Liz0316

I agree with JoJo808. If it prewarms away we give crossmatch compatible. If it doesn't, then we screen. The computer may not like the anti M, but that's why I built the override code: "antigen screening not required." ! Liz

We use a procedure like Mabel's and use it all the time. No complaints from the neonatologists. We use syringes to remove and replace, that way the exact amount of plasma is replaced. If you add a couple extra cc of AB plasma it brings the HCT just a bit closer to 50-55% which is what they are looking for. I have generalist on the night shift, so a procedure without weighing and calculating works well. Liz

As long as we have 2 types on file, no we do not perform another ABO/Rh for FFP transfusions or platelets. We have a lot of out patients who come for just platelets, and we have chronic (out) patients that get FFP prior to procedures. Obviously, if we feel blood may be needed we get the specimen. We get lots of "hold" tubes! Liz

We use CMV - Safe (leukoreduced) products hospital wide, except for the neonates. Since I can still get them (we get one pedi unit a week for stock) it keeps the neonatologists happy. Very rarely do I need to get a CMV sero-negative unit in. Fortunately the 2 transplant centers we are affiliated with use CMV - Safe.

I agree with David regarding the antisera, but I would like to emphasize having a procedure, specificaly stating what antisera you will save, what conditions you wouldn't use it (like discoloration) and things like that. CAP will like that.

We began using the Shock Watch indicators on March 1st. We have had problems - 5 units in 2 weeks activated and turned blue. I called the company (Digitrax) and was given some advice. 1. Put the tags on just before packing for transport, not after crossmatch or irradiation and then store 2. Always store the units with "tag up." Either in the refrigerator or in box or cooler. I guess the air is important. 3. The tag is ok to place on top of a label or sticker on the unit, or directly on the unit. (Still trying this). We are giving Shock Watch another chance, and I told the company this, but, if the problem continues I will switch to another supplier - checking out both Hemo temp II and Safe T vue. Hopefully these suggestions will work. So far no issues this week. We send units to the cancer center, 4 miles away, nearly every day. We validate the cooler, but the State wanted some sort of indicator.

We check for previous record on all specimens except for cord blood samples (which we check the mothers on). We cannot accept reports from physician offices.....I have an entire stack of incorrect ABO/Rh results on OB patients. Not that we would accept them in the first place.

same here, all neonates get irradiated RBCs and platelets. Once a unit is allocated to a baby, it's theirs. Each baby gets their own unit. It's very rare that the neonatologist want syringes made from the unit after the first few days, but the unit is set aside for the baby anyway to prevent additional donor exposure. Same with platelet, we sterile weld the syringes in case more than one dose is needed.

We report all the tests within the battery. The MD interpretation remains pending until the reaction is reviewed by the medical director. I then type in a brief interpretation (no evidence of a hemolytic transfusion reaction, or urticarial, per Dr. xxx, etc..) and add "see charted report" if my medical director get wordy. All paperwork is copied and sent for charting, including the medical directors written interpretation.

I've thought about more - I'm all set, thanks anyway. Liz

Hi everyone - We have an off site cancer center that transfuses nearly every day. In the blood bank we are trying to find the best and easiest way to store the crossmatched units prior to transport at 7 am. Our night shift is "lean" so I'm trying to make this easy and fast. I got word today that the night shift has asked that the units be placed in the plastic bag and set on the shelf so they can just grab the units and place them in the validated cooler with ice and be done. Now, from way back, in my blood center days, I seem to remember that platelets should not be stored for a long time in plastic bags (maybe that has changed) but I'm wondering if it's a good idea to place red cells in plastic for storage prior to shipping? Just a note: the night shift is not aware that I'm about to make it their responsibility to check the Shock Watch temperature indicator (Digitrax) prior to shipment so they won't be able to insist the units be wrapped up. But, just wondering about the storage in plastic bags. thanks Liz

