ChrisW

We have been using Cerner Millennium Pathnet since 2005 and our amazing Lab Informatics team has set up QC entry for each test in Pathnet with parameters that we defined. Each test group has an established relationship with a QC group. When opening the result entry worksheet, an appropriate QC group for the tests being resulted must be chosen.  If the QC has not been satisfactorily resulted in the established time period, a warning displays and result/interpretation verification can not proceed until QC has been satisfied. This way we are always confident that QC is current for tests being resulted. If computer downtime is expected, we print copies of QC so we know when it has been performed and when it will expire. If unexpected downtime, we perform and record QC as indicated per procedures and enter it into Pathnet during downtime recovery. This process has served us well for the past 12 years and always satisfies AABB, CAP, FDA,  and internal auditors.

We have been using Cerner Millennium Pathnet since 2005 and our amazing Lab Informatics team has set up QC entry for each test in Pathnet with parameters that we defined. Each test group has an established relationship with a QC group. When opening the result entry worksheet, an appropriate QC group for the tests being resulted must be chosen.  If the QC has not been satisfactorily resulted in the established time period, a warning displays and result/interpretation verification can not proceed until QC has been satisfied. This way we are always confident that QC is current for tests being resulted. If computer downtime is expected, we print copies of QC so we know when it has been performed and when it will expire. If unexpected downtime, we perform and record QC as indicated per procedures and enter it into Pathnet during downtime recovery. This process has served us well for the past 12 years and always satisfies AABB, CAP, FDA,  and internal auditors.

We have been using Cerner Millennium Pathnet since 2005 and our amazing Lab Informatics team has set up QC entry for each test in Pathnet with parameters that we defined. Each test group has an established relationship with a QC group. When opening the result entry worksheet, an appropriate QC group for the tests being resulted must be chosen.  If the QC has not been satisfactorily resulted in the established time period, a warning displays and result/interpretation verification can not proceed until QC has been satisfied. This way we are always confident that QC is current for tests being resulted. If computer downtime is expected, we print copies of QC so we know when it has been performed and when it will expire. If unexpected downtime, we perform and record QC as indicated per procedures and enter it into Pathnet during downtime recovery. This process has served us well for the past 12 years and always satisfies AABB, CAP, FDA,  and internal auditors.

We have been using Cerner Millennium Pathnet since 2005 and our amazing Lab Informatics team has set up QC entry for each test in Pathnet with parameters that we defined. Each test group has an established relationship with a QC group. When opening the result entry worksheet, an appropriate QC group for the tests being resulted must be chosen.  If the QC has not been satisfactorily resulted in the established time period, a warning displays and result/interpretation verification can not proceed until QC has been satisfied. This way we are always confident that QC is current for tests being resulted. If computer downtime is expected, we print copies of QC so we know when it has been performed and when it will expire. If unexpected downtime, we perform and record QC as indicated per procedures and enter it into Pathnet during downtime recovery. This process has served us well for the past 12 years and always satisfies AABB, CAP, FDA,  and internal auditors.

We have been using Cerner Millennium Pathnet since 2005 and our amazing Lab Informatics team has set up QC entry for each test in Pathnet with parameters that we defined. Each test group has an established relationship with a QC group. When opening the result entry worksheet, an appropriate QC group for the tests being resulted must be chosen.  If the QC has not been satisfactorily resulted in the established time period, a warning displays and result/interpretation verification can not proceed until QC has been satisfied. This way we are always confident that QC is current for tests being resulted. If computer downtime is expected, we print copies of QC so we know when it has been performed and when it will expire. If unexpected downtime, we perform and record QC as indicated per procedures and enter it into Pathnet during downtime recovery. This process has served us well for the past 12 years and always satisfies AABB, CAP, FDA,  and internal auditors.

1) Do you still use charts? No, we discontinued charts after several months of validation.
2) Do you take daily recording? The system captures temp readings about every 5 minutes, so we do not manually record any temps.
3) If you take manual recording, which readings? Not for any remotely monitored equipment.
4) How do you monitor your CTM? Each quarter we check function by setting off alarms and confirming we obtain alerts as expected. We also confirm that we receive daily temp reports.
5) What kind of reports do you print? Our CTM sends us Alerts on our BB computers if temp is at threshold; the CTM generates a report daily for the previous 24 hours with current, average, high, low and # of alerts. The reports is emailed to key staff and also written to a designated file. We note on a daily checklist that the report has been written to file. Manager reviews reports, signs electronically and saves to monthly file. at end of month, Manager copies the files to flash drove for backup to save for AABB required time.
6) Do you run into problem where you do not have readings and do not have charts? I the system is going to be down for maintenance we have a manual back up process in place. We also have a stash of temp charts that we could use if off line for > 4 hours or for troubleshooting. In our two years of CTM, we have not had any significant issues with temperature recordings. in fact the system is much more accurate that charts and our manual temp records as it eliminates the human error factor.

