bbbirder

It is too bad that your blood supplier won't give you what you are asking for. Can you find another source? I would think Group A platelets would be better than group O, since the anti-B wouldn't be as potent. What about pooled platelets? Some patients do better with those than single donor. If a patient has platelet or HLA antibodies, you really can't worry about the ABO type but instead need to give 'matched' platelets. Perhaps the patient isn't responding for other reasons? Spleen problems? Good luck. Linda Frederick

You should go to CMS to get the details. If your supplier does not bill for the "blood" (and almost no suppliers do--if they bill for blood, they would have a replacement program), they are billing you for processing and that is all you can bill. You can set your price whatever you want. We keep platelets on hand, but have a plt restocking fee, that means our effective cost for platelets is really higher than what our supplier charges for one. Plus there are other costs, transportation, storage, depreciation on storage equipment, etc. The HCPCS codes will depend on what products you use. Go to Section 231 of this CMS document: http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf "When an OPPS provider furnishes blood or a blood product collected by its own blood bank for which only processing and storage costs are assessed, or when an OPPS provider procures blood or a blood product from a community blood bank for which it is charged only the processing and storage costs incurred by the community blood bank, the OPPS provider bills the processing and storage charges using Revenue Code 0390 (Blood Processing/Storage) or 0399 (Blood Processing /Storage; Other Processing and Storage), along with the appropriate blood HCPCS code, the number of units transfused, and the line item date of service (LIDOS). Processing and storage costs may include blood product collection, safety testing, retyping, pooling, irradiating, leukocyte-reducing, freezing, and thawing blood products, along with the costs of blood delivery, monitoring, and storage. In general, such categories of processing costs are not patient-specific. There are specific blood HCPCS codes for blood products that have been processed in varying ways, and these codes are intended to make payment for the variable resource costs of blood products that have been processed differently." Linda Frederick

We are still in the process of validating our Echo and we had one anti-E that was strongly positive in gel, detectable in tube (PEG and N-Hance), but called negative by the Echo (hazy/fuzzy when viewed on screen or with light box). We submitted that specimen to Immucor. We also had a frozen specimen on a patient with an anti-c and we had ruled out the anti-E in gel, but guess, what? it was positive on the Echo. (In that case it really didn't matter too much because of the anti-c). So which is right? As I recall, in the olden days before gel or capture, there were anti-E's that were only detectable with enzyme treated cells. We did not change to enzyme treated screens for every patient. It seems to be the nature of anti-E's to have some variation in them, and they may not be clinically significant. I agree with John, not every technique will detect everything. Linda Frederick

Good luck! I have enjoyed your posts. Please check back from time to time. I must admit I am jealous! Retirement seems too far away for me (and more distant now, as I watch the stock market gyrate!) Linda Frederick

Ditto, ditto, ditto... We just got our Echo, so haven't really started training techs yet, but I agree with what AMcCord says exactly. Our staff has been through tube to ReAct, back to tube, then to Gel. I don't anticipate a difficult transistion to Capture on the Echo. There is always a positive control with the antibody screen, so they have another reminder about what a positive is. We looked at both the Provue & Echo, and the Echo seems much easier to load and operate than the Provue. IMHO. Linda Frederick

We are about the same size as you. We transfuse about 2800 RBCs/year. We keep a pretty big inventory of blood, because we are 2 hours+ from our supplier and along a busy interstate with frequent accidents. We can return RBCs (but almost never do) and PLTs (these are exchanged out 3x per week). Our stock level for RBCs is at 150 of various types, reorder levels vary. We also keep about 100 FFPs and 20-30 Cryos (Cryos almost always outdate.) LF

60 minutes for STATs We can do better than that most of the time, but when you have a night shift with 2 techs covering the entire lab and they are running around doing multiple things, 60 minutes is do-able. Linda Frederick

Ditto! When we went live with Meditech, we never used cards again, except for downtime. We entered antibodies, problems, etc into the system. We reviewed the card file for historical types. (We haven't moved the card file out so we still pull a historical type out from time to time.) I don't think you need to check ABO/Rh records beyond one year. It seems like having both a manual record and computer record it seems like a big waste of time as well as potential for errors. Linda Frederick

Our Quality Care Management department does these reviews. They are mostly nurses, so it helps. And it also keeps me from being the 'bad guy' (on this topic anyway...) Linda Frederick

We bill the product which almost always includes the irradiation fee. If we have irradiated product we need to give to a patient that doesn't need irradiation, I request a manual billing adjustment. There is an interesting discussion on the AABB forum and also the Cal BB society page about irradiation, indication and reimbursement issues: http://www.cbbsweb.org/enf/2008/irrad_reimb.html Linda Frederick

Mabel, Do you test these at 37? My understanding is that unless they react at 37, you can ignore them and I think the 37 reactive antibodies are pretty rare. Maybe you could make two different anti-A1 antibodies? Anti-A1 RT and Anti-A1 37, and make one not significant and the other significant? Linda Frederick