I had similar problems with transfusion documentation. Each time I did an audit, the nurses wanted the transfusion slip changed, add extra copies, change this or that. After 4 huge audits, with no improvement in compliance, I sent the final results to QA / Risk management and basically stated that this is their issue and I was done auditing. I even refused to attend the meeting! Hand the problem back to nursing. Let them deal with the regulators. I also have similar issues with the tracking of bone and tissue. Basically I told the OR that if they didn't comply, complete the paper work and follow the BB policy that the freezer is on wheels and I would simply push it down the hall and they could take care of the entire process.... we now have compliance.

my deepest sympathy to his family. An easily approachable person, he was kind enough to have a drink with me at a Reference Lab conference a very long time ago. A moment I will always remember!

I agree, I wouldn't recommend thawed plasma for an infant exchange. More times than not, coagualtion factors is one of the reasons for the exchange. I try to give the neonates the most "bang for the buck." (so to speak). Liz

factors and RhIg from BB, all others from pharmacy.

we perform a ABO recheck on anyone who will be transfused or going to surgery that has no type on file. We use a 2 ml pink top, prefer a different phlebotomist, at a different time. We use Collection manager bar code system for all collections. We do not charge and do not report out to downstream systems. It has been a difficult implementation but thankfully my medical director will not relent!

We do the same as you and use Centurion.

Don't accept that responsibility, it is not yours! We have a transfusion order form (paper at the moment) where the physician completes the products needed, with indication, rate of infusion - if not standard. Includes date of transfusion, signature (can be RN by telephone order) and any attributes needed (irradiation). We don't give out the unit until this faxed to the BB. Exceptions are the OR and emergent ED orders. Liz

Love it! and then the nurse said " this patient is critically ill...can you irradiate the blood a little longer?" !!

assuming all of your employees in the BB have gone through a documented training period.... I use several different methods for annual competency: Direct observation - each year it's different. This year with a new LIS it is ordering and issuing emergency uncrossmatched O neg units, which is a different function than XM units. I use a competency "quiz" for problem solving exercises. I assign CAP or other (ARC) on line competency exercises. I include PT testing results and also count day to day activity of my specimen work review. Hope that helps. Liz

try phrasing it as a "standard of care." We keep PAT specimens for 21 days provided we have documentation that the patient has not been pregnant or transfused in the last 3 months. Liz

We also have an X-ray irradiator. We irradiate anywhere from 80-120 unit per month, plus platelets (45?). Our BB is on the 3rd floor and the irradiator is fine - comes on wheels too. There is the water cooling factor, but it works for us. We have 2 very active hem/onc offices and the hospital is building a cancer center 4 miles away. We are nearly 2 hours from the blood supplier. Between the $$ saved on not ordering irradiated products and the time that is saved for the patients (especially those that drop in after a doctor appointment) our irradiator is going to pay for itself in just a few years and it keeps the doctors happy. Delay in treatment is something to think about if you are not close to your blood supplier. Liz

I agree with Deny and aafrin - Liz

They can complain all they want; as long as your patient has not expired, a specimen should be collected at the same time, or better yet, before they hang the first unit. We issue emergency O neg units a lot. We are a midsize community hospital in a tourist area right off the interstate. We often issue O neg uncrossmatched units prior to the patient being transported by Life Star. We have form that we start in the BB, patient ID, units, if any testing has been started, etc. Issue with the units. We have a computer battery, so we can issue the units and do the XM later. The ED gets the physician to sign the form that the patient is emergent and waiting for crossmatched blood would be life threatening. They sign the form and return it to the BB. A XM or type & screen is ordered in addition for testing and further units. The ED is very good about getting a specimen as soon as they can because if they fail at this process I will institute a Trauma pack with typenex bands...and they don't want this! Just because nursing doesn't want to collect a specimen is no reason to compromise blood banking high standards.

The AABB states there has to be a mechanism in place to identify the date and ID of the person who drew the blood from the patient when requesting blood, components, tests and derivatives. But, I don't understand why you are redrawing the patient. Is the initial blood work not including a BB tube to hold or do those samples not include the phlebotomist initials?