Eoin

Liz, We have Neoteric BloodTrack installed. Even emergency O Negs are traced to a patient. All they need is a barcoded (2D) armband. PDAs are used (User ID Scanned, Blood Unit No Scanned and then patient armband 2d barcoded) as soon as the blood is spiked and hung. Alerts come up on the manager system (monitored in lab, my office and Haemovigilance Office), so we know they are gone). Wireless comms picks up the PDA signal constantly and all info keeps coming down. All sorts of other alerts come up as well (outside 30 min removal from Issue Fridge rule). This would also give a warning to them on the PDA and would tell them not to use it. These alerts are customisable (quite a variety) as is how you set up the system to be used in the clinical setting. All packs come back to a special fridge where they are held for 48 hours as well, so we can follow unused packs there too. I did a FMEA Risk analysis on the whole process, and we have reduced risk by over 60% since its introduction. The Haemovigilance Officer keeps an eye on all vitals (incl times) and feeds back non-conformances immediately to clinical users in form of an educational letter pointing out the problem in their practice. This has seen N/Cs fall dramatically as well. Fairly well received on wards & departments, and we love it. Cheers Eoin

Hi Guys, Knew they were coming (we are Joint Commission International Accredited). We capture most of these either at audit or as direct Performance Measures now, but a tighter framework obviously. Taken me best part of a day to read , copy codes etc and inwardly absorb - ah well, we all like extra work - don't we. We will look back and laugh one day (I think the day I retire). However on the bright side, more positive side, we have been using the measures for a couple of years now, and practice has definitely improved. We have a Failure Mode Effect Analysis to prove that risk has fallen (incorporated with a full blood tracking system within the hospital). Cheers Eoin

Just gotta love that. We had similar in Oz where sister used the others insurance for op. Had us stumped for a while when the other one came in with different Rh(D). Eventually told us the truth. Cheers Eoin

Yeah, Had wondered about that Liz - Was in my "Gunnado" list. So thanks again, and works great Cliff Cheers Eoin

Hi SSA, You will absolutely need to change the mean, as I presume it is a new Lot No of the controls you are talking about. For a given test, the SD should be about the same as previously, as it is the accuracy and precision of the chemistry that determines this - I am not saying not to change it mind you. However if you have calibrated nore frequently than you normally would, you may get tighter SDs than you have been getting and if you tighted them, you may be setting up your controls to fail more often. Remember, the SDs may be the same, but if you have to enter "ranges"as we have, they will need to be changed. Good luck with it. Cheers Eoin

Welcome. Even us old timers still learn from it (isn't that so Malcolm?). Cheers Eoin

Look forward to it Liz Cheers Eoin On the lighter side of this thread - new surgeon on receiving blood on a trauma patient rang me and said he wanted "whole blood - not packed red cells because his patient was not bleeding packed red cells" (we had changed over about a year previously to this - many years ago) and lost the head when I laughed (I thought he was being funny). A call to the Senior anaesthetist who spoke to him of the benefits of managing a patient with PRBC, FFP, platelets etc cooled things down. He never did like the Aussie sense of humour, but we eventually became good friends. Cheers Eoin.

Interesting wording Mabel. I have had two experiences of taking children before court in Australia where they are made a ward, but the wardship was specifically related to transfusion of blood or blood products only. Interestingly enough, the relief of one of the cases parents was palpable when the matter was taken out of their hands. Another interesting case here in Ireland in the last couple of years - A Jehovah Witness agreed to a transfusion, but changed her mind at the penultimate moment. The doctors determined she was no longer capable of rational decision due to her condition and went ahead and transfused. The patient took the hospital and the doctors to court. The case came up recently and the decision to transfuse was upheld by the courts. For adults we have a specific refusal of consent for transfusion for adults, but it doesn't go into a lot of detail about products etc. Maybe we need to look again at the issue. I will take it to the next Hospital Transfusion Committee meeting. Cheers Eoin

Sorry Melissa, I have to agree with Likewine99. We too have a general scientists office / meeting / lunch room with a cooler in it, located adjacent to the labs. I too have noted scientists with coats on having a drink / sit down chat or breather(Not with gloves mind you, and I know they wash their hands as they leave the general lab area). I would not like to make a more accessible "clean area" for a quick drink. Long experience tells me it would not be clean for long. Good luck with an area close enough to be of use, but to make scientists to change coats (or divest themselves of laboratory coat). Cheers Eoin

Oh yes, sorry we do blood cultures on the patient as well. Cheers Eoin

Hi Brenda, Don't you just hate it when regulations don't cover enough for good practice. We came up against just this some time ago. Since then we have a very active Hospital Transfusion Committee (HTC) (Lead by Consultant Haematologist with specialty in Transfusion, DON, Best Practice Manager, Nurse Practice co-ordinator, Nursing representative, Haemovigilance Officer, Anaesthetist, Consultant Physician, Surgeon, Lab Manager, Chief in Transfusion, and me - Quality Manager). We set our own guidelines and they are at 15mins (we recommend they do not leave during this time), and each hour after start time of the transfusion. We follow with BloodTrack Manager (they use BloodTrack Tx on the wards) and we send letters to nurses who fall outside these times by any significant margin (non-punitive but as swift follow-on for re-training purposes). Nursing practice does improve with this method. Anything not done though will generate a full non-conformance. The great key is working hard at getting a good team on the committee. Look for your champions in the hospital The key is the HTC. The regs may not be there, but is no excuse for sloppy practice I feel. Good Luck with it. Cheers Eoin

