Eoin

Hi All, Agenda from (Quarterly) HTC (last week in fact) follows Agenda Minutes of previous meeting and matters arisingBlood Bank Stats Haemovigilance Report – SAEs, SARs, Blood Stats, etcQuality Manager Reports – Non Conformances C/T TATUsage & WastageQMS mattersNight-time Transfusion Practice AuditCell Salvage Activity / Audit FindingsBiovigilance SOPs, incl MSBOS new Version approvalAOB Cheers Eoin

I agree with Dr Pepper - not only where the glass is, but having trouble with the math on how many! Good Luck to you Malcolm. Unfortunately BBTS clashed with a meeting here in Ireland and I missed it - first year in a while - otherwise, we could have shared some more. Cheers Eoin

When we search for >100yrs & check against death register, even if pulling them out of the live register, we keep in a Deceased Abs file - purely for statistical purposes - could be a paper in it some time. Cheers Eoin

We also are under Joint Commission and Ireland's own AML:BB regulations (from Eu Directives) and this would DEFINITELY not be allowed. They can halt a transfusion until medical examination - if say just a mid allergic reaction, drugs can be administered and the transfusion re-started. Bloodbank or on-call scientist must be informed, but if the unit came down it would not be released back up to the ward. Sounds like you need a strong medical director of transfusion services (mandatory here) and they would put a halt to stuff like satff being afraid of consultants etc. Cheers Eoin

We are lucky with BloodTrack. They must do vitals just before hanging & record them in BloodTrack (via handheld PDAs). If you leave it to nurses judgement - that might be fine on a stable patient, but as Mabel says - How long before?? So I'm afraid we insist on the above. That of course does not stop them putting in pre-recorded vitals, but has not been detected in any visual audits by our Haemovigilance team and would generate a non-conformance if we saw it. I have done a few spot checks on patient's chart & values into BloodTrack to see if this happens, but negative - so far anyway! Cheers Eoin

Same as Dankset. First void collected and kept - examined for haemoglobinuria & bilirubinuria only if other work-up is positive. Would be looking at Haptoglobins then as well. Cheers Eoin

OH YES, Oh YES Just how come they are missing or busy when competency check time comes round????? Cheers Eoin

On a bad day you might ask - "what is the point of it all?" - " " " " " " also " - "If I don't work, can I eat freash air?" Ah point me to the retirement home! You (et.al.) will probably respond - "Ditto, Ditto etc,". Gives the regulators something to find and something for us to argue with them about and use up time where they might find something that really mattered. Mind you, I like neat forms, worksheets - but repetition sometimes becomes senseless & allows points of entry for errors. Cheers Eoin

We have remote Issue fridges. But we have BloodTrack (Neoteric) and as above, pisk-up slip needs to be scanned & fridge only unlocks if there is blood available for the patient. Not cheap, but they have removed a Lab - and it can't be replaced by fresh air. Risk assess any process you have (FMEA is good) & put in systems to mitigate that risk. There are plenty of remote monitoring systems for fridges / freezers as well, with notifying call to landlines, cell phones, pagers etc if there is an out of range temp. Good Luck Eoin

The pattern showed a Jka pattern so I would also enzyme treat panel & then perform IAT with patient's serum. - Helps. A lot of work - but I might have been empted to phenotype for common antigens of patient's original sample (admittedly @ day 10, they may have deteriorated somewhat) when a problem emerged and also transfused units. ?????? But isn't hindsight a wonderful thing! Cheers Eoin "Serving others is the rent we pay for our place on earth"

Not in a trauma centre anymore - but back in Oz - we thought like David - gave them as much blood, platelets plasma etc as they needed as quickly as we could (pre-pepared tags & paperwork [minimal]. Do the work-up where and when - and for anything that could have a "tricky" side to it, we brainstormed what we called "What happens when the fit hits the shan?" - so if we did strike any reactions, during Tx or delayed, documentation issues, Patient ID issues et. al., we had Plans A, B, C etc. It was very helpful & with experienced techs didn't take long to map out. Was used a couple of times as I recall. Cheers Eoin

What happened to National Patient Antibody Register (NPAR) in the USA? I was jealous when I read about it. Did it die an unnatural death> Years ago in Oz, we had the Aust Red Cross with an antibody register, but I don't think that all Abs were reported to it. Lots of people have been pushing for it here in Ireland, Pushing hard - but nobody (with the money control) moving. Let's just have a few more DHTRs due to Fya!!! Cheers Eoin

Pre-Transfusion Vitals, 15 mins, hourly till completion and at completion (inside 4 hrs from start). We have BloodTrack, so they cannot shortcut - all is revealed. Our Haemovigilance Officer monitors compliance, advises, retrains and re-applies competency testing as required. We also tell them that the first 15 min is vital - not to leave the bedside. Cheers Eoin

Ah yes, but Ireland won the Six Nations ! Cheers Wayne Eoin

There seems to be two threads on this forum. - SO What I am interested in is targets for C/T ratios. I guess this woulkd be for three or more populations - medical where it should be close to a C/T of 1.0, surgical {where more leeway, especially neuro and spinal surgery would be expected} and trauma. I am interested in BBs not using electronic issue, but crossing and holding units. I did a literature survey and there is a wide disparity in C/T targets, so am interested in your thoughts folks. Cheers Wayne (Eoin).

