Bill

Webersl--nice procedure!!

To play devil's advocate--with all our computerization, that order set could be set up in the computer to reflex the transuse order when the criteria of the MD is met. This MIGHT be better patient care as opposed to waiting for the MD to see the result, remember to write the order, wait for the ward secretary to enter the order, have the nurse acknowledge the order, get the product, and start the transfusion. The reflex order would eliminate the first four(4) steps of the process. Also, is this not more fitting with the US CMS stand of using "Standard of Practice" for all situations?

There are many hospital laboratories that use the add on practice--in 4 of 5 where I have worked, the add on practice has been used quite successfully. As a patient, I would object to a redraw just because the technical specialist is "uneasy."

Denny, ask your anesthesia person for the reference. If this was at a conference, the reference should be readily available. BTW, I have seen literature about using warmers for ALL fluids in surgery--is this what he/she is talking about?

I agree with Mabel that the Mass Casualty Policy should deal more with obtaining enough units for the influx of patients. Most times, the County EMS system will have an estimate of number of casualties; that way you can order an additional units to cover that number of victums. Your blood supplier may be able to help with how many units or maybe they are set up to send a standard order for the number of victums.

We built body fluid result screen so that all body fluid results are on one screen--that way no matter what dept is entering results, all tests can be seen (reviewed). Since the cytology is usually the last result, the pathologist can see all the results and mention in the interpretation portion of the cytology report.

Michaele, if you document the number of incorrect patients drawn, you can show how many potiental incorrect transfusions would be given in a year. Ask Risk Management if this is what your organization wants for transfusion therapy patients.

We do the same and have even told inspectors that it is our control to ensure consistant reactivity of the "test system."

Ditto Terry

I would consider this as one event, unless the remote site is NOT part of your organization (system).

The item that Gumby suggested is one I had in mind.

What is a "routine inpatient transfusion order?" Every transfusion, except pre-op is STAT; our hospitalists insist on everything now, our oncologists insist on everything now, ER insists on everything stat STAT.

I do not have an SOP for you but there are several different ideas: 1. Put thermometer in cooler and record temp at first picup and back at lab for all three temp storages. Record temps on a PDA using spreadsheet and then sync to PC in lab. 2. Use portable recorders--mark at beginning and end of run. 3. Invest in wireless monitoring. 4. Use 12 volt camping cooler/refrigerator or freezer instead of cooler for more consistant temps. Mix & match the ideas.

Does your Transfusion Committee oversee these transplant procedures? If so, then the MD assigned as Director of Transplantation would be responsible to see that consents are correct. These have been JC issues for several years so someone may have already addressed the isuue.

Same as Townsend at our facility

You can still search for the patient result in Meditech "Patient Inquiry" or EMR. You would use the txt file only if you needed to trace a barcode number to a specific result once Meditech purged that info.

There are strict regulations about storage of breast milk in New York state. You can read them at: http://www.wadsworth.org/labcert/regaffairs/clinical/Part52.pdf. Breast milk should be handled the same as blood and/or tissue. Hope this link helps you.

To maintain your traceability, you can create an NPR report that will match the barcode number, specimen number, and patient demographics. You can set it up to automatically run the report and store it as a txt file at any interval you desire. If you need the info, a txt file can be opened in any spreadsheet software or as a general txt file in wordpad. I did that at previous employer for a urine strip reader and it worked great.

The instrument manual should contain all this information for closed mode and open mode sampling. It should be in section about specimen requirement and preperation. Who told you that "mixing studies" are necessary?

According to New York State regulations, at 15 min, half way through, end of transfusion, and 1 hr post transfusion.

We use Symbol Tech Model SBD4278 wireless handheld scanner.

New York State has regulations about "health care providers" reporting infectious diseases. I believe that these parrallel CDC regultaions about the same.

Sounds like a good student project for someone taking a database course, including entering all the data from the cards. Other idea is to scan the cards with OCR capibility. If the cards are set up the same, it should work.

We use individual cells of outdated panels to aid in antibody ID's. We run a positive and negative for the particular cell we are using that time.

Do you have any Pos proficiency test material that you can use?