Townsend

Who is your supplier? We have ARC and they will use the E3587 for the pre-pooled cryo, frozen. I didn't even realize that there was an "open" pooled component that could then be frozen. We will use E3591 for the thawed version of the pre-pooled product "Thawed POOLED CRYOPRECIPITATE/NONE/XX/rt".

As a children's hospital, we give any ABO type (of any volume) to patients over 4 months of age. Neonates under 4 months get ABO plasma-compatible cryo. This is in-line with the AABB Technical Manual, 17th ed. (pg 657) - "Although cryoprecipitate transfusions in adults are not required to be ABO compatible with the recipient, these components should be ABO compatible with neonatal recipients because of their smaller blood volumes." The current Circular of Information, however, states that "ABO compatible material is preferred". Stephanie

Scott, we're pretty much the same as AMcCord. They still send back a carbon copy to the blood bank, but most areas use the EMR so everything can be pulled up to do audits. We audit the electronic documentation of a random sample of transfusions per month and rotate the nursing units. (we do about 12,000 transfusions per year, so we might audit about 50 txns per month) Stephanie

We use Epic EMR and Sunquest (Misys) LIS and almost all of our inpatients and clinics are now electronic rather than paper. Like Terri, the test results are viewable as well as each type of component allocated and the final status. We do not send the compatibility results to Epic via the interface. When a unit of blood is issued, it has the compatibiliy tag attached that prints from the LIS. This includes the unit details and results of the compatibility testing, which must be reviewed by the transfusionist at the bedside (with a second RN) prior to administration. The majority of the units are able to document the transfusion (vitals, bedside check, volume, unit #, etc) directly into Epic on the "blood administration flowsheet". There are a few areas not yet using the EMR which must use the paper form attached to the blood product. The checklist on the paper form matches the checklist in Epic, and if the paper form is used, it is eventually scanned into Epic. I don't think that the paper form/tag will ever go away since it is also used whenever there is Epic downtime or can be used in an emergency when electronic charting might not be done in real-time. (that's a whole other discussion:)) Stephanie

If you are retyping in the computer, the labels shouldn't be required as long as you have a way to distinguish between units which are available for crossmatching and those that still need retyping. We do this by placing all unconfirmed units on a designated shelf until the are retyped. Stephanie Townsend, MT(ASCP)SBB

Agreed - this should not be the responsibility of the Blood Bank. However, we do have the ability in our HIS to enter "standing" or "conditional" orders. The practitioner would enter the order to transfuse platelets if under 50,000 (or whatever the trigger). Then if the platelet count was below this, the nurse could "release" the order to transfuse. This is normally used in our ICU or Hem/Onc setting. Not sure if you are able to set something like this up. Stephanie Townsend, MT(ASCP)SBB

We just updated ours last year after the new AABB Standards came out. I've attached our blood tag (with the administration checklist). The nurse either documents in the electronic medical record or on this form, but the checklist in the EMR is identical to the form. [ATTACH]616[/ATTACH]

We only do an elution if the patient has been transfused within the last month. We do , however, do elutions on all patients under 4 months (initial testing anyway). I've attached our flowsheet - hopefully that helps. [ATTACH]610[/ATTACH]

We just finished finalizing our forms for this year. We have divided our Transfusion Service competency into test systems based on method. Our test systems are gel testing, tube testing, Hgb S solubility, elutions, and solid phase (we do Capture P screen). We don't do electronic crossmatches. We will also do an annual competency on component preparation and product issue, since these are important pieces of transfusion safety, even though the aren't really "test systems". I've attached our main form, which is the same one that will be used by other areas in the lab - Chemistry, Hem, etc. This will take a lot of time and documentation, but hopefully we'll be able to accurately assess everyone's competency while pleasing inspectors [ATTACH]606[/ATTACH]

We use the sterile connection device. All of our syringes expire 4 hours from preparation. Bag aliquots of red cells and plasma retain the outdate of the original parent unit, and platelet aliquots are good for 4 hours from preparation. This is from our syringe insert from Charter Medical: "Transfuse platelet aliquots within 4 hours from time of aliquot preparation. Transfuse other blood components according to current AABB guidelines or internal standards (DO NOT exceed 24 hours storage)."

