sarahk

We are looking at a new HIS/LIS system. My understanding is that transfusion administration systems used by nursing to match units to patients should be FDA approved. The vendor disputed that, saying that they had checked with the FDA and they did not require approval. I find it hard to believe that is true--does anyone have definitive information about any applicable FDA requirements? Thanks!

We've narrowed it down to the vendors/instrument configurations above--any experiences or thoughts on either is appreciated!

I have the misfortune of taking a new job where we use Meditech Magic. Is there a way to change a sample's expiration date (for samples from pre-op patients)? Also, does the expiration have to be calculated in hours? I had previously used Soft, where it could expire on day 3 at midnight rather than 72 hours exactly. We actually work that way and just say OK to all the overrides, but that seems dangerous. Thanks!

In a previous job, the BB supervisor figured out a way to bill unused thawed FFP and platelets back to the ordering floor. That sure stopped a lot of wastage!

Cerner Millenium users, We are having an issue--when a patient is merged (it's the same patient, but different encounters or accounts get merged), Cerner wipes out the historical blood type. This happens even if one encounter has a blood type and one does not. With the increasingly strict requirements about having more than one blood type for transfusion, this is problematic. Has anyone else seen this issue and (more importantly) is there a fix?

Does Helmer make something other than the 8 drawer size freezer? Those seem a little big for our needs. How many FFP does that hold? We have their i Series platelet incubator and love it, so a freezer would be great! Our old Jewett freezer was at least 10 years old when we replaced it with this one and still running fine...it's too bad the new ones aren't as high quality.

Does anyone have any recommendations for a good FFP freezer? The one I have currently (a Jewett BPL Series) is less than 2 years old and dies every 4-5 months because the fans freeze. We store about 80 units of FFP and 40 units of cryo, so we need a nice medium sized freezer. Thanks!

We routinely issue multiple pheresis units to OR for open heart surgeries. I recently found out that the storage boxes that have been in use since before my time were never validated for this purpose, so I am looking for alternatives. We have a consignment relationship with our blood center, so I need to be able to ensure proper storage conditions to be able to send unused units back. How do you handle this in your facilities? Is there something commercially available for this purpose? I am not inclined to put platelet incubators/agitators in the OR because I'm afraid the platelets may "travel" or get lost in the black hole that seems to exist in the OR department.

Bob, I thought about that! I want to bring it up...though I'm a little afraid they'll say yes. It is my understanding that Joint Commission is behind this. Another blood bank supervisor near us has been approached about the same thing. I find it ridiculous--what do pharmacists know about blood bank? There are very few contraindications for Rhogam and blood bank are the ones likely to know about patients who shouldn't get it, not pharmacy. We have dispensed Rhogam for as long as anyone can remember and have a nice computer system that handles inventory and dispensing. We have a simple, straightforward, computerized process that they want to replace with a mess of phone calls, faxes, and paper. Despite the Joint Commission thing, this was mostly precipitated by a billing problem they can't find a way around in a new computer system. I'm concerned about meeting the CAP requirements for keeping track of Rhogam administration if it's not in our hands. We deliver more than 3,000 babies a year, so that's a lot of Rhogam.

Does your facility require that a pharmacist review all Rhogam orders? Our pharmacy is insisting that Rhogam is a medication and that the order must be reviewed by a pharmacist before administration. I'm not at all thrilled with this idea.

For those of you who do cord blood testing in gel cards, do you like it? Have you found more positive DATs? I'm under the assumption that the weak D test can be eliminated--do you have a cut-off where you call Rh positive (i.e. 1+ or less is negative)? Thanks!

