2019 Advanced Track Webinars Program... · Transfusion Medicine VGH: Supports transfusion testing for 4 satellite hospitals including BC Cancer – Vancouver Center Performs 47,000

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Handouts

http://www.immucor.com/en-us/Pages/Educational-Program-Handouts.aspx


2019 Advanced Track Webinars

Link to register: https://immucor.webinato.com/register

9 January 2019 ADAMTS-13 Testing, TTP, & MORE

6 March 2019 Advanced Antibody Work-Up Techniques: MMA & Molecular Testing

10 July 2019 Platelet Refractory Patients

7 August 2019 Monoclonal Therapy & the Blood Bank

11 September 2019 ImmuLINK for Laboratories of ALL Sizes

6 November 2019 Sickle Cell: In the transfusion service and in real life!


2019 Advanced Track Webinars





learn.immucor.com


Continuing Education

• PACE, Florida and California DHS

• 1.0 Contact Hours

• Each attendee must register to receive CE at: https://www.surveymonkey.com/r/ImmuLINKforLaboratories

• Registration deadline is 27 September 2019

• Certificates will be sent via email only to those

who have registered 11 October 2019


• Course content is for information and

illustration purposes only. Immucor makes

no representation or warranties about the

accuracy or reliability of the information

presented, and this information is not to be

used for clinical or maintenance evaluations.

• The opinions contained in this presentation

are those of the presenter and do not

necessarily reflect those of Immucor.

By: Nancy Harrison

OBJECTIVES

• Introduction to St. Dominic Hospital

• Provide information about our Blood Bank.

• List automation with ImmuLINK and ways it is used in patient testing / data storage.

• Provide insight on Galileo Echo upgrade 2.0

10

About Our Facility

571 Acute Care Facility

Hospital Laboratory – full service with active outreach reference laboratory

11

St. Dominic Blood Bank

12

• Hospital Transfusion Service

– Hospital, 2 LTACs, Outpatient Surgery Center

• 13 employees

– 10 full time MTs plus 3 PRN MTs

• 8-hr shifts plus 7-on 7-off evening &

7-on 7-off night shift.

Blood Bank Automation

13

• 2008 – Upgraded from ABS 2000 & installed 2 Echo instruments.

• 2014 – Implemented ImmuLINK 1.7

• 2019 – Echo v2.0 / ImmuLink upgrades:

–Both instruments completed in April.

– Scheduled on different weeks.

Blood Bank Echo Upgrades

14

• Fall 2018 -Decision to upgrade to Echov2.0

• Early January – Dates set

• Pre-meetings to review Better Blood Banking Guide (BBBM and BBTS)

• Many informative communications with BBBM, BBTS, FSE, and ImmulinkPM

- Ensure understanding of process

- Ensure Arrival of reagents and Echo parts

- Ensure connectivity with ImmuLINK

- Post Upgrade follow-up

Why Stay with Echo and Upgrade?

15

• Echo / ImmuLINK Functionality

• Fast turn-around-time

• Superior sensitivity over tube and gel

• Ease of use

• Instrument Reliability

• Immucor Support and Service

Blood Bank Echo Upgrades

16

• Positive Total Upgrade Experience.

• Three working days or less to completion.

• Approximately 30 samples used for testing.

• Upgrade day – 5 hours hardware upgrade. NOTE: Immucor is aiming for 4 hours or less, however our facility upgraded ImmuLINK at the same time and lengthened time slightly.

Echo Upgrade Support

17

• Immucor Support during the upgrade:

• FSE communication

• BBTS on-site assistance - invaluable

• Validation panels provided by Immucor -timely / performed as expected.

• FSE / BBTS provided real-time instrument inservice to ensure our understanding the differences between our current Echo and Echo v2.0 especially camera functionality.

Upgrade Impact on Processes

18

• Change in blood bank processes:

• Improved performance will boost staff confidence in the instrument.

• Performed fewer bench antibody screens.

• Ability to run more antibody identification panels on Echo v2.0.

• Stopped reviewing all negative reactions.

