut us down.. ! I worked the night shift at another facility years ago and they used patient controls. about 10% of the time the patient control would not be within limits. Coulter Jr ya way back
  3. Several months ago may be 6 or more we had the same problem and with SCII. We made a complaint to Ortho but they denied any problems with their product because there weren't enough complaints???. we tried a second bottle from the same lot fearing the bottle was contaminated no difference. The controls were always positive or negative as expected. fortunately when this started happening we had a new lot of cells and all those we tested with SCII positive retested negative. Of course this is after doing several panels . I think the only patients that were effected were O+.
  4. lol I find that micro folks in most places only do micro. after being locked in micro for 50 years breathing those anaerobes its a wonder they even know their name hahaha Its the use it or loose it syndrome. As others have said above. I plate, do wet preps, gram stains but that's it with my micro knowledge. To be honest we are a small rural hospital and the extent of even our BB supervisor is minimal compared to any BB tech that works at a large facility. We do keep and give FFP though so when we have a nurse freakout about what appears to be mismatch we have a chart posted in the BB we show them. That is usually sufficient.
  5. What pinktoptube said... MT's get one more semester of BB training in school but how many folks actually retain that extra bit of knowledge. From my experience I find MT's and MLT's are both capable of doing the work and I cannot distinguish between the two looking at results. The true training takes place on the job and the more hands on either gets the better a BB tech they become. Is this requirement for plts cryo etc just for the MLT or MT as well..? If so I suppose the pathologist doesn't trust the MLT's judgment? At our facility we rarely question the Dr's decisions to give plts because they are usually warrented. we have in the past had OB Dr.s order plts to be onhand which usually means at the end of their life, we trhow them away. Our in house Pathologist wouldn't stop this practice and it drove me insane. He retired and our once a month pathologist isn't much better.
  6. Gilmanch we use a Sysmex xt2000i. we had the Advia and while it does a great diff when its running ours was down more often then I like to remember .. Besides all techs comparing diffs with one patient slide twice a year, we are also having two techs performing a 200 count diffs each daily (or its supposed to be daily anyway) as suggested by the last JCAHO surveyor which accomplishes two things. Checks the manual diff to the instrument as well as checks stain quality. I like that feature of the Advia by the way.. I'd seen a few MPO patients with the celldyne but there wasn't any flag to warn the tech ..
  7. When we had the Advia it would produce a report I think once a week or every so many patient samples.. I think it was called Neut X and Neut Y. I think coulter has something similar Xbar B or something like that. Our sysmex has it too but its not configured. It was handy on the Advia as it would give advanced warning of impending doom. I look at the controls once a week at the L-J chart. Pretty easy to notice trends that way in my opinion although the sysmex has had very few problems with QC (knocking on wood)
  8. The % thing wouldn't work. When I was initially trying to figure something out (and why the problem seems so overwhelming) The Neutrophil % difference was at 15 but the lymphocyte % difference was more like 32. That is comparing 15 techs. I might have picked out a slide I shouldn't have. Eos were around 16..?
  9. This also looks very impressive. I'll take a look at this as well thanks
  10. Thanks I will look at this when I get the chance. I like the idea of some feedback from professionals. we are a small rural hospital and none of us are far from experts..
  11. Thanks I used this on the comparison studies and in the most part the techs did ok. Well in relation to each other they did, however, the correlation with tech vs instrument 4 were outside Rumke limits for Monos. Do you check the tech against each other or the instrument. If there are failures what is the next step...? I didn't provide the instrument diff on purpose should I have?
  12. I've been trying to figure out how to correlate the technologists differential with each other. There should be some sort of agreement but I cannot find anywhere on the net what is acceptable and what isn't. the recent diff that we all did the techs neutrophil counts agree right at 15% but the lymphocyte count the difference is something like 32%. I'm not concerned with monos on down as much but this patient had a high eos count which may be throwing things off somewhat. . Is there a better way of doing this? is this a requirement for JCAHO even? What is everyone else doing?
  13. We had the 2120. When it was running it did a very good diff. The problem though is that it was very needy. It wanted to be squeaky clean and then for no reason at all MCV or RDW would shift. I literally had to crawl around in the thing at least once a week.
