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Where am I?


Brenda K Hutson
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Hello All!

I am glad to be back on Blood Bank Talk!:D Had a major move a couple of months ago: moved from California (Tech there for 29 years) to Maine (had never lived in Maine, but family moved there over the years). It appears I will now have time to come to this website more consistently than previously.

So, it is difficult enough to move to a new location; much less across country. But the Tech. field is also very different than my experience (thus the Title; Where am I). I am trying to interact with my peers here in Maine, but thought there might be others of you out there who have some of the same "issues/challenges/learning opportunities" that I have encountered, and might be able to share some ideas?

1. So there is not an actual Donor Center in the state! It is my understanding that the closest distribution center is in Mass. So, in addition to a standing order, we have to place any additional orders by 7pm the evening before. Obviously it is not feasible (and certainly not cheap) to just place an order anytime you want you start running low.

2. So, because of #1, there are certain Hospitals in the state that are called Overstock Hospitals; they will take some extra stock from that Donor Facility with the understanding that Hospitals can call them when in need (though their own need for a given product would take precedence at any given time). These overstock Hospitals can be an hour away or more (vs. competing Donor Facilities as I am used to; all close by).

3. Because of #1 and #2, we have a big problem with wastage. Since any additional blood would take time (and money; cab costs) to obtain, one tends to keep a little more in stock; thus increasing the possibility of wastage.

4. Currently, we use ALL Irradiated RBCs (apparently due to a case of GVHD at a Cancer Center in another state some years ago). This is something I am looking into. That then creates 2 other "issues:"

a) Can only obtain blood from overstock Hospitals that utilize Irradiated Units and/or that have an Irradiator so can Irradiate for us (we are moving into a new Hospital in 2014 and space has been provided for an Irradiator; but I don't think that decision is final). One of the larger overstock Hospitals, which like us, has been using all Irradiated RBCs, will be going back to giving IRR by diagnosis only.

B) And of course, once you Irradiate a unit, you have shortened the expiration also; thus adding to our wastage problem.

5. $$; not a lot of it in the state of Maine (actually, kind of an issue any place these days with the economy). But add to that, building a new Hospital, and the belt gets tightened even more.

6. My Hospital is actually made up of 2 Hospitals and a Cancer Center (all relatively small; at least by my experience); so as with most smaller Hospitals, we staff a lot of Generalists who may not be as knowledgeable and/or confident in the Blood Bank (and I emphasize "may not" in that I have certainly seen excpetions to that everywhere I have worked). So already things like Warm Autos are sent to the Reference Lab; which is also in Mass.

7. MLTs: Calif. used to be one of the strictest states in that it required Calif. State licensure in addition to ASCP. MLTs were never used anywhere I worked (though I believe Hospitals are starting to phase them in; largely due to Tech. shortages). So I was "apprehensive" about that at first; only to see that if you take an intelligent, motivated person with a little college background (though some are 4 year) and give them good training, they can be as good, if not better than some of the Calif. licensed Techs. I have worked with! This part was a pleasant surprise!

8. $$ leads to issues like using a 2 cell screen instead of 3 (I have always used 3 and feel much better with that when it comes to trying to catch "new" antibodies in a patient with a history of antibodies, inbetween your Antibody Work-Ups; whatever that time-frame is for you. $$ also affects other Reagent purchases such as # of Panels; Antisera you stock (for primary major allos; which could be in form of bottles or GEL Cards); additional potentiating media such as PeG or RESt.

So, I would love to hear from others out there who have faced some of these same issues; and what you may have learned and/or accomplished re: then.

Thanks much!

Brenda Hutson, CLS(ASCP)SBB :)

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Welcome to health care in rural Amercia! I've been working in almost exactly the situation you describe for 30+ years. Our blood supplier and reference lab is 2 1/2 hours away, which gets interesting sometimes, but it's not impossible....truly!

