I just discovered that if a historic clinically significant antibody screen is positive, but the current sample is negative...the reactions are being reported out as negative, but the interpretation is being reported as positive.

 

Anyone heard of this???

 

Where could they have gotten justification????

Report as NEGATIVE with a comment "Previously detected Anti-[] is not detected at this time."  Screen for antigen compatible unit and crossmatch.

There are several antibodies that will have titres that go undetectable with time - the most common one being Anti-E. This is why it is important to merge duplicate records (but merge with full criteria met) to prevent a previous positive being lost.

Sounds like some people are in the bad habit of just plain articulating something incorrectly. I bet its been done for years ("we've always done it this way"). 

 

We do something similar to what rrcc1974 is doing- we note  "historical (or previous)  Anti-X do full crossmatches with X-neg units. "

So a tech is manually entering the interpretation as positive?  It's not a computer glitch?  When we enter our history comment, we enter "KNOWN ANTIBODY" if there is a previous antibody, even if the current screen is negative.  Our computer (Meditech) has a pop-up that alerts us to a history of antibodies or special needs (IRR or CMV-) and we order gel crossmatches and antigen negative units.

Like rrcc1974

we do the same as rrcc 1974.  reported out as negative, but with a comment in the antibody identification field that states the historical antibody that has fallen below detectable levels.  we found that reporting out only a negative screen (without the comment) confused the docs and the nurses didn't understand why there was a delay if the screen was negative

Correct...not a computer glitch...written in the procedure to "change" the negative interpretation to positive. Causes the LIS to give a QA failure which is then overridden. Then the procedure tells them to order the ABID, enter the previously ID antibody and add a comment that the antibody is below detectable limits. I am mystified!!!! Any inspectors out there with an opinion and a few standards I can use to shoot this down???? I know that if I answered a CAP survey...it would fail!

 

So the results are

SC1 = 0

SC2 = 0

SC3 = 0

Interpretation = POS

ABID = anti-E, currently below detectable limits.

Same as rrcc1974; our computer system will not allow electronic crossmatch if there is a previous antibody on record even if the current antobody screen is negative. Unfortunatly the system does not require an AHG xm for patients with clinically significant antibodies and will let the tech perform an immediate spin xm.  

Besides the technical issue, I believe that if you order (and charge) a Medicare patient for tests that are not performed (ie: Antibody Panel), it could be considered to be Medicare fraud.  (That's not somewhere you want to go!)

 

Donna

Besides the technical issue, I believe that if you order (and charge) a Medicare patient for tests that are not performed (ie: Antibody Panel), it could be considered to be Medicare fraud.  (That's not somewhere you want to go!)

 

Donna

 

We're not in the US but we use a BS (bad sample) set and a COM (comment only) set for rejecting samples and giving 'advice' about previous antibody screens. In the old days we would NA the results but it is frowned on now.

I agree with all, report out your test results as they really are. You wouldn't report a negative rapid strep or flu just because they were positive in the past. Use a comment as suggested to clarify if you want. And I concur that it would be fraud to charge an ID if you didn't do one.

Like rrcc1974 and several other posts, we would always result a negative antibody screen as negative and add a comment about the previously detected antibody.  We have a separate test we can order called "Blood Bank Info".  It is added automatically to any antibody ID and we can also order it ourselves when the antibody screen is negative but we want to provide the information about the previous clinically significant antibody.  We have a number of canned comments but can also enter a  freetext comment for any information we want the MD to see.

 

You might be able to use this CAP standard as reason to stop overriding the interpretation.  I wouldn't think that you would have that defined in your procedure for interpretation of negative results as a positive.  I'm not sure you will find a concrete regulatory reason to change the practice, but personally I wouldn't want the techs to get in the habit of overriding QA failures in the computer system.  And you do need to credit the antibody ID charge, if you don't do one.

TRM.40050

Agglutination/Hemolysis Criteria

Criteria for agglutination and/or hemolysis are defined.

NOTE:  Criteria must be defined in the procedure manual to provide uniformity of interpretation of positive and negative agglutination and hemolysis results.

You wouldn't report a negative rapid strep or flu just because they were positive in the past.

 

That's like comparing apples and oranges. In fact it's like comparing potaotes and oranges... Antibodies don't go away, they just reach an undetectable titre.

I'm actually OK with this, as Auntie-D stated above, the Anti-Jka is still there, it is just not demonstrating.

 

We do something similar, for the reason AuntieS stated above: we had an Infusion Center patient with 4 antibodies and they knew that it took a long time to get units ready.  Over the years they started "going away" and the antibody screen was finally negative.  When we resulted it this way we got a LARGE number of complaints from the doc, nurses, and even the patient's family.  As much as we tried to make them understand, they didn't.

 

We also don't want to charge them though for the ABID if we are not performing it so you would need to credit that test to stay compliant.

You're right of course, Auntie, there is a big difference. Is this a better analogy (maybe apples to pears, at least back in the fruit family!): "Small amounts of IgG and complement that are lower than the detection level of routine testing techniques appear to be present on all red cells." (AABB Tech Manual) One could then result negative DATs as positive because if our techniques were sensitive enough we would have detected them.

 

I just have an ingrained feeling that a lab result is inviolate and should be reported for what it is. I fully appreciate the communication and comprehension issues involved, but it seems that the explanatory comments that many tack onto the negative result would take care of that outside of the lab, and our own files, computerized warnings and protocols inside the blood bank should ensure that the patient receives appropriate blood, even with a negative test result.

Edited December 11, 201410 yr by Dr. Pepper

I do not think you should never change antibody screen result negative to positive. Your test result was negative screen so it should be reported as such. by changing it to positive , you are actually falsifying the records. 

Re: antibody in past? we do not worry about positive in the past and negative now as floor can view patient prior record in EMR and if they have a doubt they call blood bank regarding delay. 

Besides the technical issue, I believe that if you order (and charge) a Medicare patient for tests that are not performed (ie: Antibody Panel), it could be considered to be Medicare fraud.  (That's not somewhere you want to go!)

 

Donna

 

I'm with Donna on this one. You can't charge for something that isn't being done.

Thanks everyone.

We are not charging...good news.

I agree with everyone about not changing the results.

I like the ordered test suggestion whereby we can add additional comments.

I have posed the question to CAP...and will let you know what they say.

So they're also crediting the patient when the AB ID is ordered? Or do you have some other way that charges populate to patient accounts? Even if CAP gives their blessing it just seems like that process is looking for extra ways of creating human errors.

We report the antibody screen as negative, then add a comment "antibody not demonstrable: anti [ ]".

We do the same as rrcc1974.  I have our LIS set to flag any units not screen when selecting for crossmatching with a history of  significant antibodies.