We have a Galileo and have seen 6 or 7 in the last two weeks that look similar to these. We think it's the colds. As much as Immucor says they won't be detected, they are. I also agree that this happens more in the winter. March is almost here, hopefully soon it will all be gone.

Thank you, Malcolm, for being the voice of reason.

I agree with every word you say Phil, EXCEPT that, as the baby is fine, trying to identify an antibody directed against a low-prevalence antigen is like hitting your head against a brick wall, over and over and over again!  One has to remember that it is not just the specificities within the 701 series (assuming that it is not a novel specificity all together), but most of the "larger" Blood Group Systems also contain low-prevalence antigens (just look at the Diego Blood Group System, as an example); you could spend many "happy" hours testing the plasma, and still get nowhere.
So, the serologist in me says "YES", the pragmatist in me shouts "NO"!!!!!!!
The thing is, the next pregnancy, if there is one, should, without doubt, be closely monitored (probably by MCA Doppler, or something similar), but, if either an IUT or an exchange transfusion (or a top-up transfusion, come to that) is required, finding compatible blood would be easy, even without knowing the actual antibody specificity.

We are trying to move away from CMV seronegative products, except for neonates. Our Pediatric Hematology physicians - about a year and a half ago - stopped ordering seronegative products for their patients following a literature search for current best practices. They found that leukoreduction was at least of equivalent risk of CMV transmission. We are encouraging our adult hematology oncologists to do the same or at least test patients for CMV before ordering.

We have multiple hospitals in our system. One hospital does antibody work for all the others, including providing crossmatched blood ready to transfuse. We do not re-confirm blood type on units when we transfer; receiving hospital does not re-crossmatch the units. This is clearly spelled out in the procedures shared by all the facilities. Each facility has different CAP # and only the largest one is also AABB. 

1) Do you still use charts? No, we discontinued charts after several months of validation.
2) Do you take daily recording? The system captures temp readings about every 5 minutes, so we do not manually record any temps.
3) If you take manual recording, which readings? Not for any remotely monitored equipment.
4) How do you monitor your CTM? Each quarter we check function by setting off alarms and confirming we obtain alerts as expected. We also confirm that we receive daily temp reports.
5) What kind of reports do you print? Our CTM sends us Alerts on our BB computers if temp is at threshold; the CTM generates a report daily for the previous 24 hours with current, average, high, low and # of alerts. The reports is emailed to key staff and also written to a designated file. We note on a daily checklist that the report has been written to file. Manager reviews reports, signs electronically and saves to monthly file. at end of month, Manager copies the files to flash drove for backup to save for AABB required time.
6) Do you run into problem where you do not have readings and do not have charts? I the system is going to be down for maintenance we have a manual back up process in place. We also have a stash of temp charts that we could use if off line for > 4 hours or for troubleshooting. In our two years of CTM, we have not had any significant issues with temperature recordings. in fact the system is much more accurate that charts and our manual temp records as it eliminates the human error factor.

We are working with our Pharmacy and Oncology teams to develop a process where we perform T&S and antigen typing of patient prior to administration of the drug so we have baseline info if the antibody screen becomes positive. We will be able to give antigen matched RBCs and treat similar to our patients with warm autos. So far we have not had any patients present who are on this drug - but it is only a matter of time!

We are working with our Pharmacy and Oncology teams to develop a process where we perform T&S and antigen typing of patient prior to administration of the drug so we have baseline info if the antibody screen becomes positive. We will be able to give antigen matched RBCs and treat similar to our patients with warm autos. So far we have not had any patients present who are on this drug - but it is only a matter of time!

As David said - we subscribe to the CAP survey for antibody titers. In addition, we freeze an aliquot to test in parallel with the next sample so that we can accurately identify titer increases vs techniques variations. We only perform antibody titers on pregnant women up until delivery.