Cathy

The nurses are not supposed to copy the number into the chart, though I can't say it never happens. When a sample is collected and the unique id number assigned, we require the rest of the number 'sheet' to be sent down to us. We just toss it so it is not hanging around on the chart. When a subsequent sample is collected, the blood bank id number must be handwritten on the tube. We tube blood to the OR, they also type in the last 4 digits of the id. Then they place it into a monitored refrigerator up there.

Our OB patients and some of the ED (depending upon symptoms) patients have blood bank hold samples. Label requirements are the same as a type and screen, anything less gets tossed. These samples are held in blood bank. I find that we often spot a 5gm hgb faster than hematology. Also some names become all too familiar, ex multiple antibodies. I might call the ED to find out what's up with the patient and let them know the time frame they might be looking at should blood become necessary. When we receive orders for add on testing, the phlebotomy staff brings the order and the sample to the tech running that test to add the new label to the sample and make the final determination if the sample is appropriate or not.

When the nurse is ready to transfuse, they call us with the name and bb id number. We do a dispense in the computer and tube the blood up. So normally there isn't any more conversation, they wait a few minutes for the tube station to start beeping, then they type in the last 4 digits of the id number that they just gave us over the phone. Thanks!

In your expert opinion(s), does using the secure transaction feature on the pneumatic tube system cover the mechanical barrier question? The blood will not drop at the receiving station until someone types in the same 4 digit code that we put in when we send it. We use the last 4 digits from the blood bank id band. (I know everyone is not a fan of special bb bands. Before we started using them, we used the last 4 digits of the medical record number). In the mean time, I think I am going to start a tally of how many times patients would have to be redrawn for the second type, versus pulling a sample with a different collection time. Thanks!

Thanks for the ideas. I did run the eluate on the 16 cell Immucor panel. We ended up antigen screening for Jka and Jkb. She tested negative for the Jkb so the next time we gave her Jkb negative red cells without incident. I did repeat the crossmatches, they were compatible.

We recently had a patient who we were sure must have had a hemolytic transfusion reaction but we could not find any antibody (gel, liss, peg, you name it). The dat was negative both in tube and gel. How could we NOT try an eluate. (We never found an antibody in the eluate either.)

We do much of the same that has already been listed except we use the secure transaction. We type in the last 4 digits of the id number and the tube arrives at the nursing station and beeps until the receiver types in the same 4 digits. Then the tube will drop. We have four new O.R. rooms. We can send the carrier to different addresses (same physical station located in the hallway) and the beep will be heard in the appropriate O.R. room so someone knows the products have arrived and can take care of them. We send no more than 2 units per carrier and we use red carriers just to make them stand out. The only time we have ever 'lost' a unit is when there has been a malfunction and there is an extra carrier some where in the system. The system appeared to be one transaction behind. So now after the system gets repaired, we try the secure transaction with an empty carrier to be sure all is well again.

We would do a gel crossmatch since there is no way of proving if it was clinically significant or insignificant.

We do a type and coombs on the baby, heelstick if the cord is unavailable. If the mom is available, we do an antibody screen on her, (on the baby if she is not). We always give group O rbcs. As long as the baby remains inhouse, we do not repeat the testing for up to 4 months. We do not crossmatch.

I would check the sample for fibrin, respin and retest. If it's still mixed field I would test with tubes.

Is it just her personal opinion? Maybe she can direct you to the regulation?

How about Serum Indirect Antiglobulin Test?

Oh my! I think I'd like to see some documentation regarding the pump.

Wow, we have been keeping them indefinitely! I'll have to check into this!

Hi, After defining our plan, we started by asking our Red Cross supplier for a list of products they send us. We figured that way we would be able to enter only those products that we actually get. So that narrowed things down. We were told right away that they would never be sending us products with 450ml as the original collection volume, only 500ml. That really helped. As far as the number of characters for produt codes in BB3, I think we only need to enter the first 5 characters. I think the last 3 are donation type and division characters. I started off by identifying the product codes that I thought would match what we have built for products. One issue I ran into was having too many isbt codes to enter per product; especially since we'll need to be codabar AND isbt 128 compatible for a while. We found out from Cerner that there is a way to enter extra product codes by writing directly to the tables. I haven't done that yet. Most of what we have needed so far we have gotten from the Red Cross and ICCBBA website. I am curious as to what other Cerner Classic users are up to. Cathy

We stopped doing (heat) elutions on babies of apparent ABO hdn a few years ago. There are still some instances we will perform them: if specifically requested; if the mother has an antibody; or if the baby needs transfusion. We put a comment on the positive dat result, "Probable ABO incompatibility". It seems to be working just fine for us. It is especially nice when it's a busy weekend and there are just a few techs on!

We don't either.

How do you do that in cerner classic. When you print the form with unit # ...you do not have patient's name on it. Is that correct? I figure you would have unit type and expiration date on the form. Can you please write here where do I go to print this form. DO I need to build in BB3 or is already there and we are not using it?? I'm not sure who is on what version here. In BB3 under the product, you can define what sort of tags you want to print. We have the 'emergency' tag checked as an option for our red cells. Then we have a 'patient' who's name is 'code 11, trauma' and leave the id field blank at that time. When we have to respond, we use DIS to dispense to Onegs to this 'patient'. When the patient used the blood we hand write the name and id on the form and use RBB to 'bring it back' and redispense to the actual patient.

We have a super group that includes the following groups: ABO DAT Overall interp: We have control cell groupings for patient and unit pre and post ABO and patient DAT. We also still have a manual form that goes along with this. Hope this helps. Cathy

In Cerner Classic we have a "Trauma Pt" that we dispense to. It is a QC patient so it never purges. Does Soft allow for QC type patients?

What do you all do when you find an M on your OB patients? We have found several that react in gel and are negative in tubes and the OB physician insists on having a titer.

We were taught that leaving the air space in the microtube was the goal, but not a necessity and reactions would not be affected. We don't require it.

Our OB patients also have a CBC and hold sample drawn upon admission. The hold specimen is banded for possible transfusion. The type and screen is usually requested for c-sections, and as needed otherwise. We get all the cord bloods to hold for two weeks. When we close out this cord storage order, we fill in the mother's type. It is a required field so if the floor forgets to order a workup on an Rh neg mom, we will catch it. If we don't have a type on file, we perform a type at no charge to the patient on that hold sample.

We do them automatically and the charge for the panel is included in the titer charge.

I don't know of any documentation, but we would give the unit to an adult also.