  14. lol we had a pediatrician that always ordered a manual diff. Most of the other techs would send the CBC which included the auto diff and the manual diff as well. The instrument allowed one to run a sample and not report the auto diff but only the manual. I sent one out to her office one day and she called the lab shortly there after wanting to know where her diff was. I calmly pointed it out to her that the difff was there and it was the manual diff per her order. She was confused but didn't argue the point. Oh and you are correct in that you cannot charge for both diffs..
  15. last night we had a febrile suspected transfusion reaction which the pathologist determined was not a transfusion reaction. We are a small rural hospital and we don't do more than antibody ID. In this case the AB screen was negative, the patient was redrawn and pre and post ABO Rh and screens were performed with everything looking good except the DAT's were positive 2+ on the pre transfusion sample and 1+ on the post. Both DAT samples were negative with IGG only and positive with IGG/C3d. I called our blood provider in hopes they could work this up as the patient is supposed to get more blood soon and I was afraid as to what night happen. the nice lady informed me that working up compliment isn't something that is done. I'm horribly confused with this as the work-up was at the request of our pathologist. She mentioned taht compliment coating the RBC's was more than likely due to some medicine she was taking ans suggested I simply inform the patiens Dr. to premedicate with Tylenol and Benadryl. Could someone please explain this to me as it seems comflicting. Thanks
  16. I agree with SMiller. I have a related question though. I'm trying to learn Excel so I can make nice graphs of correlations for several reasons but I cannot seem to find a good reference with hospital lab examples to complete the task. Sysmex was helping me with correlating instrument diffs to manual diffs but they seemed to be reluctant this time to help me. They use PC evaluator I believe and so does Seimens which makes very nice pretty graphs but I "think" I can do the same thing with Excel. If anyone uses excel can help me I'd appreciate it or perhaps point me to the correct reference. If anyone uses pc evaluator is it worth the money. My director says we can "try" to buy it if I thojught it was worth it, however, I'm sure the CFO would complain about the price. Thanks
  17. We crossmatch blood that leaves via ambulance. we have found in the past if the blood is "not" hanging already the receiving facility will throw the blood away so we never send blood unless its already being transfused. If its emergency released the Dr. has signed that he takes responsibility for the uncrossmatched blood. I do remember one instance where the patient arrived here, got a unit of uncrossmatched but was gone via helicopter so quickly that the lab did not have time to draw any blood on the patient so it was never crossmatched. If we have blood we always crossmatched emergency released blood.
  18. Respiratory does blood gasses now but when we did them we would draw all labs from the artery along with the ABG. There was some correlation performed sometime before I came here so I assume that they correlated. We just threw away a drawer full of glass blood gas syringes. Some of the old tech that were here when I first came here said they washed/autoclaved and reused the syringes and would resharpen needles.. wow...
  19. We perform a microscopic for positive parameters you mentioned and if a microscopic is specifically ordered. Darn OB Dr.'s want a micro even if the urine is crystal clear. A previous lab I worked at did micros on all urines but that was 20 years ago.
  20. JCAHO surveyor was doing a tracer several years ago and one of the patients she was tracing had received FFP. She wanted to see that we had typed this patient before she received the FFP which we had. Its our policy and has been the 20 years I've been here. She mentioned that it is a good practice even with patients we are very familiar with so I never bothered to look up what AABB says but from what she said I wonder now if it is indeed required..? It may not be that much revenue but it is a procedure and we justify our FT employees by the number of procedures we perform so there is that.. lol
  21. Auntie-D I looked at the link above. Interesting... I've sent an e-mail for more info but in the mean time does this software grade the techs diffs or does a file have to be sent in? Thanks
  22. I'd be interested in knowing what others are doing as well. Currently we are doing a tech vs. tech correlation every 6 months and using the instrument diff as the standard to check against but we do not have anything in place for training for the rare diff that is way off. I would also like to know what criteria folks are grading this sort of thing against. I.e. neutrophil count +/- 10% works but the 10% thing doesn't work for the lower count WBC's such as Basophils or even eosinophils. Thanks
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