Have worked in all size labs - I agree small labs pose a problem (I am now back in a small lab). We have a quick review by another member of staff from another dept coming in before crossmatch is released to check all work (countersigned). For Group & holds, they also do check group from primary sample (as above) and check work as well & sign off on it all. They will run a quick eye over the daily and new batch QC at the same time - very quick and works OK. On call- reviewed by scientist performing a separate group separated in space and time from the original sample and rechecking work and paperwork. The work is reviewed by another scientist when normal shifts resume. Another useful rule is that any reaction workup must be performed by scientist other than one who originally performed the crossmatch. Cheers Eoin

Hi Heather, We culture unit (no gram) by sampling (aseptic technique into unused port) & then transferring into culture bottles. We use >1.5C rise, with or without appropriate symptoms. There have been papers re contamination during this process, so worth looking for & considering (don't have a reference to hand). Important to consider - because the question arises was it a contaminant entering the patient from contaminated unit - or was it introduced during the testing of the unit? The good news is that we have had a low hit rate for positive cultures, but they do obviously occur. There is also a need to consider patient's underlying co-morbid conditions. Good luck with it. Cheers Eoin

Hi Shadya, We use the POCH 100i (Known as the POCHI). It is also a Sysmex analyser. We use it as a back-up analyser to the bigger sysmex XE-2100. Correlation is excellent. It is robust and very reliable. Reagents are i a single Pack, but not knowing your workload, it may be expensive on reagent packs if used for a high volume. We run controls through it daily, EQAs when they come in and only if the XE is down for service etc otherwise, and it works fine every time. Cheers Eoin

This is not a commercial plug, but we use Ortho QC7, which will control your ABO&Rh typing sera or gel cards and has three antibody sera as well (Usually an Anti-D, An anti- Kell (or Duffy) and one negative). I am sure there are other products similar on the market. Cheers Eoin

We have a floder for each piece of equipment. Additionally they have stickers on them stating when validated and when next routine service and thus validation following this is due. Additionally, we have a wall calendar with due dates for what equipment listed, so staff can see at a glance when it is coming up. We set this in collaboration with suppliers / testing companies at the beginning of each year and have a contract for all that stating dates specifically. A big job each Dec / Jan, but well worth the effort as all is coordinated. Cheers Eoin

Hi Bev, We list under suppliers first, then name as per the reagent insert, including supplier codes. This list of essential reagents is required under ISO:15189 and Joint Commission have also looked for it. Also we make sure that there is an MSDS sheet for it in the MSDS Folder. Cheers Eoin

Kathy, Congratulations. With your background I am sure you will not have too much trouble. After 40 years in BB (although in semi-retirement in Ireland, I have moved to Quality Management - yes Malcolm, I am probably older than you), I see the same old chesnuts arising, so there shouldn't be any nasty surprises for you. From the regulatory side of things - I tell students - your Quality Manual should reflect what you do in response to the regulations; your SOPs should define this exactly; and lastly ensure that what is happening in the lab is what you say you do in these documents. Good luck with it. Cheers Eoin

We have used gel for years and have encountered similar problems to all above. Despite that I am an advocate for their use. Far less messy - also very good (no - make that great) when you get called by junior scientist with a problem (particularly in middle of night) - because the cards are still available and able to be read by you. That doesn't mean you won't want to repeat testing for yourself - but a lot of basic groundwork will often not have to be repeated. For all that, we will never get away from tubes for some testing. We also use tubes for check grouping. By the way, we got a non-conformance for describing our testing method as Gel in our Scope of Accreditation - it is actually column agglutination technique (CAT) - so our scope is now corrected, but we all still call it Gel. Cheers Eoin

We use Neoteric BloodTrack with Virtual Kiosk attached to remote issue fridge. Needs training and competency signoff for all staff on operating. The benefit is instant tracking of who is doing what. Expensive - but cut down a lot on non-conformances around issuing. Cheers Eoin

Its attached - just after my name - work away. Cheers Eoin

Wrote a big long reply Brenda, but it disappeared when I previewed it :mad:. Just look at the attached form & you will get the gist of it. If you want more details, just let me know Cheers Eoin BB101F.doc

Reports on the SHOT website in the UK will be handy (www.shotuk.org ). Have a look at their annual reports. Here in Ireland, you can access annual reports of the National Haemovigilance Office through the Irish Blood Transfusion Service website direct link to the publications is http://www.giveblood.ie/Clinical_Services/Haemovigilance/Publications/. Obviously if you are looking at a specialised population (i.e. Cancer Patients) in particular, that may skew expected rates. Keep in mind that there is more reporting over this side of the big pond because of legislation making such reporting mandatory. You would also have to take in to account rules for reporting, as a lot of minor reactions are not reportable (mild allergic springs to mind). If you are dealing with advanced stage cancer patients, a lot may have pyrexia going on underneath related to their disease, not the transfusion. The variables are endless (types of product etc). I haven't seen any comprehensive study on a large population, but would be very interested if you do come across any. Good luck with it. I think they are asking a question about which they have little or no knowledge - evidenced by just asking the question anyway. Cheers Eoin

Hi, There are commercial metrology companies that are ISO accredited for this purpose. If you are using your own thermometer to measure temperature of blood fridges, or any other equipment, you will need to have the thermometer calibrated annually. Also you will should calculate the "Uncertainty of Measurement" and include that in your validation of any equipment you are testing with it. Cheers Eoin

Hi Sue, I agree - temp is much better than time rules - BUT it would have to be Controlled temp - measuring it on return, whilst a good idea may fall short of the mark, but would love to see your validation for measuring temp inside the bag - do you use indicators? If not - scenario - blood is left in sunlight for 20 mins - nurse says $^"!£ slap that bag into a fridge quick while we sort out this patient's IV line - can't be sorted easily - may need a central line - blood sent back to lab later with temp nice and cool - but what has it been up to in the interim? I still feel this is one we can sort out and would love to see lots of ideas on this. Cheers Eoin