Echo Upgrade Benefits

19

• Key benefits of the upgrade:

– Image quality

– User interface

– Reliability

– Improved process workflow

– Performance in results

Automated Weak D Test

20

• Rationale for Implementation: It was easier to consider running Weak-D as a reflex test since we run Cord Blood samples on the ECHO

• Validation (PQ) Testing:– 40 samples were run using tube method and

Solid Phase.

– 20 positives and 20 negatives

– 100% correlation

Automated Direct Antiglobulin Test

21

• Rationale for Implementation: there was a better flow in the work up if the crossmatches were done by the same method, with the same sensitivity.

• Validation (PQ) Testing:

– 40 samples run using bench and Solid Phase

– 30 compatible (negative) crossmatches and 10 incompatible (positive) crossmatches.


Automated Pediatric Sample Testing

22

• Rationale for Implementation: there was a better flow in the work up if the crossmatches were done by the same method, with the same sensitivity.

• Validation (PQ) Testing:

– 40 samples run using bench and Solid Phase

– 30 compatible (negative) crossmatches and 10 incompatible (positive) crossmatches.


SDH Blood Bank & ImmuLINK

23

• Cerner Millennium

• Echo automation with ImmuLINK

• Computer (Electronic) Crossmatch

• Perform Pediatric / DAT cord blood testing on Echo.

• Dara / Sickle Cell / Multiply Transfused Patients

Workflow

• Orders come into ImmuLINK via LIS.

• Tests populate on the Echo via interface.

• Tests run/completed.

• Echo set for 1 step approval.

Approval Transmit to ImmuLINk

Results approved in ImmuLINK; populated

to LIS; then verified/released.

24

Benefits of ImmuLink

25

Password Protected

Different Security Levels of Users

Color-coded, User/friendly Screen

Multiple Search Filters

Minimal Problems

Improved Archive Function

ImmuLINK Worklist

26

ImmuLINK Results by Sample

27

ImmuLINK Archive

28

Assessors really like how quickly patient and QC results can be accessed in the Archive function of ImmuLINK!

Validation Testing Plan

29

A. 30 Adult Samples

All Groups and Rhs

At least 5 Positive SDH AB Screens

Panels, Antigen Typing, Crossmatches,

Confirm, etc.

B. 10 Cord Blood Samples

All groups and Rhs (Weak D included)

At least 4 Positive DATs

C. Immucor – provided Validation Panels

Regional Support Applications using ImmulinkTM

Vancouver Coastal Health

Lawrence Sham, MLT

Vancouver Coastal Health

Lower Mainland Pathology & Laboratory Medicine

September 11, 2019

Background

Courtesy of Google EarthImmucor Webinar Sep 2019

31

Vancouver Coastal Health Authority (VCH)

9 hospital health authority (HA) with large variation of hospital sizes

Provides health services to parts of the lower mainland, including the

sunshine coast and sea-to-sky corridor

VCH serves a population of about 1.2 million people

3 of the largest hospitals in the HA perform automated transfusion

testing:

Vancouver General Hospital (VGH)

Lions’ Gate Hospital (LGH)

Richmond Hospital (RH)

Vancouver General Hospital (VGH)

Second largest hospital in Canada

Teaching hospital affiliated with UBC Faculty of Medicine

Level I Provincial Referral Trauma Center (1 of 3)

Provides specialized and Tertiary Services to Adult patients (no maternity)

including:

Cardiac Surgery

Internal Medicine

Neurology

Burns Trauma

ECMO support

Provincial referral center for:

Adult leukemia and bone marrow transplant

Solid Organ Transplant for Lungs, Liver and Kidneys (1 of 2)

Apheresis activities including plasma and sickle cell exchange transfusions (1 of 2)

32Immucor Webinar Sep 2019

Transfusion Medicine VGH:

Supports transfusion testing for 4 satellite hospitals including BC Cancer –

Vancouver Center

Performs 47,000 type and screens annually transfusing 25,000 Red Blood Cells

Is the VCH regional referral site for all antibody investigations

Automation includes 2 Immucor NEO® and 1 Immucor ECHO®

Backup method is PEG IAT by tube

LGH Community hospital serving North Vancouver

Regional referral hospital for the Sea-to-Sky region


Automation includes 1 Immucor ECHO®

RH Community hospital serving Richmond


Automation includes 1 Immucor ECHO®


ImmuLINKTM

Centralized Data Manager for Immucor Analyzers (NEO® & ECHO®)

