luhubert

I think you must NOT accept a historical blood type without confirming it, especially in an emergent situation. I have many stories to share about scary situations involving people using other people's identification, tubes being mislabeled, admission mistakes, etc. I won't bore you by relating them here but my experience has certainly convinced me that historical blood types should never be used without confirmation.

You got all the right answers, but I can't imagine what prompted the question in the first place. all blood banking teaches that once an antibody, always an antibody. One of the answers was right on with the comment that it's a scary place out there. Can you imagine the amenestic response that woman might develop if she got E positive blood? I don't want to imagine it.

We use our pre-op type and screens for 10 days. If the question had been worded so that previous transfusions and pregnancy had been addressed, we could have answered the poll more easily. I can't answer the poll because, it the patient was pregnant or transfused in the last 3 months or if I don't know, then the TS specimen is only good for 3 days. Crossmatches are held for 3 days in our facility with the exception of autologous which stay crossmatched on the patient until discharge.

Is CAP changing its requirements, too. I hate to disagree with JCAHO but isn't this overkill? At the present time, we have two racks and QC 1 of them each day, alternating days. The same lot number is on each rack. We QC new lot numbers before they're put into use. With the type and screen reagents I've never seen a QC failure in my 20 + years as a blood banker except a contaminated A and B cell when someone had switched the tops and those were still useable. This rule is going to be time and reagent consuming for those places which use 10 - 20 racks. I didn't know JCAHO went so in depth in the Blood Bank, I thought they left that up to CAP, CLIA and AABB. Lu

I just heard that one of the accrediting organizations, maybe JCHAO is going to require the use of blue ink. The reason given was that copies are now hard to tell from originals and a blue ink signature will be easy to differentiate. Anyone else heard of this?

Yes, and I'm sorry this is only anecdotal, we had a woman who was pregnant and had a 1:16 RPR titer, a negative MHA-TP, a strongly positive DAT with no specificity and we never got an answer about her diagnosis.

We do exactly what mtheriault does. What we're getting and when we get it is maintained through our purchasing department. Lot numbers are maintained when doing QC. The appearance and acceptability is noted when the first QC is done before being placed into use. We have a statement on our spreadsheet for Blood BAnk QC that says "Reagent appearance acceptable? ___ Y/N" If No, document problem and resolution below. I personally don't think we need more than that.

We use the Charter Neonatal syringe set, get an irradiated unit from our supplier with 4 - 6 aliquot bags attached. We push into an aliquot bag and then take our syringes from that, leaving the rest of the bag intact until original expiration. We made our own label using Word and card stock. Copy attached. We attach it to the syringe with string through a punched hole in the corner of the tag. We put the assigment/crossmatch information that prints on adhesive labels on the other side of the label. Aliquot tags.doc

We had a similar problem with a tech who worked infrequently in BB. We certainly didn't dismiss her. We did a root cause analysis, found some procedural changes to make. Made the Blood Bank techs different levels of competency and certain levels can only perform certain things. We put all our highest levels (3 of them) on a rotating call schedule to help techs that are on lower levels. I don't think dismissing is the answer unless the errors are done willfully or repeatedly without improvement.

I'm looking for ways to ensure that nurses notice and document reaction symptoms. We get so few reported, something like .2 of 1 % that I know under-reporting is going on. I've read the 2% somewhere, too, but can't remember where. We present symptoms at a competency fair, have them written in a nursing manual, have them in a "lab manual for nurses" on each floor and give periodic inservices. Other suggestions would be welcome.

Several years ago we made a concerted effort to have the "reaction" reported to the Blood Bank no matter what the physician decided to do. Even after 7 years, we still hear the nurses tell us that the doctor didn't want a reaction called. We've moved away from the word reaction and told the nurses they are just reporting symtoms, which indeed they are, and that the Pathologists and doctors will decide if it's a true "reaction". The syntax has helped a lot and the nurses are now not so reluctant to tell us what they have observed.

The proposal to change from RhoGam to Rhophylac is going before our OB/Gyn doctors at their next meeting. I'm going to print out all these answers and include them with the proposal. I'd like to hear from someone with some long term use. The hospital using it for a year was a really good endorsement.

I agree that the California e-forum is a "Great" site. Go to CBBS and you'll find it. You can sign up too. It's run by Dr. Ira Shulman, a noted transfusion medicine author.

