L106

I'm not sure this is the best way, but when we issue an irradiated blood product (that the physician has ordered), our computer sends a test code to bill for the product and a second test code (CPT 86945) to bill for the irradiation fee. If we happen to have an irradiated product and need to give it to a regular patient (who does not require irradiated products), we do not charge the patient for the irradiation fee. (In this case, the BB/Lab absorbs the ARC irradiation fee.) There have been times when a doc has ordered 2 irradiated plateletphereses for a patient, but we only have one irradiated plt available. If the physician decides he can't wait for us to obtain a another irradiated plt, we will issue the irradiated plt and a regular plt. In this case, we would charge for 2 plateletpheresis products and one irradiation fee.

Congratulations! We have a very active Cancer Center and I've often thought it would lend itself well to what you have done. I hope things go well for your new service.

Grade rxn and note "mf". (Same as Melanie.)

Are you perhaps seeing a minor case of vitiligo (which is not uncommon, often hereditary patchy loss of normal pigmentation)? If so, this has no bearing on an individual's eligibility to donate. Donna

Are you talking about the Rho(D) typing, or are you perhaps referring to Rh phenotyping for the other Rh antigens? Donna

Do you mean training materials and checklists for MTs/CLSs and MLTs/CLTs that are either newly graduated or experienced, but are new to your facility? If so, I'd be glad to send you a copy of our training checklists. (We have one for BB testing procedures and one that covers all of the computer procedures.) Donna

Tony - I don't have a Helmer blood refrigerator, but I have several other devices (Platelet Chamber, Platelet Agitator, Thawing Water Bath, etc.) from Helmer, and I agree with David....They have all been great!! The last several blood refrigerators we purchased from Jewett a few years ago have given us a lot of problems. I will not purchase another Jewett. (Actually, I believe the Jewett products were bought out by a company called Thermo Electron Corporation a year or two ago.) Donna Brandis Ehler

In regard to QC'ing the scale, I did something even cheaper. For our "known weight", I discovered that an old metal stapler weighed exactly 512 grams, so we simply weigh that stapler on our rocker/mixer before collecting the first unit of the day. We decided that 510-514 grams would be our acceptable range (and it's always within this range.)

We collect autologous donor units here at our hospital (usually only 5-10 units per month.) We have had a GENESIS Blood Collection Mixer, Model CM-735, by NHS (National Hospital Specialties, 65 Commerce Way, Hackensack, NJ 07601) for several years. It rocks the unit as it is being collected, it has a scale and LED display that shows you the amount collected throughout the process, it has a timer, and it sounds an alarm if the flowrate in inadequate, etc. We really like it.

We used to have a Cytotherm. We had quite a bit of trouble with it and our BioMed staff were really glad when we retired it. We have had the small Helmer tabletop thawer (that holds 4 units) since 2001 and we really, really like it. I can't recall ever having a problem with it since we have had it. (You do want it near a sink to making draining and cleaning easier.) We have have very good luck with any equipment we have ever purchased from Helmer. All equipment seems very reliable, customer service have been very helpful when I have requested price quotes, they responded promptly when we needed a rush order for a new platelet agitator when we had a "little crisis". I will definitely consider them if we should need to replace our blood refrigerators. (I have become increasingly disappointed in Jewett's products during the last few years. That's such a shame, considering that they were the "gold standard" for so many years.) Donna Brandis Ehler, MT/SBB

Bill is correct. The current CAP Checklist item TRM.30575 has been revised to read as follows: "Does the facility have a plan to implement a system to reduce the risk of mistransfusion for non-emergent red cell transfusions?" They go on in their "Comments" note to describe several examples of various things you can do to achieve this. (Currently, this item is a Phase I deficiency.) Donna Brandis Ehler, MT/SBB

I have a question for adiescast regarding this possible scenario: Let's say the nursing unit requests a unit of blood on Ann Smith, the Blood Bank issues a unit for Ann Smith, and the nurse goes into the wrong room and transfuses the blood to Amy Smith. (Let's assume no fatal harm is done.) Are you saying that this transfusion error does not need to be reported as a BPD?

I know of other institutions that use coolers for blood in Surgery as you do. What problems have you (or anyone else who is reading this) encountered with your system of using coolers? We have four satellite blood refrigerators (in Surgery and Cardiac areas) we now have those personnel pretty well-trained to return unused donor units to Blood Bank at the end of the day. (When they do slip up, I notify the appropriate Director/Supervisor and then things improve for several months.) Has anyone using coolers ever had a problem with the cooler being left in the Surgery suite, then assumed to be for the next patient using the suite? Or maybe the cooler got transported with the wrong patient to ICU or CVU? (I worry about those problems.) Thanks in advance for any comments on your experiences. I'd love to get rid of the satellite refrigerators (but it'll never happen here!!) But on the other hand, I think I'd rather have the continuous temperature recording charts from the refrigerators than the handwritten logs of the cooler temperatures.

bevydawn- Several months ago we were exactly where you describe yourself to be. A combination of: 1) outrageous antisera prices and 2) years of repeating the reference lab's antigen testing and never finding an error, led us to feel comfortable to change our policy and not repeat the antigen typings. As jhaig, DANDERS, and drsbright all mentioned, we perform a full IgG crossmatch for donor units intended for an antibody patient. Once our special typing antisera supply dwindles down, I will give more thought to which antisera we will want to continue to stock. (Fortunately, our Blood Bank computer system can search and report exactly which antigen typings and how many we have done over the last year or two, so that will help us make our decisions.) It sounds like almost everybody is going this route, doesn't it? Small wonder, with the prices now-a-days.

If no history, we retype the same specimen. Our policy is that the retype may be done by a different tech OR by different methodology (ie: automation and tube.) We do not require two people to identify the patient at the time of draw. Donna Brandis Ehler, MT/SBB

I agree with John's response. Our situation is very similar (340 beds, using an Echo with PeG tube back up), and we also went with an automation for Blood Bank strictly because of the "not uncommon trend" of increasing difficulty in procuring staff. I suspect that an Echo would meet your needs nicely for quite some time. We have been "LIVE" on our Echo since September, it handles our volume well, and we have had very few problems. (P.S. Also, it's a breeze to throw an Antibody Identification Panel on the Echo!) I would be happy to respond to any questions anyone might have about our experience with our Echo. Donna Brandis Ehler, MT/SBB

Mark - We have an Echo here at our 340 bed hospital in Central Illinois. I'd be happy to share any information / opinions with you.