Just For Fun

[jcdayaz]

This is my vote for the explaination of the situation you described. It took a good bit of training and lots of headache, but our nursing staff are the ones making the call of whether the signs and symptoms qualify for a reaction workup. The logic follows that the nurses are the primary caregiver, at the patient's bedside, describing the situation to the physician. They have been empowered to call reactions even when the physician says it is not (we had physicians brushing reactions off too ofter). We have had good success with the process. All nursing staff have annual re-education in reactions. The lab staff is always available to discuss what nursing is finding as well. I have had several calls from lab staff during the night regarding signs and symptoms, etc. while this process was changing. Nursing's first reaction is to call the physician whenever something goes wrong during patient care. The most difficult part was convincing them to call blood bank first so we could get specimens collected and begin the reaction workup. It took a while, but physicians and nursing are on board with this "change of mindset" now.

Whoa--I would be afraid to have nurses in charge of transfusion reaction decisions. That would be totally scary in our facility!

We review all completed transfusion records. We, unfortunately, not infrequently see documentation of transfusion reactions that were not even recognized by the nurse and were therefore not evaluated at the time. They will usually call us if their patient develops chills or urticaria but sometimes don't notify us if their patient has a temperature spike during the transfusion!!:cries:

I can not even imagine the education process it would take to trust empowering them with making the ultimate decision.

I applaud you if you have figured out how to make it work!!

[Deny Morlino]

Having the nursing directors and unit managers "buy in" to the process was invaluable. It took a dedicated education process (still ongoing by the way) to provide the confidence level for nursing to take ownership of the responsibility. Keeping the process sucessful is an ongoing effort, but has been well worth it

[Orr Austin]

What about when the patient has multiple antibodies, and the physician has ordered 2 units of blood STAT. When you call to tell him that you can't find 2 units quickly due to the antibody problem, he tells you - "Well, then get 4 units !!". LOL.

[Brenda K Hutson]

I can relate to both of these posts.

1. Every place I have worked (5 Hospitals) has had a Nursing SOP that describes signs and symptoms that may constitute a Transfusion Reaction. In general, Nursing follows that; but I think they ask the Physician first on some of them. The Transfusion Service (my predecessors; myself; Medical Director) has had "input" on their SOP, making sure it includes everything it should. Nursing staff have a computer module of PowerPoint slides which they are required to read and sign off on annually. I also had input for that (it was just created last year at my request). Also every place I have worked there is the occassional Nurse that will call and tell us the symptoms; then ask us if they should call a Transfusion Reaction. I always tell them that is "their call" and we cannot make that decision for them.

2. One place I worked also got back 1 copy of the Transfusion Slip record and audited them for signs of a Transfusion Reaction. There was also a box on that Form that they checked if a Transfusion Reaction was initiated on the blood product. I also found situations in which "according to Policy," they should have initiated a work-up and did not. Those were documented on Quality Reports; then sent to the Manager of that Nursing Unit.

Brenda Hutson, CLS(ASCP)SBB

Whoa--I would be afraid to have nurses in charge of transfusion reaction decisions. That would be totally scary in our facility!

We review all completed transfusion records. We, unfortunately, not infrequently see documentation of transfusion reactions that were not even recognized by the nurse and were therefore not evaluated at the time. They will usually call us if their patient develops chills or urticaria but sometimes don't notify us if their patient has a temperature spike during the transfusion!!:cries:

I can not even imagine the education process it would take to trust empowering them with making the ultimate decision.

I applaud you if you have figured out how to make it work!!

[jcdayaz]

What about when the patient has multiple antibodies, and the physician has ordered 2 units of blood STAT. When you call to tell him that you can't find 2 units quickly due to the antibody problem, he tells you - "Well, then get 4 units !!". LOL.

HaHa! Better than the "Well, just give him O negs then" response when you call with an antibody issue!!:cries:

[Deny Morlino]

What about when the patient has multiple antibodies, and the physician has ordered 2 units of blood STAT. When you call to tell him that you can't find 2 units quickly due to the antibody problem, he tells you - "Well, then get 4 units !!". LOL.

Funny you should mention that situation as we have had similar experience (as has most everyone!). The options we have to offer the ordering physician include emergency release of blood after explaining to the physician the risks involved in the given situation. The other possibility is issuance of incompatible blood products (again with pertinant education given the situation). Both require the physician's signature per our SOP. Amazing how ofter they slow down a little and weigh the situation!

[cbaldwin]

We recently received a request for a "Kline Hour Bed Key". We weren't sure if we should draw the patient or call the Locksmith.....

[jcdayaz]

Good one! Some of my fav's in the blood bank are OOtologous blood, autojelous blood and now irrodent blood.

[EDibble]

Yes, I had a situation a few weeks ago where the nurse said "The doctor wants to keep transfusing units until there is a unit that doesn't cause a reaction." Yipes. I told her in the nicest possible way (we always have to try to do that, right?" that that really wasn't a possible scenario. Could we please do the workup and then go from there? ::Sigh::

[Dr. Pepper]

Scrambled syntax written orders are always fun, but has anyone found anyone outside of the lab who can actually pronounce "autologous"?

