Automation in the transfusion service.

Several instruments are now available for full automation of serologic testing in the transfusion service. Selection of an instrument is based on the facility's needs for testing and its resources. Installation, validation, interfacing, and operations require new skill sets for most transfusion service personnel. The newer instruments are suitable for use in smaller transfusion services, where procedures may not have changed recently and installing new equipment is a rarity. It is difficult to compare turnaround times and the cost of operating the instrument because the number of specimens and specific tests per run and test optimization features of the instrument's software all can vary. Automated instruments have proved to be suitable for testing most, but not all, specimens submitted for testing. While automation reduces overall turnaround time, the quickest way to determine a patient's blood type remains the manual tube test. Autoverification of results and placing these instruments in an automation line in a core laboratory may lie in the future.

ISBT 128 blood labeling: introduction and reference laboratory applications.

ISBT 128 will be implemented in the United States during the next two years. In addition to improving unit traceability and lookback tracking, this information technology standard has the power to detect and prevent errors in data entry by using data identifiers and check characters. Additionally, its ability to encode special testing results such as CMV and RBC phenotype on a label provides laboratories a computerized mechanism to verify the accuracy of such labels.

Modifying blood bank processes for efficiency and effectiveness: a case study.

Among the lessons to be learned in the case study is that the use of quality tools provides the opportunity for success. It will take longer than the group intends to implement change effectively. However, it is better to take smaller steps and be successful than to take giant steps and struggle or fail. Failure to communicate is often the reason that change is difficult. When staff are asked to make changes, the rationale for the change is often essential to acceptance. The quality improvement process requires documentation of goals, decision steps, implementation procedures, and monitoring outcomes. Success breeds success. Sharing the information with everyone from hospital support staff in the laboratory and maintenance department to direct patient care givers at the clinic site or the patient bedside makes everyone a part of the success.

Practical use of computerized hospital information systems to improve blood transfusion.

Data collection can be enhanced with the use of computers. Care must be taken, however, to ensure that the data collected have a purpose and meet either the quality assessment needs or business functions of the transfusion service. Required data elements are frequently in several data repositories and must be merged to obtain needed information. Effective data collection may be hindered by several factors, including a lack of data elements in the computer systems, data retention limitations, and changes in the computer system or collection needs. Personal computers with commonly available spreadsheet and database management software are useful in preparing summarized reports. An ideal report is legibly printed on one side of a sheet of paper and includes graphs and charts that enhance data presentation and facilitate trend analysis.

Blood utilization in adult patients undergoing extracorporeal membrane oxygenated therapy.

BACKGROUND: The impact of extracorporeal membrane oxygenation (ECMO), performed on adult patients, on the blood transfusion service of a tertiary-care hospital was assessed. The quantity and pattern of blood component utilization by these patients were compared to those in a previous evaluation of neonatal patients receiving similar treatment. STUDY DESIGN AND METHODS: The records of blood component transfusion to 74 adult patients, treated with ECMO within a 6-year period, were reviewed. This information was correlated with the clinical indication for ECMO and duration of ECMO treatment. In addition, daily use of components for these patients was studied to ascertain whether the blood requirements were predictable and uniform. RESULTS: Over 15,000 units of blood components, with platelet concentrates making up the largest portion, were transfused to these patients while they were undergoing ECMO. The duration of ECMO varied from less than 1 day to 53 days. However, the length of treatment could not uniformly be correlated with blood utilization or with survival. Daily blood transfusion needs often could not be anticipated, which meant that the transfusion service frequently had to respond to urgent requests for transfusion support. The provision of platelet concentrates proved to be the most difficult part of the maintenance of this program. CONCLUSION: Whereas ECMO treatment of neonatal patients has a relatively minor impact on a transfusion service, the same is not true for a program that uses this form of treatment for adults as well.

Electronic verification of donor-recipient compatibility: the computer crossmatch.

BACKGROUND: This article describes standard operating procedures (SOPs) for a computer crossmatch to replace the immediate-spin crossmatch for ABO incompatibility between patient blood samples submitted for pretransfusion testing and the blood component selected for transfusion. These SOPs were developed following recent changes to the Standards for Blood Banks and Transfusion Services of the American Association of Blood Banks (AABB). STUDY DESIGN AND METHODS: SOPs were developed, utilizing currently available software, for pretransfusion testing. The SOP for donor unit processing entails bar code entry of the unit number, component name, and ABO/Rh type; computer entry and interpretation of serologic reactions; warning of discrepancies between bar code-entered blood type and result interpretation; and quarantine of the donor unit in such instances. The SOP for patient sample testing requires bar code entry of specimen accession number, which accesses patient demographics; computer entry and interpretation of ABO/Rh tests; repeat blood typing at the time of crossmatch if only one patient blood type is on record; and warning if there are nonconcordant current and historical blood types. The computer crossmatch SOP requires bar code entry of specimen accession and donor unit numbers; release of group O red cells pending resolution of discrepancies; and immediate-spin crossmatch during computer downtime. Tables validated on-site prompt warning messages and prevent both computer crossmatch and release if blood components of the wrong ABO type are selected. RESULTS: These SOPs meet the requirements of the 15th edition of the AABB Standards. Projected annual time savings at this institution are > 100,000 workload recording units. Further benefits include reduced patient sample volume requirements, less handling of biohazardous material, and elimination of unwanted positive or negative reactions associated with the immediate-spin crossmatch. Release of incompatible blood components when the wrong patient blood type is on record is addressed by requiring the use of group O red cells in the absence of two concordant blood types, one of which must be from a current sample. CONCLUSION: A combination of existing computer programs and carefully developed SOPs can provide a safe and efficient means of detecting donor-recipient incompatibility without performance of serologic crossmatch.