The key to keeping supplies, reagents and blood products stocked is organization and planning ahead - no different than what you've been doing, except look at it in terms of a week or a month, rather than a day. I'm afraid a certain amount of waste is unavoidable, but it can be minimized once you get a feel for how much product you use over the course of a week, a month or a year. One thing that improves our waste numbers is a plan that allows us to rotate stock back to our supplier. Is that an option with your supplier or one of your overstock hospitals? We actually function like one of your overstock hospitals, transferring product to our neighbors, mostly the small ones. Holding a little more blood for transfer gives us a little extra cushion for our needs. Being on good sharing terms with our neighbors is a huge plus - we have the same supplier and we can help each other out when we're in a pinch.

As to keeping all the cool reagents for antigen typing, absorption, elution etc etc - you just can't, it's too expensive. Take a look at your problem patient population and stock the stuff that will give you the biggest bang for your bucks and let the rest go. Some ugly antibody IDs and most warm autos get sent out here (but honestly, that really doesn't make me too sad - I have lots of other things to do). Sometimes, not often, patients will be transferred because we don't have blood on hand that will work for them - negative for 4 or 5 antigens, Sickle Dex neg, whatever. It's reality. Good communication with the physicians is key to the best patient care under these circumstances.

Your MLTs and generalists will do fine. The majority of the patient work done in a Blood Bank is uneventful. As long as everyone is well trained and follows the rules, they'll function very well. They'll handle straightforward antibodies with little or no guidance. To deal with unusual things, they'll need a little support in the form of continued learning/refreshers and your phone number for middle of the night hand holding.The 'fun' antibodies will be your babies or if you're not there, they'll send them to the reference lab - and don't allow yourself to stress about the one you could have taken care of, if only you had been there. Once a 'fun' patient has been deciphered, you can hand the workup off for future visits to one of your generalists or MLTs with instructions (and supervision) on how to procede. If they have the support of knowing what they need to do, what they should expect to see and when they should call for help, they'll be be able to deal with all kinds of problems. Use those patients for teaching - just like you've probably always done. You'll find that you a have an MLT or generalist MT (several, if you're lucky) who will have an interest in Blood Bank, or at least be willing to learn new things. Take advantage of that and teach them as much as they can hold - then you'll have someone you know you can trust to tackle problem patients when you are not there and who will know when it's time to send it out because they are in over their head.

Take home message........you've been doing it all already, just in a different place on a different scale. Some things will be a little inconvenient (blood supply), but you'll adapt and make it work. Some things will be more stressful sometimes (blood supply), but you'll adapt. Look for creative ways to work with what you've got. Your experience other places probably means you can bring in some great ideas - but not too much at once. Remember, too, that the doctors and nurses working where you work have been told before that they are going to be waiting for the blood to come in or the reference lab to call. Doesn't mean that they won't worry and call you lots, but they've been there before.

Think of it this way, if you have wait for blood to come in from an hour or more away, that just gives the nurse time to call you 6 times instead of 2 - what's a little extra stress to a lab rat!

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McCord hit the bullseye- life in the rural hospital is def an adjustment if moving from a large facility!

Also in regards to the MLTs- don't count them out! I've worked with many MLTs as generalists and they are completely capable of doing things as most MTs (in fact- I've worked with some MLTs that were more competent than some MTs.... :S) It actually frustrates me when people assume that MLTs are only good for things such as spec processing etc- There are so many hospitals out there (especially the rural ones) that would not be able to survive if it weren't for the fact that MLTs can work in the same capacity as MTs.

Enjoy the East Coast!

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MLT's are invaluable in the rural setting. Other than the supervisor of a given section MLT's perform the same duties as MT's here. I also agree with the thought that it is not the "degree" so much as the person performing the job. VERY rarely do we concern ourselves with the alphabet soup behind the name.

As has also been stated, the biggest challenge in a rural setting is the distance and time issues. The upside is familiarity with the patient histories due to frequency of contact. Hang in there. The adjustments will take a bit, and you are bringing a wealth of experience from a different world. Some of the experience will be very applicable and some not so much. The challenge will be deciding what fits your new world. Good luck!!

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Welcome to New England (although why you would swap California, the land of milk and honey, with Maine, land of frostbite, black flies and bad tattoos is another story.....Just kidding there Mainers, I love the state). The above posters have given you some excellent advice.

