Barriers to understanding

[Kellar]

Humour aside, if the problem is persistent and universal, and situation analysis/education after the fact insufficient to bring about change, perhaps more upfront involvement is necessary.  Different results require different action, otherwise we end up moving in circles.

[Dr. Pepper]

Sorry, couldn't resist that. We have indeed retreated further into the basement lab. We used to draw the morning blood. Then lab-based phlebotomy teams did so. Then RNs. Now barely trained CNAs are doing so. The specimens took a quality hit with each of these steps. I think that the upfront involvement you seek is what you can do yourself and what you are fortunate enough to be able to do within the framework of your particular system. Some things you can do:  We monitor specimen quality and misidentifications and report to the hospital QA people. I work with the nursing education staff who sincerely want to make sure their staff does what it should, and knows the "whys" which makes buyin for the "how-tos" much easier, and in the process complies with CAP and AABB. We have to remind the ever-changing nursing management to get lab input when revising lab-related nursing P+P. Your transfusion committee should be a good forum. In short, it's communication and cooperation between departments, and forging some relationships along the way where docs and nurses realize that we are the experts and, if not seek, at least respect our knowledge and opinion. I think over recent years there has been an increased desire around most institutions to "do the right thing" in all areas of patient care. It may be a bit more indirect than being a physical presence as a member of a transfusion team, but there are still opportunities for the lab to aid in process improvement.

[BankerGirl]

I have heard similar stories many times and am a bit disheartened that the narrative never changes.  Do you think there would be value in having a person from the transfusion service "issued" along with the first units when a mass hemorrhage plan is activated?  I imagine this person acting as a liaison/translator/educator/helping hand/cool head with respect to transfusion.

 

I have actually done this with a MTP and was invited to do so by our Trauma Coordinator.  She gets the implications and always has my back.  The one I went to was a GI bleed in the ED, not in surgery, but it actually went very smoothly.  Of course the folks who ran it were ones who had done it together a few times before and are always very good.  Unfortunately they are both no longer employed here.  I haven't had an opportunity to go on one since because I am usually the tech preparing the products.  So, did I make a difference??  Probably not, because they were proficient to begin with.  Oh well!

[Eoin]

I have heard similar stories many times and am a bit disheartened that the narrative never changes.  Do you think there would be value in having a person from the transfusion service "issued" along with the first units when a mass hemorrhage plan is activated?  I imagine this person acting as a liaison/translator/educator/helping hand/cool head with respect to transfusion.  I can imagine that when things are going badly in OR or Emergency, all the little details that are important for transfusion are NOT priority in the minds of those involved in direct treatment of the patient.  Perhaps the TM service could provide a little assistance. 

 

From a broader perspective, as lab professionals, are we too attached to our labs? Whether it is true or not, we tend to feel that we are undervalued and under appreciated, but at the same time we stay hidden away in the lab making demands that seem like nit picking to those without training in laboratory practices.  I think, traditionally, that pathologists have been the link between lab professionals and primary care providers (i.e. physicians and nurses).  But pathologists can be very busy with their many other duties, is there a place for non-pathologist lab professionals to step in make more direct connections with primary care providers?  

That is a very valid point. We have on one occasion had our haemovigilance nurse liaise with the massive trauma coordinator and things went smoothly. Perhaps training of the episode coordinators as to the importance of getting collections and documentation right first time, every time could be another avenue, but we will put it on our agenda for the next Hospital Transfusion Committee meeting.

 

Thanks for food for thought.

 

Cheers

Eoin

[Auntie-D]

Do you think there would be value in having a person from the transfusion service "issued" along with the first units when a mass hemorrhage plan is activated?  

 

Absolutely wonderful idea but unfortunately not practicable. When there is only one person covering haematology, coag, biochemistry and transfusion, and answering the phone, and doing the job of a lab assistant - that person cannot be released.

 

We do have a policy that if we get a massive haemaorrhage we can call a chemist to assist from our sister hospital (for some reason chemistry needs two staff overnight but haem/transfusion only needs one). Sadly the hospital is a 30 minute drive away so by the time they have arrived the situation is usually pretty much in hand. They are never really that much assistance anyway as they can't report haem/coag samples so there can be urgent results just sat there until the person dealing with the transfusion is available.

 

When asked why they can't assist further, the response for the chemists is they want 'danger money' to do transfusion...

[carolyn swickard]

The best we were able to manage on a recent OB Massive transfusion episode, was that they settled down on only 1 communication person with the Blood Bank so we weren't overwhelmed with calls ("Is it ready yet?!?") as we have been in the past.  The sole tech in Blood Bank (most common staffing level now) was barely able to keep up.  There was no one to spare to go to the event.

 

It went well even though she was Rh neg - they knew enough not to worry about the plts and we were even able to keep her on Rh neg blood so we didn't have to go through that change.  Yes - the pathologist on call did help them some with a few questions and using them in that way needs to be done more frequently than we sometimes think to use them.  The best part of the whole thing was that the senior anthesiologist in the hopsital was called in and he was a ROCK of knowledge and skill.  Two days after the event, he also called for a Review and ran a 2 1/2 hour review of the case that went over everything - everone learned a lot from that.  Staff turnover is one of the hardest things to cope with.  Even though everyone learned a lot from the case and the review - that crew may not be there next time around and the newbies may again, not have a clue.