Blood consent is required for any human blood derivative at our institution. This would include albumin, IVIG, PPF, etc. These products are administered by pharmacy. We do not require blood consent for recombinate products such as FVIIa or recomb. FVIII or IX. Stephanie Townsend, MT(ASCP)SBB

Sorry for the late response.... For all non-group O patients, we require a second sample that is collected at a different time than the first PRIOR to the issue of type-specific red cells. All samples submitted to the lab have the same labeling requirements. We are in the process of completing house-wide bedside barcoding requirements for sample collection, but we do not plan on changing our policy on second sample confirmation before giving non-O blood. We do not require second type prior to plasma administration. Only a historical type is required. We also do not perform electronic crossmatch. Nationwide Children's Hospital (Columbus, OH)

Everything is handled in Pharmacy for us as well. Consent is required only for the products that are derived from human plasma (IVIG, PPF). It is NOT required for recombinate factors such as Novoseven or Advate ( F VIIa, VIII). Stephanie Townsend, MT(ASCP)SBB

Well said Mabel! We also prefer computer-generated labels in which the patient wristband is scanned at the bedside. (we are rolling out hospital-wide in the near future) We will not however reject a hand-written label as long as all of the required information is legible. (full patient name and second identifier - we use med rec number) Date/time collected and phleb ID are also required (either on the label iteself or on the accompanying requisition). Stephanie Townsend, MT(ASCP)SBB

Our policy is to irradiate plasma as well, so we would also label the reconstituted whole blood as irradiated. (Irradiated plasma added to irradiated red cells) However, if you do not irradiate plasma (as many institutions do not), I'm not sure that you could label the final product as irradiated if only the red cells were irradiated. Never really thought of this one before. You could always irradiate the product AFTER reconstitution, but this would require you to have a blood irradiator in-house. Sorry... that might not have been much help Stephanie Townsend, MT(ASCP)SBB

[ATTACH]587[/ATTACH] We use Epic (and Sunquest LIS). When a "transfusion order" is placed into Epic, an order prints in the blood bank. I've attached a copy of an order, with the patient and ordering practitioner's info blacked out. The first three order questions (see middle section of form) are required. The next six questions are optional and help us place the patient on the required protocol (irradiated, CMV, etc). The patient weight auto-fills from Epic. The order comment is also optional and is free texted by the practitioner with any additional info requested. The system works well and ensures that we have all of the required information prior to filling any blood product order. The only problem is if we have any kind of print server problems/downtime. Our IS team would like us to go to an electronic order list of some kind, rather than a paper print-out, but we are quite a ways away from that at this time. One other thing to consider... our transfusion orders are handled like lab orders, however we have since implementation wondered why they weren't set up like medication orders. That may be something else you wish to explore. Good luck! Stephanie Townsend, MT(ASCP) SBB

We also used whole blood about 8 years ago at the request of a particular cardiothoracic surgeon. It was a nightmare to coordinate with the blood center (fresh, possible directed donors, antibody/maternal antibody, etc). We also spun the whole blood down and created a packed cell unit if it wasn't used in surgery. This required a sterile connection device and FDA registration, both of which we already had. Now, we just give CPD units for patients under 4 years, adsol units for all others. All open heart surgeries also get fresh rbc, preferrably less than 5 days old. Platelets and plasma are ordered on a case-by-case basis, sometimes when the patient is being warmed and coming off of the circuit. Stephanie Townsend, MT(ASCP)SBB

We leave the supplier license number and registration number on the original unit since they are the ones who collected the unit. Our registration information is added as the ones who did the additional processing/preparation. Both labels must also be barcodable. Stephanie Townsend, MT(ASCP)SBB

I agree, sounds like they are being way too picky. We are using the "old school" white light boxes that Immucor recommends. What I don't understand is why they can't incorporate such a simple piece into the workstation so that the extra light box isn't necessary..... I'm just sayin. :handshake Stephanie Townsend, MT(ASCP)SBB

Wow, that is disappointing. We still do manual gel and manage less than 45 minutes for ER type and screens, usually more than 95% of the time. We have just over 400 beds and are looking forward to the new automated options we will have in just a few more years! Stephanie Townsend, MT(ASCP)SBB

P9052 for HLA-matched, leukocyte reduced plateletpheresis.

We do the same as aakupaku. We ran about 20 patients and 20 donors in duplicate (or compared to reference lab reports) for validation testing. We would not use our typing results as a workup for McLeod - that would go to our experts at the IRL. Stephanie Towsend, MT(ASCP)SBB

At our pediatric institution, all of these products are stored and distributed by the Pharmacy, whether they are recombinate or not. This includes albumin, IVIG, all coag factor concentrates including AT III. The transition of factor from the TS to the Pharmacy was made about 15 years ago, and as far as I know we haven't had any concerns or complaints since then. Yeah! Stephanie Townsend, MT(ASCP)SBB

It is just a regular spirit-filled thermometer which is placed in that bottle of glycerol. The thermometers are checked against an NIST-certified thermometer annually. Our double-door units have one thermometer/bottle on top and an additional on the opposite side, bottom shelf. The single-door units have only the one on top. Is anyone doing this differently? Stephanie Townsend, MT(ASCP)SBB

Nope, they're just the good old plastic bottles with about 100-150ml of 10% glycerol solution. The thermometer and refrigerator probes are just inserted into the bottles.