applejw

Our system uses Epic as HIS and rates are defined within the Transfuse orders. The documentation is in Epic where you can see the starting rate and any rate changes. We also have had TJC examine transfusion rates to ensure that nursing is following the ordered rates.

Correct me if I'm wrong but this version 4.0.0 update only applies to licensed manufacturers. It would apply if your Blood Bank lab is licensed and manufactures blood and blood products.

I went back to your original post and it clearly said "Trigger" for some posters. My lab only uses the microscope for FMH screening tests and rarely (like once in a blue moon) looking for mixed field during post-transfusion reaction investigations. I would consider it to be looking for Zebras, as Malcom said, to want to see rouleaux or a cold-reactive antibody by letting tubes "sit before looking under the microscope" (slightly adulterated version, my apologies). I didn't see any mention of "only for ABO discrepancies" or even "reverse type". I've seen cold reactive antibodies look like rouleaux and rouleaux that gave the same appearance as cold reactive antibodies. Some are helped to be clearer with saline replacement, some not. That's probably where I stopped looking at these things under a microscope. We predominantly test using automated gel method with tube usually being the "come to the rescue" method to not see just those things you were talking about. Do I saline replace or pre-warm the test components for those things? If I need to, but I try not to wake the sleeping beasts so I don't see them in the first place.

I'm still wondering why you want to look under the microscope and why you want to see cold-reactive antibodies and rouleaux. Are these things written into your SOP and following the manufacturer's instructions?

I have experienced ABO mismatch accidents three times in my career. Twice the recipients were Group O with reduced isoagglutinin titers and received between 2 and 4 units of Group A RBC. The other was a middle aged male that was A Pos receiving 8 units of Group B RBC during heart surgery. The Group O patients experienced an immune boost of their anti-A titer and quickly removed the incompatible RBC from circulation. The A patient who received 8 units of Group B RBC developed DIC intraoperatively but survived. I have also experienced a situation where the Group O inventory was reduced to less than 5 units during a liver transplant and major trauma. It seemed that every patient that needed a transfusion was Group O that day and we ended up harvesting blood from the liver donor and processing it to transfuse to the liver recipient to save the remaining units for other patients. Fortunately, we restored the Group O inventory quickly. It did not happen in the face of mass casualties or the level of shortages seen during the COVID shutdown.

WE ran into this with their MTP coolers - even bought 6ft zip ties to try to ziptie it to the box. Nope. Had to buy a new MTP cooler which has doubled in price and is almost entirely different than the original.

We do not perform ISXM unless the LIS is down or a second sample for ABO confirmation is not available. We use Softbank and the system has been validated to detect ABO incompatibility as long as there are 2 blood types tested on record, patient has no history of antibodies and the current antibody screen is negative.

This scanning into Epic sounded intriguing.... I don't think it is unique to your build. Are you scanning in all of the paper generated during an antibody investigation or do you have an algorithm that you follow? We send large volumes of patient workups to be stored off-site forever and have multiple file cabinets for the most recent 2-3 years worth of records.

Both can be performed on the Vision Swift.

For us it would depend upon the patient's age and child-bearing potential. If that is unknown or unclear, routine transfusion after MTP would be A NEG. Additional massive bleeding A POS.

We accept verbal requests but should be followed by an order for emergency released (RBC, WB or plasma) placed in Epic. We issue blood with a triplicate form and require a physician's signature and a copy returned to the Blood Bank. The form documents the units that were issued, product type, attestation statement, diagnosis, and issue information including a visual inspection of the product, person picking up the product, date/time for issue and the employee ID of the person issuing the product(s)

I have posted my battle with CAP over this requirement. I lost and waved the white flag. I will do the bare minimum (1 sample) for antibody identification for automated gel, manual gel and tube-LISS methods. Done. They said they would revisit the standard for this year but they have not.

WE would test a segment of the tubing containing the last wash and send it to Chemistry for a Total Protein.

No issues that can't be attributed to temporary cognitive disunion. The instruments do what they are supposed to do and it makes it much smoother for the interfaced result review in Soft. We don't have it set up as Chemistry and Hematology do - we do have to review and complete the result even if normal and/or negative. But one less step for us helps a lot.

Running a 10% bleach solution through the system is part of manufacturer's suggested maintenance. We do this weekly (high volume testing lab). The carrier should have hot water run through from the top for a few minutes to remove encrusted salts. You can use a pipe cleaner for any outlet that is still appears blocked. After running bleach through the system (let sit for 10 minutes), run 4 cycle wash with distilled water, and follow with a 4 cycle wash with saline to ensure no bleach solution remains.

I just answered this question. My Score PASS  

I just answered this question. My Score PASS  

I just answered this question. My Score PASS  

I just answered this question. My Score PASS  

I just answered this question. My Score FAIL  

We have Soft and Epic and they don't manage our remote refrigerators in ER, OR, and ambulatory infusion center. My predecessor had electronic magnetic locks installed on these refrigerator doors controlled by a button located physically in the Blood Bank. There are phones located above/near each refrigerator and the Blood Bank is autodialed when the phone earpiece is lifted. They give us patient information and we press the button to open the door; unit information is verified and records are maintained in Soft. (Emergency released units have attached paperwork to complete and return to Blood Bank as well) I would love to have Haemonetics dispensing refrigerators!

Is your patient either taking Darzalex or Sarclisa or has taken it within the last 12 months?

Level 1 Trauma Stock ED refrigerator with 4 units Low Titer O POS WB

I just answered this question. My Score PASS  

I just answered this question. My Score PASS