Eoin

I agree Deny. We use 1.5 degrees Centigrade) rise. Our policy is to turn off, seek clinician direction and recommence if directed (often with some paracetamol), or cease if they are unhappy to continue. They are weighing up advantages / disadvantages for that particular patient (or they should be!) A lot of oncology and haematology patients would never get blood into them if strictly applied. I often follow-up on what would appear to be needlessly ceased trasfusions, but at the end of the day if they are good nurses, I trust their instinct. They know the patients better than I do in the Quality Office. Always better half a bag of blood lost, than a missed transfusion reaction. Additionally we are probably the last group in clinical labs doing good old fashioned experiments when we perform compatibility testing (I heard of a doctor, who went on to become a Haematology Consultant mixing donor whole blood and recipient whole blood in a saucer (emergency in the Oz outback). If it goes lumpy, don't transfuse. It is not an exact science and probably will continue the same for some time, despite moleculomics. Cheers Eoin

Hello Folks, The return limit is 30 mins here too. In fact, the BloodTrack system will not grant them access to return after 30 mins, and it would not allow it to be taken again, even if they knew how to bypass the electronic lock. So our nursing policy clearly states that there must be a patent IV line, and if the patient is pyrexic, they must ask consultant advice before they come to collect blood. The thirty minute rule is intriguing - I have a feeling that it may even go back to issue of whole blood in bottles (sorry guys, I am ancient) and rise in temp, and I agree it is because of the possibility of repeated issue if returned and increase in bacterial growth with accumulated time at room temp. It would be a good project / paper for someone to perform some experiments on blood (different bags, different volumes, different ambient temp etc) - maybe when I retire and have the time. Cheers Eoin

Our Transfusion Committee, Consultant Haematologist who is the Chair, Laboratory Services Manager, Chief BB Lab, Haemovigilance Officer, Quality Manager LAB, Best Practice Manager Hospital, DON, Nurse Practice Manager, Nursing Rep, Anaesthetist, Physician, Surgeon (these medical rotate a bit). I would check with your regulators re make-up. It is one of the things that they look at when they audit. Sounds like yours is top heavy and not representative of the Transfusion Service as a whole. Cheers Eoin

Ah yes - The God syndrome is decreasing now though - not nearly as prevalent as years ago. We have a dignity clause in our quality statement for the hosp, and they are not immune from that. They have been reported, but it doesn't help with cooperation into the future I have found. For you oldies I remember when we changed from whole blood (in bottles) to packed cells and a trauma specialist wanted 20 units of whole blood. I told him we could only supply packed cells and he screamed at me that the patient was bleeding whole blood not f))& packed cells. I got the chief of anaesthesia to tell him the benefits of controlling bleeding with products - never heard from him again. Never apologised either. Cheers Eoin

Wow, I am coming over there. Here we have a full validation protocol to follow (IQ,OQ,PQ) - electrical safety certs, calibration certs, mapping unloaded and loaded, hook up temp recorder, then validate that. Takes about 1-2 weeks usually. Then have to write up an executive summary, with all participating signing off & then goes into active service. Cheers Eoin

Hi Folks, Firstly we have a "Blood Transfusion Information Leaflet" spelling out risks, benefits and encouraging patients to ask questions when the physician (ideally, consultant - often Junior Doctors) come to consent them. By law, consent is required before transfusion can take place ( signed off on the Prescription and Transfusion Document and checked & countersigned by Nurse managing the transfusion). In addition to the consent form, we also have a "Declaration against Transfusion" form for use with Jehovah Witness and others who specifically do not want to have a trasfusion. Surgical consent also has a place for indication that transfusion may be required, and consultant will tick this if necessary. The big thing through it all is"INFORMED" consent. Obviously I agree with all before me in saying that it is the patient who gives consent, after infformation by leaflet and conversation with the consultant of the pros and cons. Cheers Eoin PS Obviously, this works well for planned planned transfusion of the patient with full faculties - different in the emergency situation.