We have always hired ASCP med techs, with the exception of some venerable (i.e. my age) techs who went straight from high school into the lab and who grandfathered into HEW- certification. They remain some of the best techs in the lab. We just hired our first MLT because of the lack of ASCP med techs, and, you know what, she is the equal or better or anyone we've hired in years. So don't worry about that, those MLTs will get by just fine without that history 203 course.

I prefer a 3 cell screen, too, but as has been pointed out in other threads, we weren't exactly killing patients left and right with 2 cell screens or the old one cell pooled screens and albumin crossmatches back in the day.

Good luck, keep in touch, and ALWAYS brake for moose.

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Best piece of advise I've ever read (and we don't even have them in the UK)!!!!!!!!!!!!!!!!!!!!!!!

:haha::haha::haha::haha::haha:[/quote

It's actually quite a serious matter. There are about 1,000 moose/car collisions a year in Maine. The trouble with moose is their size. You hit a deer, it bounces off your car bumper. Moose are tall enough that when you hit them, you knock their legs out from under them, then you have a 500-700 kg animal very rapidly coming in through your windshield into your lap.

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I too have spent my 30+ years working in more rural areas 2-5 hours from my blood supplier--one in Idaho and now in Oregon. I have been at the "big" rural hospitals (100-300 beds) in areas with smaller ones (15-45 beds) and often served as the "depot" or "overstocked" hospital. Plts are our nemesis! Totally unpredictable usage but absolutely must have them and a ridiculous shelf life. If I can be of help I'd be happy to. So far the folks above have covered things quite well...including the moose vs car warning which I have heard from northern parts of this half of the country also.

I have started to use the following for disaster planning: how fast can your patients bleed and how long till you can ship them out or get more blood? We have a remote little hospital in Central Oregon that keeps way more blood than the AABB formula says they should. They deliver babies and are on a fairly main highway at least 3 hours from any hospital of any size. I say they need to keep enough type O blood to save the life of one bleeding patient until help can get there (in the winter). At my 261 bed hospital, I think I need to be able to save 2 type O patients until I can get more blood, first from the small surrounding hospitals, then from our supplier. Our blood supplier is 3+ hours away over a mountain pass but we do have a medical helicopter and a plane for moving patients faster.

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Best piece of advise I've ever read (and we don't even have them in the UK)!!!!!!!!!!!!!!!!!!!!!!!

:haha::haha::haha::haha::haha:[/quote

It's actually quite a serious matter. There are about 1,000 moose/car collisions a year in Maine. The trouble with moose is their size. You hit a deer, it bounces off your car bumper. Moose are tall enough that when you hit them, you knock their legs out from under them, then you have a 500-700 kg animal very rapidly coming in through your windshield into your lap.

Years ago I interviewed and was offered a job at the Blood Bank of Alaska. During the interview they told me of a case from the night before where a woman hit a moose with her pickup truck. Her most serious injury was from the moose biting her shoulder when it's head came through the windshield. I often think back that I should have accepted that job but there was no way I could get my wife to move to Alaska in January!

:cries:

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Years ago I interviewed and was offered a job at the Blood Bank of Alaska. During the interview they told me of a case from the night before where a woman hit a moose with her pickup truck. Her most serious injury was from the moose biting her shoulder when it's head came through the windshield. I often think back that I should have accepted that job but there was no way I could get my wife to move to Alaska in January!

:cries:

It's very rare to see moose in southern new England. We had one wander into Rhode Island several years ago. Despite the state's history as a haven for the oppressed, the moose was deemed a undesirable intruder and shot with a tranquilizer dart. The game wardens could not lift up the comatose moose, so they got a front loader to do the job. They snapped off an antler in the process, the moose went into shock and died. Word of this gentle welcome must have spread in the northwoods moose community as we haven't seen any since.

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Gee, Brenda......from California to Maine....that's quite a change! Good like in you new position and in you new habitat.

AMcCord just about said it all. Obviously she's "been there, done that!" Great advice. I also echo the comments from several posters about MLTs. Some are better than others (just like MTs), and some MLTs perform equal to or better than some MTs. (As with any laboratorian, it's just real important that "they know when they don't know something"....ie: know their limits.)

Good luck!