We use an additional Blood Bank Band when a Blood Bank specimen is drawn. Since that puts up a barrier to transfusing the wrong patient. With the band in place, we only type the new patients twice from the same tube.

There used to be a Quality Department but then there was reorganization and the Blood Bank supervisor took over doing all the blood bank oversite and statistics which are reported to the Blood Utilization Review Committee. She determines if the C:T ratio is OK and if transfused blood meets criteria - if it doesn't, the chart is taken to the Committee where peer review is done. She also looks at low hgb. which aren't transfused and why. She also reports those results to the B.U.R.C. along with trans. reactions, reports on Quality Indicators and the kitchen sink.

I just came from a CAP Inspector Training Seminar and was told that CAP was going to start requiring 2 typings on 2 different samples before anything but O cells could be given. Seems pretty stringent to me and wondered if others had heard this and what they thought.

We just bought a 2 door Helmer to be delivered April 5 and after reading all these posts, I even more excited, if that's possible. We haven't had a new blood bank refrigerator for over 15 years.

There are only 2 people in our blood bank on days and 1 on evenings and about 1/2 on nights. We don't tube on nights because it takes more time than just issueing through the Blood Bank window. We transfuse about 700 products a month. We only tube Packed Cells because Platelet Pheresis are too expensive to get lost in the tube. We check blood between the two of us if two are here, otherwise, we carefully check it ourselves. We only tube to Oncology - everyone else picks it up. Oncology calls for it giving the patient's name and Med record number. We issue to ourselves, then tube and write on a log: date, time, person sending, pt. name. When it is received, Oncology calls and tells us if it's cold and intact. We then complete the line on the log with the name of the person receiving the unit and that it was OK and cold. We are expanding our lab space and Blood Bank will move to an area containing the tube system. At that time, ICU hopes they will be included with Oncology in receiving their packed cells and possibly FFP that way. We hope we'll get a clerk to help handle all the tubing of blood.

Teri, I believe the only way the patients in our hospital could be of use to you is if I could tell them about you when I explain about their antibody and let them contact you. I'm concerned that you don't mention a company that you work for. We buy all our rare antisera from one of 2 companies, either Ortho or Immucor. Do you work for one of them? I agree that some of the antisera is very difficult to obtain and would be happy to tell our patients of this opportunity but I'd need to know a bit more about your operation before I recommend their getting in touch.

I would run 20 tests in duplicate - you could do Screening Cell 2 on your QC twice every day for 20 days using Rabbit IgG on one tube and Monoclonal on the other. Keep the results in a validation folder to show anyone who asks. If the results are not the same in all 20 tests, you have to do at least 20 from the different one so that you end up with 20 alike. It really isn't very difficult and shows you didn't just "pop it in" without checking.

I did get a fairly decent price break from Immucor by signing a letter of intent that I would buy 90% of my reagents from them. The cost went up but not like Ortho or Immucor without a letter of intent. Here's what I'm dealing with: Screeing Cell Trio in 01 was 6.40, 03 was 21.78 and in 05 will be 72.00. If we project that out for 10 years it gets really scary. I agree that the manufacturers are trying to make the reagents for tube testing and automated testing equally expensive. I don't know enough about the law to know whether we can take it to the FDA but it might be worth a try.

I believe that these aliquots would fall under the same guidance as any unit that has been entered. Any refrigerated units (packed cells) that has been entered for any reason is given a 24 hour expiration date. These syringes are like a unit that has been entered, so at our facility we give them a 24 hour outdate.

CAP states "Is there an appropriate inventory control system in use to track the use of all lot numbers of critical materials. According to the checklist, a "critical material" is a good or supply used in the collection, preservation, storage, testing or TRANSFUSION of blood components ant directly affects quality or patient safety (for example, blood collection sets). What is everyone's opinion on tracking blood administration "Y" sets and if we should, how should we go about it?

How about plain and simple "Blood Bank Forum"

We normally stock 15 O Negs and our policy states that when we are down to 6 on the shelf, we will switch the person who is using (males and females over child bearing age). We have limited the use to 6 O Negs during open heart or trauma when their is anticipation of greater use. I'd love to send my procedure but I don't know how to get it onto this page.