We use BloodTrack - so transporter (trained porter, nurse aide, or nurse) must have their barcoded ID scanned, and we have the Compatibility Report barcoded, which they must scan at the issue fridge and BloodTrack Kiosk. Without these (and them being valid or if there is no blood for that patient) the Issue Fridge Electronic Lock will not open. Also we get an audible and visual alert on the system (opened always in BBank Lab and in Quality Office) that someone is using the kiosk in error. Their identity will be known if they have scanned their ID barcode. Closed lots of non-conformances for us when we installed it three years ago. Cheers Eoin

As we learn more and more about the human genome, old theories sometimes go out the window. I agree, this is what makes BB so fascinating. Just for info - I read recently that with the number of amino acid substitutions, additions or deletions in smokers v/s never smoked, some clever person has worked out that every cigarette is responsible for 70,000 of the above changes. - Nearly put me off my after dinner cigar! Is it "The more we know - the less we know". Cheers Eoin

We use the Immucor control cells - They provide Positive only - but like David, we use a patient with no histroy or symptoms as a negative (usually someone in for elective surgery group, screen & hold). Cheers Eoin

Some gels do miss D (VI), but we confirm with two different monoclonals as well. What were called Du in past, newer anti-ds (particularly monoclonals and gel system) will type as D positive, albeit a weaker reaction. Cheers Eoin

We produce an armband when a crossmatch is requested to go up with the compatibility report (which is also coded with Patient Record Number). We have in place the Neoteric BloodTrack Manager combined with BloodTrack Tx (you will find description on web). Currently as a legacy we also use the Typenex system (useful for emergency crossmatches) on all patients, but would like to get rid of them as they are now not required with full use of the BloodTrack system. The BloodTrack Tx system briefly - nurse uses a real time wireless PDA - scans her ID, scans the patient's crossmatch armband, and scans the unit (when prompted) and gets a good to go or an error if wrong patient or unit. (Mind you, unit should be right, as they use the barcode on the compatibility report to get blood out of issue fridge using BloodTrack Courier system- will not unlock the fridge unless there is a useable unit for the patient. - Won't let them take units that may have been returned if out of controlled refrigeration for more than a half hour also {a bonus}). They also enter patient vital obs, which they can print off at the time of recordings for the patient transfusion management document. This also goes real time to the BloodTrack Manager. If there is an error made - the BloodTrack Manager will sent a visible and audible alert to anyone logged on to the system (usually always in Bloodbank and Quality Manager's PC and Haemovigilance Officer's PC.) The number of non-conformances has dropped dramatically since introduction of the system. As always, the software has some limitations - but as we all know none are perfect. Cheers Eoin

We are the same as David Salkin - an excerpt from our SOP follows - 20.0 Transfer of a patient with blood units and/or blood transfusion in progress to another hospital 20.1 Contact BSH Medical Scientist for direction at Ext 581/583 or out-of-hours on PHONE NO. 087 7749674 20.2 If possible transfusion will be completed prior to transfer 20.3 Patients requiring urgent transfusion during transfer will have this recorded in their medical notes by the Doctor 20.4 Patients with a blood transfusion in progress will be accompanied by a nurse who will monitor the patient as per Point 11 20.5 The BSHG nurse will ensure that transfusion documentation is recorded and retained/returned for BSHG records, which will include:- § BSHG Traceability Label, BB101 C § BSHG Compatibility Label, BB101 B § Compatibility Report Form, BB101 E § The Prescription/Transfusion Record BB102. § IT IS IMPERATIVE THAT THESE RECORDS ARE RETURNED TO BSHG FOR TRACEABILITY PURPOSES 20.6 The nurse will convey transfusion information to a member of staff at the receiving facility and record same in the BSHG nursing notes 20.7 Extra units will be sent with the patient in transit only if specifically directed by the doctor in charge of the patient. Again Like David, we have never had a problem. Cheers, Eoin

Thanks for the "warm" offer Phil. Moved to a 4WD jeep this year, so snow ca=hains & thermal underwear next season perhaps. Had heard that the Gulf Stream is slowing. Maybe a mini-ice-age is starting. We better take a leaf from the Danes. They rarely have problems with their airports. Happy Christmas to all & talk again in 2011. Cheers Eoin

Ditto re Seasons Greetings. We are crippled with snow and ice at the moment. The country is just not equipped for this rare event. We store paper (& electronic) records off-site. The company is audited every two years and must comply with an ISO acreditation. We also check urgent re-call response time once a year. We keep records of what are kept in the off-site boxes(which are barcoded for ease of use). Cheers Eoin