[KKidd]

Scrambled syntax written orders are always fun, but has anyone found anyone outside of the lab who can actually pronounce "autologous"?

Or for that matter, how many people in the in the lab???

:clap::highfive:

[Dr. Pepper]

(Stuttering): "Auto-log-agog-alogagus...."

Speaking of which, non-New Englanders and certainly our international friends may not have heard of Lake Chargoggagoggmanchauggauggagoggchaubunagungamaugg (a.k.a. Webster Lake).

Its 17 uses of "g" are the most instances of any letter in a word. The name also contains 10 instances of the letter "a" (not including the "a" in "lake"), more than any word in the English language.The lake isin the town of Webster, Massachusetts, United States. It is located near the Connecticut border and has a surface area of 1,442 acres (5.83 km²). The name comes from Nipmuc, an Algonquian language, and is believed to mean, "Fishing Place at the Boundaries -- Neutral Meeting Grounds". This is different from the translation, "You fish on your side, I fish on my side, and nobody fish in the middle", a hoax believed to have been concocted by the late Laurence J. Daly, a Worcester newspaper correspondent.

Thank you Wikapedia.

[Malcolm Needs ☆]

Brilliant Phil!

[Mabel Adams]

I've heard (and occasionally said) Blood Blank quite a few times.

[jcdayaz]

How about answering the Blood Bank phone after being paged by the central lab to take a call "Hi, this is Jane in the......um(long pause), um(long pause)...How can I help you?":redface:

How sad is it that your brain can get so fried by some ridiculous antibody you've worked on the entire day that you can't even remember which department you work in????:cries:

[jcdayaz]

I've heard (and occasionally said) Blood Blank quite a few times.

I'm guilty also!

[BankerGirl]

I have been known to call our reference lab and say, "Hi, this is Miriam in Blood Bank." Well, duh, I am in blood bank, but which blood bank? Fortunately, the staff there know me pretty well, and since my name is fairly uncommon, they always know who I am and just chuckle.

[Dr. Pepper]

Ah, the name game...

One of my daughters (we'll call her Dr. Jones) is a physician, currently doing her residency in pediatrics at a local hospital. She was over for dinner a few nights ago. I was waiting for a call from one of our docs (Dr. Smith) so I could give him an update on one of his antibody-laden patients. I'm puttering at the stove when the phone rings. My daughter picks it up and says hello. The caller says "Dr. Smith." She says, "No, Dr. Jones". Smith says "No, Dr. Smith!". My daughter says, "NO, DR. JONES! I think you have the wrong number!" At this point I put down the spoon , grab the phone and apologize to Dr. Smith: "I'm sorry, Ray, that was my daughter who is indeed a physician. She's a blonde one, though."

[jcdayaz]

Great one phil!!!!!

[bduff]

I have been known to call our reference lab and say, "Hi, this is Miriam in Blood Bank." Well, duh, I am in blood bank, but which blood bank? Fortunately, the staff there know me pretty well, and since my name is fairly uncommon, they always know who I am and just chuckle.

I do this very often as well! I have gotten out of the habit of answering the phone like that at home though!

[doctmpg]

several times i got phone calls from interns(junior doctors) how much time it will take for FFPs to be cross matched for a patient

[AMcCord]

I like requests to thaw platelets, "or whatever you do with them".

[Malcolm Needs ☆]

True, but it is tragic/disgusting that:

a) they don't know and

they don't care that they don't know.

[jcdayaz]

True, but it is tragic/disgusting that:

a) they don't know and

they don't care that they don't know.

Very true Malcolm! In my humble opinion a good nurse/doctor is one who will admit he/she is not very "schooled" in Transfusion Medicine issues, ask for help from us, and then actually take it!

[Brenda K Hutson]

Wow, this Thread is still alive! I have not been able to login for some reason but finally made it.

Just had to share "yet again" what has been 1 of the common themes on this Thread.

One of my Techs. just received a call from a surgeon asking for blood for his patient (as is all too frequent, we received the specimen and orders at the last minute; then they scream because the blood is not ready). The Antibody Screen was positive. The Tech. tried to explain that, and that this would result in a delay in blood. His response? Then send me the universal donor! When she tried to explain to him why that would not help, he was incredibly rude and told her she did not know what she was talking about! She told him to call our Medical Director. A few minutes later, the Medical Director walked in. This surgeon had been extremely rude to him also.

I have taught enough residents and fellows in my career to know how little of Lab training they get in Medical School; and then the limited bench level training they get in the Transfusion Service. But it just seems like this very basic principle should be explained better in Medical School. I mean how can they really sign a form saying they need uncrossmatched blood and they "accept responsibility," when they do not even understand the ramifications of what they are asking for?!

Aaaahhhh

Thanks, I feel better now.

Brenda Hutson, CLS(ASCP)SBB