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Posts posted by TreeMoss
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Where do these inspectors come up with these things? We have never had this difficulty. When we issue the aliquot, we point out the AO, BO, etc. at the bottom of the new label. If you use a sterile welder to make your aliquot, I suppose you could show that paperwork to prove that it is a closed system. I'm curious to see if anyone knows the answer to this one.
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On 2/5/2018 at 7:06 AM, ADawson said:
Our physicians order the workup on Rh neg moms for the morning after giving birth. We check the infant's blood type to determine the need for the workup and cancel if not necessary.
Our result includes "Candidate?" where we result "yes" or "no". This documentation helps the nurses know right away whether the mom needs RhIG or not. We credit the patient account for any testing not performed but resulted.
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Our facility currently has a consent for transfusion that is good for 30 days after which a new consent has to be signed. Our NICU staff would like to have a transfusion consent that is good for the length of stay since their patients can stay for up to 4 months if not longer. We are inspected by The Joint Commission and CAP. Is anyone aware of specific guidelines that apply to these consents?
Thank you
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We dilute up some anti-D and use an aliquot of that to crosscheck the newly received antibody screening cells with the screening cells currently in use. When the cells are put into use, we check all three cells using anti-D or anti-c diluted up so that we are testing all cells for something positive.
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We listened to an ARC sponsored reimbursement webinar a few years ago where we were told that we could charge for all crossmatches and antigen typings performed, within reason. We will also crossmatch first and then antigen type the compatible units if the antibody is showing -- to conserve that expensive antisera.
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We are using EXM on Meditech 5.6.7 and love it. I was able to get the building and testing information from ATLAS and just followed that information. You will begin by having changes made to the LIS Parameters and then will just build what is needed. The whole process went well with that information.
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We have 2 O Pos and 2 O Neg units all labeled and written on Emergency Issue and Blood Cooler forms ahead of time. Segments are also set aside for these units. When a full trauma is paged (we have full and partial traumas in our Level II Trauma Center), we call to find out the age and gender of the patient. We then pack up the appropriate units in a blood cooler. For most of our full traumas, someone comes from the ED to pick up the cooler. Sometimes they call first, and sometimes someone just appears at the blood bank window for the blood. These units are usually taken to the ED prior to the patient's arrival.
If the patient is an inpatient, the courier comes to pick up the units and brings patient identification. Orders are not usually in the computer prior to picking up the units. If a type and screen has been completed, we can quickly do an electronic crossmatch and have the units available. If it has been necessary for us to put the order for the packed cells in the computer, we complete a sheet for verbal orders that the physician signs later.
If an MTP is needed, that order is place in the computer. We prepare the first pack, and then blood bankers order any additional packs that are needed. Since this is an approved protocol, we don't need additional signatures from the physician.
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On 11/27/2017 at 5:54 AM, BankerGirl said:
Our system is down at the moment, so can't give you the exact dictionary page, but for the products you wish to retype, you first create an order group that contains the retype group (or profile). Then in the product dictionary, under Assoc Unit Order Group, you put that order group in the desired field, probably Non-Affiliated Source. Then when you enter your unit it will create a specimen for the retype. You cannot use the RBC Unit label, because the testing is on the specimen number. Hope this helps.
We don't have this version, but when we scan the DIN barcode (or type U#[unit number] under result entry, the specimen pops in and we can enter the results. Has this changed in later versions?
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4 hours ago, BankerGirl said:
I was asked about the courier training a couple of inspections ago. She asked what training they received. I told her I wasn't sure because they were nursing personnel and they were trained by nursing. That's all the further that conversation went. I can't think of a standard covering that, so if you can let us know what one he cited, that would be appreciated.
Annual training for nursing staff.
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21 hours ago, Cliff said:
@SMILLER, we have always been able to determine who received our products, including all emergency release products. We have a form the physician signs that lists the units. The blood bank issues those products (when they have time) to that patient and we can track where every product goes.
What I take exception to is the inspector insisting that we also put the patients name and MRN on the product. They again insisted this made the process safer. It does not in any way make it safer, especially if it's a system assigned name / MRN and more importantly, when it takes a modest amount of time to generate these labels.
We have done a tremendous amount of planning to ensure we can give out emergency release coolers, almost on demand. It takes us very little time to give the requester their products, these labeled units have put a significant delay on that, and in my opinion, has deceased patient safety.