Hi khalidm3, There are already forums on this site where you will get information re this matter, with information on a number of systems. We use a REES Centron monitoring system. It is very relaible, and can work through wireless networks, or connect into an intranet for data transmission. It can be programmed in numerous ways to suit yourself. It will telephone when it goes outside set parameters, and you can check the status over the phone as well. We have the notification set to ring at main laboratory desk first, then the on-call mobile, and if after two tries it for some reason it does not get answered, it will contact the hospital switchboard, who will alert staff that there is a problem. For out of range events, you can free text in actions taken to correct. One major bugbear we find is that the transmitters are battery powered, and so if the (small) batteries run out of power, it will alarm and then requires follow-up (often at night). It will close any compliance problems you have. Good luck with it. Cheers Eoin

Funny that Malcolm, My wife was not impressed either when I told her she was in as such. Even my mobile knows well -she is also under P-Mobile in the phone, but always comes up as I.C.E. Is that Freudian or what! Liked the ICEDOT on the website too. Would do well in any country I would think. Cheers Eoin

Hi Marine, Very Interested in this if it goes global. It would end up one mother of a database mind you. The idea is great. I personally have a bracelet for warfarin, and have my wife listed as ICE in the mobile, but I like the idea for bloodbank problems too. Are you involved with this company? I would be interested in communicating with them re the global idea. There would need to be control as to who put what on the registry. Contact number for the hospital BB where the issue arose might be an option. Data Privacy issues also would need to be overcome, but I still like the idea - for all sorts of medical problems. Cheers Eoin

If you have an upgrade of any part, I would advise full recheck, particularly any critical risk areas. We were caught many years ago by just checking the upgraded area, but the upgrade had affected another rule based response and luckily we had an experienced worker on who used her knowledge and over-ruled the warning that had flashed up. Can't remember the details of the scenario now, but remember that when we contacted the IT company, they told us it couldn't happen as they had not touched that part of the program - very apologetic when they came on site and we demonstrated the wrong warning coming up. It is a pain in the butt, BUT if you have inexperienced workers on-call they could be caught out, so well worth going the extra mile. Cheers Eoin

Madame du Châtelet I believe - only one of Voltaires many lovers - but probably his favourite. They could converse re esoterical matters of interest of common interest to both of them in their quiet moments. Oh La La Eoin

I would add a vote for that book too folks. Cheers Eoin

Quite right Lisa M. Sir (Frank) Macfarlane Burnet Macfarlane was a brilliant Australian virologist and immunologist best known for his contributions to immunology. Burnet won the Nobel Prize for Medicine or Physiology in 1960 “for discovery of acquired immunological toleranceâ€. He was a pioneer in the application of ecological principles to viral diseases and proposed two concepts in immunology-acquired immunological tolerance and the clone selection theory of antibody production, which explains how lymphocytes target antigens for destruction. His research on immune tolerance provided the experimental basis for developing methods of transplanting solid organs. Another of his contempories was Gus (Gustav) Nossel. Cheers Eoin

Malcolm Malcolm - hitting below the belt - Rugby - there's always the World Cup next year Malcolm - & be fair - we are rebuilding. And strangely after Adelaide I don't want to talk about the cricket. Cheers Eoin PS Offline till next Mon - will post answer unless someone gets it and sorry Max Bryn is not the answer.

Hi Folks, We have a big orthopaedic load and use pre-op clinics extensively. We use typenex system and will collect 30 days prior(given the caveats of not pregnant, no history of antibodies, not transfused within last three months). Plasma is aliquoted before testing and then stored at -30oC. We saw the typenex band as a high risk area, and now use the attached form which patient signs at time of collection and then patient must identify their signature to the admitting nurse on the ward (as well as the positive identity check on name & DOB). This TCI (for To Come In) Form and Typenex and Group, Screen & Hold result are held in BB lab until admission). Reglators were happy we had risk assessed the process, and closed what we saw as a high risk area. We had tried applying band, but compliance with keeping it on was poor and level of illegibility on admission was high. We have not identified any non-conforming events in the five years we have been operating this system. Cheers Eoin[ATTACH]437[/ATTACH] BB101F.doc

Who was this Scientist ? OK here's one. Aussies are not to reply. His research on immune tolerance provided the experimental basis for developing methods of transplanting solid organs. Cheers Eoin

Hi Guys, Nice logical thought process Brenda - well worth a second read as Malcolm says. Just a thought - have you tried enzyme treating a set of panel cells & then running coombs? - I remember running this in years past and it solved the problem - unfortunately I can't remember the antibody - old timers disease I think - or the cold is infiltrating the grey matter. Cheers Eoin