BB1956

We are a community hospital and  frequently transfer patients to a larger facility.  We also have had issues with dialysis patient's needing a blood transfusion during dialysis where there sample has been collected at another facility.  We do not crossmatch or transfuse blood from a sample that has not been collected within our hospital system governed by our patient identification and labeling policies.   The  larger hospital where our patients are transferred does not crossmatch or transfuse based on any tube we have collected at our facility.  There is far too much risk in patient safety in my opinion when you loose control over collection and identification of the patient.

We are a community hospital and  frequently transfer patients to a larger facility.  We also have had issues with dialysis patient's needing a blood transfusion during dialysis where there sample has been collected at another facility.  We do not crossmatch or transfuse blood from a sample that has not been collected within our hospital system governed by our patient identification and labeling policies.   The  larger hospital where our patients are transferred does not crossmatch or transfuse based on any tube we have collected at our facility.  There is far too much risk in patient safety in my opinion when you loose control over collection and identification of the patient.

We are a community hospital and  frequently transfer patients to a larger facility.  We also have had issues with dialysis patient's needing a blood transfusion during dialysis where there sample has been collected at another facility.  We do not crossmatch or transfuse blood from a sample that has not been collected within our hospital system governed by our patient identification and labeling policies.   The  larger hospital where our patients are transferred does not crossmatch or transfuse based on any tube we have collected at our facility.  There is far too much risk in patient safety in my opinion when you loose control over collection and identification of the patient.

For years we have been using our QC antisera and rotating one cell from the panel each day and testing it with our routine daily tube QC.  It was not so overly burdensome( one additional cell)  and even though we are testing only one cell each day we make it through the entire panel at least once during the month.  This way we are testing the "panel" if not every cell each day of use and  we have some quality control.  Everyone is correct there is no way to check every antigen so we felt this was a good compromise.

For years we have been using our QC antisera and rotating one cell from the panel each day and testing it with our routine daily tube QC.  It was not so overly burdensome( one additional cell)  and even though we are testing only one cell each day we make it through the entire panel at least once during the month.  This way we are testing the "panel" if not every cell each day of use and  we have some quality control.  Everyone is correct there is no way to check every antigen so we felt this was a good compromise.

We are able in the blood bank to receive verbal orders and to place them into our LIS system which is Meditech.  We realized this could cause issues so there is a field in Meditech when you place an order that defines whether the order is written or verbal.  Up until this time it was set to default as Written.    We requested a change from our IT department and now we have the option of selecting Verbal with the default setting of Written.   When we select Verbal the ordering physician is electronically prompted to sign orders.
  It worked much the same way verbal physician orders to the nursing units worked at our institution.  It seems to be working well.

I ordered a microwave from Ark Bio-Medical in 2016 and waited a year to receive one.  It is true they have had a manufacturer of some of their parts go out of business and it has taken time to find another.  They have found a new manufacturer and are in production, however now all the paperwork must be re-approved by the FDA and that is where the problem lies.  They have complied with all FDA requests but are awaiting approval.  In the mean time the distributor just installed one he had in stock for us and we love it!  It works very well.  We were instructed to make sure the sensor in the microwave was not placed on the side of the unit with a bubble.  We are a small hospital and it has saved us over $3000 dollars a quarter in wasted plasma.  Now we thaw on demand and it takes about 8-10 minutes to get a fairly large size unit ready.  We still have the Helmer water bath plasma thawer for cryo and units that do not fit the carrier but the microwave is great in a trauma.  We are also taking the temp of every unit we thaw upon completion at least for a while.  I am an old blood banker and I was very skeptical at first but so far we love it!!

Could you have the community hospital inoculate the Blood culture bottles used by your main Microbiology laboratory and transport those instead of the bags themselves.  When we wish to culture a blood bag we inoculate the blood culture bottle here at our facility as well and set it up on the Bacti Alert. 

Could you have the community hospital inoculate the Blood culture bottles used by your main Microbiology laboratory and transport those instead of the bags themselves.  When we wish to culture a blood bag we inoculate the blood culture bottle here at our facility as well and set it up on the Bacti Alert. 

We reported the patient as a weak D positive patient.  Due to cost cutting we no longer have a different Anti D sera on site.  We use the same reagents on the ECHO and for Tube typing. That is why I was concerned when we were able to pick up the D in tube testing using the same lot number of Anti-D typing sera and we did not even see a ? on the original ECHO run.  We are a community hospital and most of the time there are no problems.  Cost vs Benefit indicates the few patients that have typing problems are more cost effective to send out for resolution.  Gone are the days we can do our own work ups I'm afraid.  In this case it was safe to call the patient Rh negative for transfusion purposes.  Since she is prenatal the physician can order molecular studies to get a more accurate picture.  Thanks for all of your help.  Some great ideas!

We accept verbal orders in emergent situations, however we recently configured our LIS system so we could record the order as verbal.  In the background the computer system generates a physician order and a notification that he or she must sign the order.  It solves the issue of policing up physicians and getting them to enter the orders after the fact.  So far it is working great.

I have the initial EHCO printout which does not look grainy for the individual reactions but I will go back and check the reaction strength on the instrument for both runs to see how that compares.  You could be absolutely correct.  There has to be a break point somewhere and it could be that these samples just might have fallen into those areas. I do have techs review the reactions before reporting and I don't see anything on the printout that would have caused much alarm.   Unfortunately it is difficult to explain all of this to a physician or mid-wife to get them to understand why you "mistyped" their patient.
It is good to keep in mind  the probe sampling position in discrepancies with transfused patients. Should this occur again, it will be one of my considerations.   In this case my patient had not been transfused.  We learn  much from each other and I do appreciate this forum.

First, I would point out that Nursing accepts verbal orders from Physicians all the time.  I too  have worked places where we accepted Verbal Orders "for emergencies only;" but we had a Manual Form where we wrote down everything the caller was saying to us (including their name and the name of the ordering Physician).  We kept those documents.  At 1 Trauma Center I worked at, we just had an alarm go off in the dept. as an indication that the ER wanted us to bring over a Trauma Cooler (6 units of uncrossmatched RBCs).  That is even less than a verbal order....so sometimes, you just have to "do what you have to do" in an urgent situation.  Also worked at a place where a post-partum woman hemorrhaged to death on the Night Shift.  Labor and Delivery was sending erroneous orders in their urgency (i.e. Fresh Frozen Platelets....).  Perhaps talking with them on the phone and getting immediate clarificaiton, might have resulted in a different outcome; don't know.......  You have to follow regulations and you have to be safe....but you also have to be realistic and do everything possible to ensure a patient does not bleed to death, just because you do not have a writen order in hand.
 
Just my thoughts/experience....  
 
Brenda Hutson