bbbirder

We haven't done this for emergency issue, but I think it is an excellent idea! We do have physician signature on file for our trauma protocol, when we automatically take 2 O negs to our Emergency Department, and this seems to cover for these first 2 units. Linda Frederick

I must agree with SMW, the CMS "P" codes don't always match FDA approved product codes. When we have HLA matched PLTs, we manually adjust the billing. We are lucky that this is rare for us. I don't know what your LIS system is, but you may be able to create charge rules based on unit/patient markers. Linda Frederick

Thanks, I thought maybe it had something to do with trombones or trumpets.

Someone else asked this, suggesting that this is non-immune hemolysis... could the unit have been mishandled (stored in an unmonitored refrigerator)? was the patient getting other infusions at the time? etc. Linda Frederick

Cathy, we used to freeze control slides as described in the Sure-Tech product insert. These are fixed before freezing. Then one time we had a proficiency testing failure. Turns out that there was a problem with our current lot of fixative, so our frozen control slides were really not controling our entire system. Lucky for us we had only tested one patient with this lot prior to discovering the problem and we could follow up easily. Freezing the control slides made it easier, but we no longer do that. Lidna Frederick

I have to ask: What is a "Tooting Center"? Linda Frederick

Eoin, Where are you getting your bands with 2D bar codes? Do you print these out of your computer system or purchase them? Linda Frederick

This reminds me of a discussion we had about this at our hospital. (I don't know what they ever decided totally, I left that up to the Quality Care Managment and Lawyer types). Anyway, a surgeon said... "I always tell my patients they will be getting a cadaveric graft." To which the director of surgery said, "Half the patients probably wonder if that is some new designer thing? Similar to a Calvin Klein". Linda Frederick

I had this same question, but it turns out our Surgery department tracks the room temperature on every case (it is in the patient's surgical record.) I felt that temperature was sufficient (since I can track which patient the item was issued to.) Also, our Engineering department has records of daily temperature in each surgical suite. Linda Frederick

We extend, up to 2 weeks, for our pre-op patients who sign a form that they have not been transfused or pregnant wihtin 3 months. The only time we have encountered a patient who may have two bands on his/her arm is a patient using a lot of blood and we need a new specimen. Good communication with the nurse usually takes care of this. The nurse can cut off the first band after the last unit from that draw is given. Since most of this type patient is in ICU, the nurse is probably the one collecting the specimen and putting the BBID band on the patient anyway. Linda Frederick

I think you will need to keep tube, especially for the antibody screen and antibody ID. There are patients who may react strangely in gel or who have warm autos that gel enhances and you need tube for them. Linda Frederick

I guess I should have been more clear in my response. We DO have the Echo interfaced to Meditech, we are just not going through the DI Middelware for the interface. I dont' know of any advantage to go through middleware for this analyzer. Middleware seems best if you are going to use autoverification for Chemistry, Coag, Heme, etc. results. I wouldn't want to autoverify BB results (too many messages about patient special needs, etc.) Linda Frederick

We do these on all shiftsl. We have a 2nd tech review all slides (results report is not delayed for this review.) Linda Frederick

I have a whole drawer full, and I'd share them, but we still use our Immufuge. I love that little centrifuge and wish it were still manufactured.

While I am all for bedside scanning, and we want to implement it at our hospital... I know how inventive nurses are (scanning water pitchers, etc.) that some serious monitoring needs to be possible before I jump on that bandwagon. Linda Frederick

We just got the DI in our 'core lab' (it is not up and running yet), but we have not interfaced the Echo and we probably will not. We are primarily a transfusion service, so having automated resulting of the type & screen doesn't really gain that much for us, we still need to get the product assigned & out. To ANORRIS, from what I have heard, Meditech Client/Server interface isn't available yet. We are Magic, so I don't really keep up with that. We are interfaced with Meditech Magic 5.62, currently working on the upgrade to 5.63 (that includes a fix for the antibody screen problems). Linda Frederick

This is an interesting discussion. At our hospital, there is no transfusion committee, these functions are addressed in a peer reviewed Medical Excutive committe or subcommittee. I don't do anything except provide statistics. However, I also communicate directly with the quality care department and will suggest, 'can you review this chart?'. We aren't a large institution, so it works pretty well for some inappropriate use. However, if you are really going to impact use, you need administration at the top on board. In my experience, most pathologists are not willing to question orders and physician education about blood use is falling behind. They may try to keep up with the literature, but mostly remember what the were taught, 5, 10 or more years ago. This is a challenge. Linda Frederick

Some computer systems allow for a second check signature by one nurse while another is logged on (or so I have heard). Check with your pharmacy staff also... if they are doing Bedside Medication Verification, some of these meds also require 2 signatures. If pharmacy has been up with this for a while, they can also tell you the work-arounds nursing has tried. Linda Frederick

We also give surgery extra armbands for rebanding, as well as the form that goes with it. (I like the idea of a sleeve.) At our hospital, one area that gets gold stars for patient ID (other than the lab), is OR. They take their 'time-outs' very seriously. We don't have a problem with OR. If a BB wristband name has one letter different (say the patient name was updated after collection), they catch it and call us. Linda Frederick

Could they put a barrier of some sort between the patient and the band? (cotton sleeve?).

I would love to see your "good book" also, if you can share. Linda Frederick

For us it depends on the type of reaction. If they have hives, no workup. If low grade fever, minimal workup (DAT, etc.) If they have chills, etc. or a more significant fever (over 102) we will do DAT and culture the bag. If they had severe dyspnea, suggestive of TRALI, we'd ask our supplier to investigate. Linda Frederick

I would contact the frozen Tissue supplier directly about your issuing, return, and reissue questions. When our -40 Freezer was down and we had to use an alternative, -32 freezer, they were able to tell me this was OK and we wouldn't have to discard $$$ worth of frozen tissues in 6 months. Linda Frederick

Here is another article on 5 day plasma: Coagulation factor levels in plasma frozen within 24 hours of phlebotomy over 5 days of storage at 1 to 6°C Transfusion Volume 48, Issue 12, Date: December 2008, Pages: 2525-2530 Mark H. Yazer, Andrea Cortese-Hassett, Darrell J. Triulzi Abstract | References | Full Text: HTML, PDF (75K) CONCLUSIONS: The activity of all factors assayed, except for PS, were within their normal range during the 5-day storage period. These results show comparable factor assay levels in TP prepared from fresh-frozen plasma and FP24. Linda Frederick

About interfaces & Meditech. We are Magic and still having interface 'issues', this is complicated by a sudden decision to upgrade our system to 5.63. So I am trying to get 5.62 test validated, waiting to go LIVE with it, then upgrade to 5.63 (and 5.63 has new DTSs related to the interface.) I have heard from some other sites with C/S that Meditech does not have an interface for the Echo in C/S. This is bizarre to me... need I say it? typical Mediech. As for the anti-K's, we have not missed any anti-Ks with the Echo. We had some anti-E's that were very weakly reactive on the Echo vs gel. We sent these to Immucor. Not all reports are back yet. At least one of these was probably IgM. There is another thread related to this that you might want to follow. Linda Frederick