Jsut returned from a break (watching Oz beat Engl in cricket 5 - zip {Sorry Malcolm}) to see a most interesting discussion. I remember something similar many moons ago in a cancer patient, but can't add specifics. That aside I would be most interested to hear if there is a resolution to this case Laurie. Despite being bad for the patient, this is very interesting to all BBers as who knows when it could crop up in our hospital/s. Cheers Eoin (Wayne E)

I was at the Frontiers in Laboratory Medicine where the report was launched. Great ideas - a small, readable report with recommendations. I think it is very good. Link is http://www.england.nhs.uk/wp-content/uploads/2014/01/path-qa-review.pdf Cheers W Eoin

We don't use benchmarks (Don't personally know of any published) but we do set targets and try to hit them every year (e.g. 5% reduction in pre-analytical non-conformances; C/T Ratio of 1.2, 10% reduction in wasted units etc), but we have set them for ourselves over the years - Continual improvement is what Joint Commission (and other regulators) loke to see, and they like targets. I think that we have our data analysed to death, Pareto Charts - Tracking & trending, but you can definitely see trends and attack them (reminders about specimen & request completion care and talking to repeat offenders, plus targeted education on any errors that become a trend. We also have a matrix with names down one side and error types across the top. - If there is a horizontal line of numbers of errors against a person, you have a problem person and they can come in for special education sessions - similarly if you have a vertical line of errors , you well could have a system (or process) error. Good luck with it anyway. Cheers W Eoin

Hi David, I have in the past seen lymphomas throw out atypically presenting "antibodies or antibod-like" reactions. What I had noted over the many years (pre-gel or enhanced IDC) that the more undifferentiated the lymphoma, the more reactions you are likely to encounter (often reacting at 4 deg C). Away from the questions posed re auto or not - are you considering phenotyping for common antigens (as far as it is possible to still supply phenotypically identical blood) to supply matched blood if available, if the patient is becoming transfusion dependant? Cheers Eoin

Yes, Found a long time ago. I wrote for permission to use some material on transfusion reactions. Nice clear presentations.Education as it should be. Easily understood. Cheers Eoin

Completed

Fresh sample for us on admission. Over the years, I have seen too many patients answer NO to the standard questions and found they have recently been transfused in another hospital "Oh, I though you meant here in this hospital." I have never run a retrospective risk assessment on it though. Might be one for when I am short of work (LOL). Cheers Eoin

Ah ! The pain in the butt issue. Tear your hair out - rant and rave, Occurs everywhere I think. Let's microchip everybody at birth with a unique No. and have readers at Admissions. No seriously, when we find a previous number on checking our database, we contact records/admissions and insist that all records are merged to the new number. This creates a lot of work for them, but the alternative is to correct the records to the old number, which means that we would have to issue new armbands, medical record (hard copy), new sheets of identifier labels etc. When we merge, any with antibodies are automatically updated with the new number in our antibody register. We don't issue Ab Cards, so no issue there. The old Medical Record Number is still searchable and directs to the new number, so traceability is covered. Cheers W Eoin

Transfusion Medicine Transfusion and Apheresis Science (formerly called Transfusion Science) Trasnfusion Medicine Reviews Vox Sanguinis Also American Society of Quality have a monthly newsletter, and on-line articles and may be worth a look. Cheers W Eoin

Hi Kathy, We too have rotation of non-dedicated BBers through the dept. We do have BloodTrack as a good tool for tracking not only the blood, but the actions of our scientists. I have just read a good article in TRAQ on "nudging". I have followed up with other reading (plenty of references in Govt, financial world etc) on the subject. I have for a while been keeping a matrix, with names on the vertical list, error types on the horizontal. I complete this for each month (for those found or reported to me). I then anonymise for all other staff members (keeping just the name of the one you give the matrix to). This is done for all staff and they can easily see if they are outside the norm. This has lead to a kind of competition among staff (so I have been told) and this has "nudged" them into better compliance with requirments. I try to keep them to really important requirments, but will consider expanding to other niggles (like not doing daily QC' on a new batch when old batch is likely to run out on next shift). Bit of work, but I have found it worthwhile. I do the same with minor specimen / form errors (labelling, lack of information etc) from around the hospital - and graph shows a definite reduction in non-compliant requests / specimens after its introduction. Majors go through the CAPA system. Cheers Wayne