bevydawn Posted November 21, 2006 Share Posted November 21, 2006 I am trying to come up with some new things for QA for this coming year and wondered if anyone had any ideas? Currently we monitor all of our mislabeled specimens, our TAT on stat and ER specimens, our crossmatch to transfusion ratio, etc. We've tried monitoring transfusion tags to make sure they were properly filled out by nursing but when we were getting less than 50% nursing decided they would monitor that themselves and now it is miraclously 95-100%, imagine that! I am most interested in adding things we the techs can improve on ourselves for now, that way I know I will get compliance! Can anyone share what different things you monitor? Thanks! Link to comment Share on other sites More sharing options...
Eagle Eye Posted November 21, 2006 Share Posted November 21, 2006 I monitors everythig you monitor. I also monitor Specimen/blood component request slip: 1)I look for completeness---Diagnosis, physician name, typenex number, rationale for ordering blood component, test ordered(I find some without any test checked off)2) > 4 hr transfusion3) Transfusion records4) Blood product outdates5) blood product wastage6) Transfusion reactionsLet me know if anyone else have any other suggestions. Link to comment Share on other sites More sharing options...
Mary Posted November 22, 2006 Share Posted November 22, 2006 We have electronic charting so we can monitor whether or not the completed record of transfusion gets to the patient's chart. We had a programmer write a program which matches component charges to the number of transfusion tags that are on the charts.It was surprising how many were missing.Since this has been an issue on inspections by our State Board of Health, if we find that tags are missing, we send the Blood Bank copy to Health Information for electronic scanning to the chart. Link to comment Share on other sites More sharing options...
Laura Mc Posted November 22, 2006 Share Posted November 22, 2006 You may want to think of items that improve your current processes. For example, we monitored units out of the bank too long, FFP outdating (we shouldn't have any as we changed to thawed plasma), labeling errors on blood products, computer entry errors. We did audits which could lead to a long term monitor. Some audits we did: were techs following our solid organ crossmatch policy, our conditional release policy, were we getting variances for issuing low yield platelets. Find areas where you are perceiving problems and see if there is a problem. Look for areas where you think there are no problems, you may be surprised. We were with one of our audits that lead to a monitor being put into place until the problem was resolved. Link to comment Share on other sites More sharing options...
rcurrie Posted November 22, 2006 Share Posted November 22, 2006 Here is a list of things I monitor. This may not be of use to you if you do not have a donor center as well as a transfusion service, but you may see something you like:INTERNAL AUDITSViral Marker Deferral Record Audit # Records Reviewed (total positive viral marker tests) # Discrepancies / Error Rate Donor Deferrals (Total and Percentage of 'Donors Seen') Deferrals for Low HCT (Total and Percentage of 'Donors Seen')Allogeneic and Directed Donor Blood Collected - Total Fixed Site Allos Directed Neonatal CPDA-1, O neg MobileTherapeutic Exchanges / Therapeutic PhlebotomiesLSDP Collections / Total SDP Including Double CollectionsProducts Not Meeting QC Monitor Specifications LRBC Residual WBC QC Failures (residual WBC>5x10e6) LSDP Residual WBC QC Failures (residual WBC>5x10e6) LSDP pH QC Failures ( pH<6.3) LSDP-- Prequalification Platelet Count Failures (<3x10e11) LSDP-- Intended Double Failures LSDP-- QNS at Collection LSDP-- Positive Culture / Confirmed NegativeUnusable Products - Donor Services - Total QNS Whole Blood Collection Clotted units- collection 10 minutes or less Clotted Units- collection more than 10 minutes Air Contamination and Unusable Overdraws (Phlebotomy) Air Contamination and Wasted RBCs (Component Processing) Donor Card Errors Resulting in Loss of UnitAdverse Events/Complaints ReceivedClass "A" FDA Reportable Errors & AccidentsClass "B" Non-Reportable or Pt/Donor Safety ErrorsWasted Products - Transfusion Services and NursingTotal Number by Service RBC + LRBC + WRBC FFP CRYO Apheresis LSDP Products WB/AWB Aliquots / Exchange Products for NeonatesImproperly Labeled Samples (mislabeled, incomplete)Specimen Problems (hemolyzed, QNS, hemodiluted)Proficiency Testing: CAP J: Transfusion Medicine (Jan /A, Jun /B, Sep /C) CAP DAT (Feb, Nov) CAP HBF ( May, Nov) CAP ABT (Jun /A, Oct /B) CAP ELU (Mar, Jul) Hct: Jan, Apr, Jul, Oct (25 samples/event) Transfusion Related Cell Count (Jan, May, Aug)Products Received from Other Centers - Total LRBC SDP Cryo FFPTransfusion Services STAT T&S TAT (% within 1hr/Total # ) % within 1 hr 15 mins / % within 1 hour 30 minsQA Review with StaffBC Link to comment Share on other sites More sharing options...
John C. Staley Posted November 22, 2006 Share Posted November 22, 2006 So Bob, what do you do in your spare time? Link to comment Share on other sites More sharing options...
rcurrie Posted November 22, 2006 Share Posted November 22, 2006 As a passenger train locomotive engineer (35 years), I run excursion passenger trains, usually about 4 times a month. Running trains is my relaxation. http://www.austinsteamtrain.org BC Link to comment Share on other sites More sharing options...
Eagle Eye Posted November 23, 2006 Share Posted November 23, 2006 BOb, How many assistant do you have? Or may be you have very nice computer program which can collect all the data you need directly from your LIS system!!! WE do not collect so most of your list doesn't apply to us but you gave us a very good list of monitors one can use. Link to comment Share on other sites More sharing options...
rcurrie Posted November 24, 2006 Share Posted November 24, 2006 I am glad I could help.I am a one-person QA department in the donor center. I do a lot of administrative queries in the two modules (donor and transfusion services). I review 100% of all work done. Most of what I review is in the computer, but we also have a lot of cGMP forms that I review. To prevent calculation errors, I have created calculating spreadsheets so that the processing techs just enter the test results (platelet counts, for instance) and the spreadsheet says PASS or FAIL. All I have to do is make sure they have entered the correct test results, weight of the unit, etc. I couldn't do what I do without the review tools I have created.BC Link to comment Share on other sites More sharing options...
Karen Olsen Posted December 2, 2006 Share Posted December 2, 2006 We monitor product wastage and expense,improper storage,phlebotomy TAT, recollects,>4 hour infusion times,Transfusion Slip completeness,logs for refrigerators in surgery and cardiac ICU, blood usage in surgery, C/T ratio, and then anything else each year where we perceive there may be a problem. Link to comment Share on other sites More sharing options...
bevydawn Posted January 15, 2007 Author Share Posted January 15, 2007 To monitor the >4 hour infusion times, do you just go to the patients' charts to see the start and stop time? Link to comment Share on other sites More sharing options...
Bettiec Posted January 18, 2007 Share Posted January 18, 2007 In additions to the QC items listed we monitor "blood products not immediately available" as we are a small hosptial. Link to comment Share on other sites More sharing options...
Bettiec Posted January 18, 2007 Share Posted January 18, 2007 In additions to the QC items listed we monitor "blood products not immediately available" as we are a small hosptial. I think I made a big mistake and erased the quote by aakupaku. I am sorry Is there a way to retireve the quote? Link to comment Share on other sites More sharing options...
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