Deming was, of course, talking about quality in a manufacturing environment. Whether or not those principles (and six sigma and TPS and kan ban, etc.) are transferable to health care is debatable. Certainly, they cannot be applied exactly as is--they need some tweaking. Quality in an environment like health care cannot be reduced to 14 points. To be truly effective, quality needs to start and be championed by those in the highest levels of an organization. Including one question in a specific department checklist isn't the way to achieve buy-in by hospital administration, especially when the benefits of such a requirement are unproven at best. And because this is truly a multi-disciplinary issue, is it appropriate to address it in only a laboratory inspection? Wouldn't an initiative by Joint Commission be a better way? The reality is that the problem of mistransfusion is primarily a nursing issue. The lab doesn't hang blood. In fact, many laboratories (along with their nursing services) have excellent systems and processes in place to prevent mistransfusion. With this question, CAP says that those systems are not good enough no matter how well they've worked. Makes you wonder who owns stock in the bedside barcoding companies...

I love the idea of a second draw. What do you tell the patient when they ask why they're being stuck again...well, we're not sure we did it right the first time? So sorry to wake you up again and stick you for the 12th time today, but CAP says we have to, despite the multitude of processes we have in place to prevent errors. No the audioconference didn't give any suggestions. They seem really stuck on this whole thing, so I'm not sure how much leeway they'll give. Maybe they'll just fork over the millions of dollars and hours it takes to implement a bedside barcoding system or maybe they'll cough up a few extra phlebotomists so we can meet their requirement.:mad: Ha!

CAP briefly discussed this in their audioconference today. Currently, just a plan of some sort to eventually implement something is required...though I believe that the moderator said that having a system in place would be required in the near future (he said maybe 18 months.) During the question and answer section, one caller asked if CAP had any documentation to prove that a second sample or barcoding was any safer than a separate banding system. The moderator said he "assumed" the transfusion medicine committee did, but did not have any references. I would sure like to see them if they do, but I'm not holding my breath. Our time would be better spend educating and enforcing our current policies, whether it is a separate blood bank banding system or just good ol' stringent patient identification standards. Maybe CAP needs to spend some time in the real world before they legislate impractical regulations that don't address the root cause of the problem. Thanks, I feel better now!

Gel users, what do you do when you get a mixed field reaction in the antibody screen?

Aww, I don't think benchmarking is completely useless! It's just difficult, and as with anything in medicine, an inexact science subject to outliers. At the very least, it would be interesting to see the average usage for open hearts (I may only say that because we tend to use a lot at our facility. Every aspect of medical practice is evaluated and quantified--why leave transfusion medicine out of the fun? It just seems like there needs to be something to compare to--C/T ratios don't tell me much when the surgeon dumps in everything he orders (it's not that unusual for us to give more than 100 products in a day)--is that excessive or ok because he gave everything he ordered? I absolutely agree with your philosophy when it comes to communication with physicians (it seems like the root cause of almost every complaint and error is lack of effective communication), but would like it to be a two way street. It's hard to communicate delays if they won't return your phone calls! You are a brave man for teaching med students and completely correct about their lack of transfusion medicine training. It's our responsibility to be the experts in this field and communicate that knowledge to physicians. Wow, you can keep those antibody patients in Texas! Thanks for sharing an obviously effective method of keeping docs happy (always appreciated!)

If physicians are defensive about the practice of benchmarking, it is probably because they are aware of their tendency to over-order. The one-time inability of the blood bank to find a suitable unit for a patient with five antibodies and get it ready in fifteen minutes is not a reason to consistently over-order. If physicians expect seamless interaction with the lab, we should expect the same (i.e. realistic expectations, appropriate orders, an awareness of what an antibody is, not thinking we should have "known" their patient would need blood when they didn't order any.) Not only is there tremendous variability among surgeons, but even more variability among patients. The same surgeon will use no blood products one day and more than 50 the next. Open heart patients are more high risk than ever, many have multiple stents, and almost all are on medications like Plavix that wreak havoc with their coagulation. Not that benchmarking can't be useful--if some institutions can use relatively little blood for similar patients undergoing similar procedures, why can't everyone? We should be looking at the practices of surgeons who use excessive amounts of blood products. But good luck finding benchmarks--I haven't found any. Please share if you do!