PAWHITTECAR

It could also become an issue if they end up giving him an A BMT. I would think??

I'm glad to find that it is not just my tired eyes... not quite cold enough for real snow here but close.

Ok Malcolm..no need to rub it in.

Oh no I'm having flashbacks to statistics....HELP!

Yes bill for anything completed prior to the call informing the BB that the patient expired.

Way to go...I know you are relieved that it is over.

You boys are bad...but you make me smile and today I needed that... Thanks Trish:o

Ditto..I for one would finish the work-up. I don't think my curiosity would let me quit but I would not bill the patient for any testing performed after he/she expired.

Several years ago we has our waterbath go out and were not so lucky to find something esle to use. Of course we has an OR go wrong and had to have FFP. We improvised in the sink with running water and a thermometer. Quite a trick but we had constant agitation (manual) and a constant monitored temperature. Luckily they purchased us a back-up after that.

Terri, We are still totally paper..though they have promised me the Blood bank computer module in May. Having just taken over, and finding no policy as to what they had been doing (I know that nothing was done from May until September). We get a copy back with the two signatures and the times the transfustion was started and finished. No vitals. I have been checking these for completeness and that they were properly billed (we do that manually here in the BB). I have a meeting set up with the head of nursing education to set up some inservices on how to properly fill them out then set up a "corrective action" for when they are not. One thing I have learned in the 2 1/2 months I have been here is that nothing gets fixed fast...But I keep after them until it does.

Malcolm, I just meant that it can take a while to get used to how you think but you are usually a well of knowledge and that you really are just trying to share that knowledge with all of us. I know that I have definately learned my share from you. Trish

As most of you know I just took over as supervisor here and in reviewing the procedures found that they had been allowing physicians to sign a release to have a mislabeled blood bank specimen tested. Needless to say that was the first thing to go. I have butted heads with several physicians since then and even had a call from the CEO whom I explained that this was not negotiable. The risk was just too great. I think that any physician of nurse insisting a mislabeled specimen be tested should be considered on occurance.

sshel55 please don't leave....Malcolm is not really that bad you just have to get used to him....

We also only perform if the doctor specifically requests, then any abnormal PTT would get the study. Trish

Kathy, I know how you feel. I just took over here last month, my first technical supervisor position after 18 years as a bench tech. Our "window" opens January 1st. I'm scrambling around madly to try to get things up to par. They were without a Blood Bank technical sulervisor for 5+ months so a lot of stuff was not done. I've even got a procedure manual that hasn't been reviewed in a couple years and antiquated procedures that have not been revised since the 90's. I will send good thoughts your way if you will do the same for me:o

Yes Manually...

We also require a second specimen on all patient's with no history (with or without units ordered). I am looking at this now to see if it needs updating (along with the rest of the manual).. We send a little "kit" to the floor with a purple bullet and the stuff to do a finger stip for just a couple drops of blood. Saline Memorial, Benton Arkansas

Panel-C comes as a set same cells both untreated and Ficin treated.

Thanks I'm sure you guys will be getting a lot a questions from me...I have already used several posts as a "resource" in getting some items addressed.

Malcolm, Sorry to hear about your house..hope everything works out ok. Thanks for the "ammunition". I have just taken a position a technical supervisor is a small(~150 bed) hospital. It is crazy the stuff that is in this procedure manual and that is being done. Du testing on every Rh negative always. Yes 60 year old men getting a Du every three days. And AHG crossmatches for every unit. Those were the first 2 things to go..lucky for me the lab manager and the pathologist that is "medical director" both realize I know a little about blood bank and are letting me make the changes needed. Now if I can just get all these procedures updated by January when CAP is expected....Some haven't been "revised" since 1992... Wish Me Luck, Trish

We have been using the 5600 for more than a year and it is doing fine. It is not less prone to problems that the ECi or FS but has it's own new set of problems. You can turn off different componants (like in the FS) so if the immuno side is down you can still run slide tests and vice versa. It does not have nearly as large of a sampling area, only 4 carousels, so if you are running a high volume of specimens they could be off the analyzer when you discover the need for a dilution. One nice feature is that if an sample from any position in those 4 carousels so if you need to add-on or if a dilution is needed it doesn't have to wait to get to the "secondary sampling" position. They have made some definate improvements with the tip delivery system as compared to the FS. No more hoses dlogged with tips.

Like David stated just say NO!! And use having to retest all patients with the "possible delays" in getting blood products as justification to leave both armbands.

I work in a pediatric hospital with an NICU that routinely has 75+ babies so putting one baby per unit isn't very practical. We try to limit it to 2-3 babies per unit babies that weigh <1 kg at birth generally bet their own unit. We give CPDA-1 units that are leukoreduced, irradiated and sickle cell negative. We always start with a fresh unit and then give out of it until it expires. Occasionally if they are having a baby that's K+ is getting really high we will start them on a fresh unit or (rarely) wash an aliquot for them.

I work at a large pediatric facility (75+ NICU babies) We do not wash units unless the K+ is extremely high or the patient is waiting for an ABO incompatible heart exchange then we do wash in-house. We give ABO and Rh compatible units that are leukoreduced and Irradiated. We irradiate in-house as well. We also use a unit until its expiration or its empty.

We do a red cell exchange to prevent sickle crisis in out known patients. They first evaluate the pateints to determine which are at increased risk for stroke (I do not know how) and then set them up on a schedule of usually monthly exchanges. They do this with an apheresis unit so it is basically like when you donate a unit of platelets and they give you your cells back but in the case of the sickle cell exchange they spin the blood, replace the red cells, and give the plasma portion back with new sickle negative cells. It really works well in that we are seeing far fewer patients present in the ER with sickle crisis. They can do this on the really young patients (we have a couple of 3 year olds) all the way up to adults.