Donna

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Wow, thanks for taking the time to give me so much feedback! I do not yet have the mindset you describe; but I will work on it. One of the problems I have seen with sending things out to a reference lab that is hours away, is that like most places I have worked, we are often not given a lot of notice (i.e. they recently had to postpone surgery on a guy). So I need to find that happy medium; where we at least keep enough reagents to work up a fair amount of things (not Warm Autos; don't have the staffing and/or experience of all staff). But you are correct, I am already having to decide which antisera to keep stocked. I was wondering how they were able to complete so many of their own work-ups, with only 1 panel! Found out it is because they will use them up to a year's expiration! That will stop.

I will keep your name close by; in case I need a shoulder to cry on once in a while! :cries:

Thanks!

Brenda Hutson

Welcome to health care in rural Amercia! I've been working in almost exactly the situation you describe for 30+ years. Our blood supplier and reference lab is 2 1/2 hours away, which gets interesting sometimes, but it's not impossible....truly!

The key to keeping supplies, reagents and blood products stocked is organization and planning ahead - no different than what you've been doing, except look at it in terms of a week or a month, rather than a day. I'm afraid a certain amount of waste is unavoidable, but it can be minimized once you get a feel for how much product you use over the course of a week, a month or a year. One thing that improves our waste numbers is a plan that allows us to rotate stock back to our supplier. Is that an option with your supplier or one of your overstock hospitals? We actually function like one of your overstock hospitals, transferring product to our neighbors, mostly the small ones. Holding a little more blood for transfer gives us a little extra cushion for our needs. Being on good sharing terms with our neighbors is a huge plus - we have the same supplier and we can help each other out when we're in a pinch.

As to keeping all the cool reagents for antigen typing, absorption, elution etc etc - you just can't, it's too expensive. Take a look at your problem patient population and stock the stuff that will give you the biggest bang for your bucks and let the rest go. Some ugly antibody IDs and most warm autos get sent out here (but honestly, that really doesn't make me too sad - I have lots of other things to do). Sometimes, not often, patients will be transferred because we don't have blood on hand that will work for them - negative for 4 or 5 antigens, Sickle Dex neg, whatever. It's reality. Good communication with the physicians is key to the best patient care under these circumstances.

Your MLTs and generalists will do fine. The majority of the patient work done in a Blood Bank is uneventful. As long as everyone is well trained and follows the rules, they'll function very well. They'll handle straightforward antibodies with little or no guidance. To deal with unusual things, they'll need a little support in the form of continued learning/refreshers and your phone number for middle of the night hand holding.The 'fun' antibodies will be your babies or if you're not there, they'll send them to the reference lab - and don't allow yourself to stress about the one you could have taken care of, if only you had been there. Once a 'fun' patient has been deciphered, you can hand the workup off for future visits to one of your generalists or MLTs with instructions (and supervision) on how to procede. If they have the support of knowing what they need to do, what they should expect to see and when they should call for help, they'll be be able to deal with all kinds of problems. Use those patients for teaching - just like you've probably always done. You'll find that you a have an MLT or generalist MT (several, if you're lucky) who will have an interest in Blood Bank, or at least be willing to learn new things. Take advantage of that and teach them as much as they can hold - then you'll have someone you know you can trust to tackle problem patients when you are not there and who will know when it's time to send it out because they are in over their head.

Take home message........you've been doing it all already, just in a different place on a different scale. Some things will be a little inconvenient (blood supply), but you'll adapt and make it work. Some things will be more stressful sometimes (blood supply), but you'll adapt. Look for creative ways to work with what you've got. Your experience other places probably means you can bring in some great ideas - but not too much at once. Remember, too, that the doctors and nurses working where you work have been told before that they are going to be waiting for the blood to come in or the reference lab to call. Doesn't mean that they won't worry and call you lots, but they've been there before.

Think of it this way, if you have wait for blood to come in from an hour or more away, that just gives the nurse time to call you 6 times instead of 2 - what's a little extra stress to a lab rat!

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Right, that is what I have found with MLTs! I think that having trained in California during an era where ASCP alone was not acceptable for employment; one had to be California licenses, leaves us with what we would describe as "higher standards." However, that did not prove to be true (and I won't even go into that). While they have dropped Calif. licensure, they are still not quick to make the leap to MLTs (and I will admit, I was one of those people).