We do the same. If we have a "Doe" patient arriving, we ask for the age and gender, then issue O Negative or O Positive packed cells depending on the answer. These units are labeled only with an "Uncrossmatched Blood" sticker. If, by chance, we have received a specimen prior to the need for uncrossmatched packed cells, we quickly do a blood type and will then issue type compatible packed cells with a patient identification sticker and "Uncrossmatched Blood" sticker on the units. There is also the paper for the physician to sign acknowledging the need for the emergency blood. These are sent in a blood cooler and are issued to the patient after the cooler is returned and we have paperwork showing the units were transfused.
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The Intermountain States Seminar is the regional ASCLS meeting for Idaho, Utah, Montana, Wyoming, and Colorado. This meeting is held in the fall -- usually the end of Sept/ first of October at the Snow King Hockey arena in Jackson, Wyoming. Each state in this region also has an annual spring meeting.
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3 hours ago, BldBnker said:
We do not notify our medical director. We alert the nurse taking care of the patient that more than 1 vial of Rh Immune Globulin is needed due to a positive FMH. The KB results are on the chart also. The nurses inform the patient's physicians.
This is also what we do. We treat this as a blood bank "critical value" and do a "write down, read back" to nursing.
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You should be able to show your procedure -- do you have a sterile welder with documentation of use? Your procedure will show them what you do. Meditech will add the letter at the end -- has nothing to do with a closed or open system.
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American Red Cross has SUCCESS courses -- or you may find something if you have a different blood supplier.
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We change our wasted products to Inactive Status FS2 to differentiate from those transferred to another facility or returned to the Blood Supplier. When we look up the disposition report, we can see those wasted units easily.
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We fill out a transfer form from the blood supplier to send with the units just in case the new facility will accept our units. With that paperwork, we include a note for them to call us if they receive the blood. We are also able to get the information from the flight team, if necessary. One of the major hospitals we send patients to in the "big city" will also send us a letter informing us of the disposition of any units they receive (that they were discarded!).
- SMILLER and Marilyn Plett
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Last I heard, she was working in a hospital transfusion service in Roseberg -- but that's been several years. Thought it was worth asking. Thank you.
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Do you know Julene L., by chance?
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We have always done an auto control with the antibody screen if the patient has been transfused within the last 120 days. However, closer review of the latest revision of the package insert revealed that all reference to an auto control with the antibody screen had been removed. We should only be doing the auto control with the antibody ID.
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Perhaps this could be included on the Transfusion Medicine specimens -- our forms have a place to record that the ABO Subtype was tested (or not). Although that is not a graded choice, it could probably be shown when results are returned and compared with other facilities that do the subtype.
Just an idea!
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When we have two or three products with the same DIN, a box pops up after the DIN is scanned asking for the product code -- so we scan that, as well. The correct unit is issued. You cannot do this simply from a look-up screen but need to use the scanner.
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As long as the panel in in date, CAP says that we only need to check to make sure the reactivity matches the previous panel. If you are using expired cells as rule-out cells, you would need to check them for reactivity on that positive antigen.
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When we receive new reagents, we crosscheck with the current anti-sera and use cells currently in use as well as the cells that most recently expired.
Crosschecking the fetal bleed screen kits (we use FMH RapidScreen - Immucor), we use the new anti-D with the old kit cells (controls and indicator cells) and the old anti-D with the new kit cells.
We crosscheck the antibody panels when they are received against the panel currently in use using diluted anti-D reagent to give 1+ reactions.
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On 7/27/2017 at 5:38 AM, galvania said:
Does the AABB state a reason, Treemoss?
I looked up Method 5-3 "Using Antibody Titration Studies to Assist in Early Detection of Hemolytic Disease of the Fetus and Newborn" in the AABB Technical Manual, 18 edition -- One of the NOTES states: "Do not use enhancement techniques [albumin, polyethylene glycol, low-ionic-strength saline (LISS)] or enzyme-treated red cells because falsely elevated titers may be obtained. Gel testing is not recommended."
The next note states: "LISS should not be used as a diluent in titration studies; nonspecific uptake of globulins may occur in serum-LISS dilutions."
Neonatal Type &Screen for transfusion collected from the placenta
in Transfusion Services
Posted
They do this occasionally at our facility. The specimen(s) are labeled at the time of collection with a label made by scanning the infant's identification band. We also do not use cord blood specimens for crossmatching/transfusion purposes. This source is also often used for chromosome testing due to the larger volume that is needed. They will not use placental blood when twins are delivered.