Here is what I know about Meditech and instrument interfacing (Provue, Echo, Tango, whatever.): If you want Antibody screen results to go across, you need to create a new "P" or "G" type test with the T-type individual reactions for cell 1, cell 2. This is a work around only. It will cause problems with antibody screen showing in your history downtime report, if you use it. [We have an NPR for downtime that we created before Meditech had a downtime report available, so we don't use their downtime report.] They do have a DTS (Magic Lab #14465) to fix it to allow antibody screen results to cross the interface. It will be available in 5.63. Unfortunately for us, we just upgraded to 5.62 and Meditech will not load this DTS until our next upgrade. So it will be 18 months or so until our next upgrade. Antigen typing results are a "whole 'nother problem" and won't go across either. We just got our Echo and will be looking to interface it soon. I will be building a new ABS test as a "P" or "G" type test to work around this issue. What computer system you get is usually not up to the Lab Manager or Transfusion Service supervisor, integrated systems are what everyone wants. What instrumentation to get will probably be up to the TS supervisor, unless you are part of a larger group and they want uniformity. We went with the Echo based on what we saw in ease of operation, add on specimens, turnaround time, and ease of repair. We felt the switch from gel to solid phase would not be too difficult (we have been through tube, ReACT, tube-Peg, then Gel, what is another method?) I will let you all know how it goes now that we have the analyzer. So far I really like it. Training was excellent. Excellent materials and excellent instructor. Linda Frederick

Try this link to "Health Care Without Harm". They have listings of DEHP products, including blood bags. http://www.noharm.org/us Linda Frederick

I would keep the patient Rh negative. We upgraded to Meditech 5.62 PP 8 recently, and I am 99% certain the problem with blood type changes was fixed. I don't recall details or the DTS number, but something about this is familiar. Linda Frederick

We are also using tube for ABO/Rh and manual gel for Antibody screen and ABID. We just got our Echo, so are looking forward to training and validating. 1) We do Fya, Fyb, Jka, Jkb in gel. We validated all of these with 20 specimens each. Besides saving reagents, we also have an easier time keeping antigen typing on many units at one organized. 2) If you are doing electronic XM, AABB standards requires both forward and reverse for the retype (Std 5.15.2.2 says two determinations as specified in 5.13.1, and 5.13.1 describes both forward and reverse.) 3) We do DATs on cords from all group O moms and the Rh negs. I would love to get rid of this and only do if there is some clinical evidence of HDN. We don't do elutions on these, except in rare circumstances. Linda Frederick

I think I would rather call a weak or questionable result "Rh negative" and give them Rh negative blood and RhIG than call them positive and have a partial D that gets sensitized. We follow John Judd's recommendation and anything less than 2+ with anti-D in tube is called Rh negative. He recommened less than 3+ when testing using gel. (I am not talking about donor testing, just patient). Not all reagents are the same, and they react with different D variants differently. You should see some variations in reactions with different reagents and methods. There have been multiple articles about this, and most recommend dropping the weak-D test. Linda Frederick

This is the same as we do. If no evidence of Hemolytic reaction, no further workup (except for high fever, if the patient has experienced a fever of >102, we will usually culture the unit, regardless of other findings) For FFP & PLT, we do same thing. Positive DATs after ABO incompatible PLTs are expected, the pathologist will expound on that in a consult. Linda Frederick

If anyone has interfaced anything with Meditech, can you upload Antigen typing results? It seems that Meditech doesn't allow anything except "T-type" and "B-type" tests to be uploaded. We will be getting our Echo soon,and I hope this is wrong, because I'd love to run antigen typing on units on the analyzer and then send the results across on the interface. (That's being optimistic that we can get anything to cross the interface!) Linda Frederick

Here is a link to a CMS web page that is very helpful...(if there is a more recent version, sorry I don't have it bookmarked) http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf Search the document for what you need or start at section 231 related to blood products. Here is what it says about irradiation: 231.5 - Billing for Irradiation of Blood Products (Rev. 496, Issued: 03-04-05, Effective: 07-01-05, Implementation: 07-05-05) In situations where a beneficiary receives a medically reasonable and necessary transfusion of an irradiated blood product, an OPPS provider may bill the specific HCPCS code which describes the irradiated product, if a specific code exists, in addition to the CPT code for the transfusion. If a specific HCPCS code for the irradiated blood product does not exist, then the OPPS provider should bill the appropriate HCPCS code for the blood product, along with CPT code 86945 (irradiation of blood product, each unit). Linda Frederick

We stopped collecting Autologous units about 2 years ago, for all of the reasons you have mentioned. Our blood supplier visits once a week and collects autos, therapeutics, and (occassionally) directed and regular donors. We don't regret dropping this at all. Linda Frederick

Well, I have another question or two related to this... (Has anybody got this working?) Did you change your settings in Customer Defined Parameters for the "BBK Autorelease XM" hours, etc. ? What about your Customer Defined OE/NUR parameters for XM add on hours? It seems that Meditech provided this new 'enhancement' to allow us to extend specimen expiration hours, without making it available in all of the areas we need it. Am I missing something here? Thanks, Linda

Liz, Thanks for your suggestions. When I say 'filter' for the L/R PLT apheresis, I mean the administration set (which does have a filter in it, Yes?). What kind of Administration set are they using? How much extra volume do you allow for these sets? If you are giving apheresis PLTs to a baby, are you aliquoting them in the BB? putting into a bag or a syringe? Thanks... Linda

I wish I could help youm but we just went to Magic 5.62 and the printing that worked in 5.5 no longer works in 5.62.... Meditech is still working on this for us. (How do I add those little cartoons with their heads pounding to this post?) Linda Frederick

We have a computer based training for this. I think the nurses prefer this, since they can do it at their convenience. Linda Frederick

We use Meditech to track our tissues. Almost all are in as Products. There was one kind we had to enter as "Lots" because it used the same lot number for several. It was hard work to set it up initially (entering all the product codes). Sometimes I called it something different than surgery would call it, so that caused some confusion. We have excellent cooperation from our surgery department for this. We have been through several inspections without problems. Linda Frederick