But as with you, I too have seen MLTs here who know more Blood Banking that some of the ASCP/ California Licensed Techs I worked with for so many years.

Thanks for your input.

Brenda Hutson

McCord hit the bullseye- life in the rural hospital is def an adjustment if moving from a large facility!

Also in regards to the MLTs- don't count them out! I've worked with many MLTs as generalists and they are completely capable of doing things as most MTs (in fact- I've worked with some MLTs that were more competent than some MTs.... :S) It actually frustrates me when people assume that MLTs are only good for things such as spec processing etc- There are so many hospitals out there (especially the rural ones) that would not be able to survive if it weren't for the fact that MLTs can work in the same capacity as MTs.

Enjoy the East Coast!

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Ha...I am very nervous about that actually! :eek: There is a sign on my way to work to Watch for Moose! And add a snowstorm or freezing rain to that, and it is enough to send a Californian packing (not really; just in my head).

Brenda

Best piece of advise I've ever read (and we don't even have them in the UK)!!!!!!!!!!!!!!!!!!!!!!!

:haha::haha::haha::haha::haha:

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Thanks, I feel so much better now! :rolleyes:

Brenda

Best piece of advise I've ever read (and we don't even have them in the UK)!!!!!!!!!!!!!!!!!!!!!!!

:haha::haha::haha::haha::haha:[/quote

It's actually quite a serious matter. There are about 1,000 moose/car collisions a year in Maine. The trouble with moose is their size. You hit a deer, it bounces off your car bumper. Moose are tall enough that when you hit them, you knock their legs out from under them, then you have a 500-700 kg animal very rapidly coming in through your windshield into your lap.

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Thanks for the advice! I am still learning!

Brenda

I too have spent my 30+ years working in more rural areas 2-5 hours from my blood supplier--one in Idaho and now in Oregon. I have been at the "big" rural hospitals (100-300 beds) in areas with smaller ones (15-45 beds) and often served as the "depot" or "overstocked" hospital. Plts are our nemesis! Totally unpredictable usage but absolutely must have them and a ridiculous shelf life. If I can be of help I'd be happy to. So far the folks above have covered things quite well...including the moose vs car warning which I have heard from northern parts of this half of the country also.

I have started to use the following for disaster planning: how fast can your patients bleed and how long till you can ship them out or get more blood? We have a remote little hospital in Central Oregon that keeps way more blood than the AABB formula says they should. They deliver babies and are on a fairly main highway at least 3 hours from any hospital of any size. I say they need to keep enough type O blood to save the life of one bleeding patient until help can get there (in the winter). At my 261 bed hospital, I think I need to be able to save 2 type O patients until I can get more blood, first from the small surrounding hospitals, then from our supplier. Our blood supplier is 3+ hours away over a mountain pass but we do have a medical helicopter and a plane for moving patients faster.

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You guys are making me more afraid of the Moose than all of the Blood Bank Issues I posed in the Thread!:tongue:

Brenda

Years ago I interviewed and was offered a job at the Blood Bank of Alaska. During the interview they told me of a case from the night before where a woman hit a moose with her pickup truck. Her most serious injury was from the moose biting her shoulder when it's head came through the windshield. I often think back that I should have accepted that job but there was no way I could get my wife to move to Alaska in January!

:cries:

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I could have done without "that" story! As an animal lover, that makes me very sad to hear.

Brenda

It's very rare to see moose in southern new England. We had one wander into Rhode Island several years ago. Despite the state's history as a haven for the oppressed, the moose was deemed a undesirable intruder and shot with a tranquilizer dart. The game wardens could not lift up the comatose moose, so they got a front loader to do the job. They snapped off an antler in the process, the moose went into shock and died. Word of this gentle welcome must have spread in the northwoods moose community as we haven't seen any since.

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Brenda, in Maine they just admire the moose, not kill them like in RI. (One wonders why they just didn't leave it alone. I'm sure it would have wandered back eventually from whence it came.) And it all goes back to my original bit of advice: always brake for moose (hey, I brake for chipmunks!) Good luck with the lab and with the wildlife - Phil

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