ImmuLINK middleware allows web-based review of data and results from

multiple analyzers

Bi-directional interface with VCH Sunquest 6.4 and 8.1

Patient demographics and tests ordered are transmitted to ImmuLINK from which

the analyzers can then download

Along with results, images and log files are also transmitted

Consolidated test results can be printed by Sample ID


ImmuLINK – Example: Result by Sample


ImmuLINK – Printable Reports


NEW Positive Antibody

Screen requiring STAT

AI Process

Run Ready-ID on ECHO STAT

Order VAI* Test in

Sunquest

Complete Referral AI

Request Form

Ensure timing of Panel

Completion is recorded

Fax & Phone request for STAT AI to

VGH

Order Additional Samples if

needed

Package Samples for

Sendout

Send out samples via

CAB or COURIER

Print Panel & Screen Report

from ImmuLINK

Perform Exclusions and

Initial Conclusion

If Additional Solid Phase Panels are...

Arrived

NOT Arrived

Contact RH / LGH

to perform panel testing

Receive Call and run

requested panel onto ECHO STAT

Phone VGH when testing

complete

Samples arrive at VGH

PhoneRH / LGH with Final

Results

RH / LGH to order

Phenotyped Units if

required

Crossmatch Units,

Phenotyping as required

Fax & Phone received from

RH / LGH, note time of

Panel Completion

RH

/ L

GH

Pro

cess

VG

H P

roce

ss

Complete AI Process

Not RequiredWait for

Samples to arrive

Required and if Samples

have...

SAMPLES

If Patient still at RH / LGH...

* RH use STAT priority LGH use Urgent priority

Referral Antibody Workflow


Referral Antibody – Example STAT AI from LGH – Initial panel run prior to sample send out

Results transcribed onto worksheet

Anti-E identified and LGH notified


Referral Antibody – Example STAT AI from RH – Initial panel run prior to sample send out

Remaining exclusions performed using PEG IAT

Anti-c, unable to exclude E39

Immucor Webinar Sep 2019

Instrument Reagent Performance NEO® & ECHO® both have printable reports to summarize analyzer

reagent performance For NEO® - built-in statistics feature

Difficult to use & limited evaluation options

Only keeps summary information until archive

For ECHO® - simple summary print out

no method to specifically look at screen lots and indicator cell lot combinations

Includes QC results as part of summary statistics


ImmuLINK Data Extraction and Export ImmuLINK – Centralized Data Manager for Immucor Analyzers (NEO® &

ECHO®) All result data exists within ImmuLINK

Result extraction tool created in ImmuLINK

Data is extracted exported to Microsoft Excel


ImmuLINK Data Extraction and Export

Missing ingredient – Indicator Cell Lot Numbers

Manually retrieved by reviewing log files of QC results in ImmuLINK (resource

intensive) and reapplied to database

From ImmuLINK Added


Data Analytics

Data compiled using Excel to show rates of antibody screen results for

each combination of Antibody Screen and Indicator Lots for each site


Noise Rate

≤ 2.5%

2.5 to 5%

5% to 10%

10% to 15%

> 15%

0.0%

5.0%

10.0%

15.0%VCH - Noise Rates for 3 Cell Screens

E00416 E01450 E01451 Overall


R746

R757

R758

R766

R771

R779

R781

R792

R804

R820

R821

R831

Data Analytics

More recent data!

45

Post Camera Upgrade


0.0%

5.0%

10.0%

1-Feb-19 1-Mar-19 1-Apr-19 1-May-19 1-Jun-19 1-Jul-19

VCH - Noise Rates for 3 Cell Screens

E00416 E01450 E01451 Overall

Noise Rate

≤ 2.5%

2.5 to 5%

5% to 10%

10% to 15%

> 15%

Lot Feb Feb Feb Feb Mar Mar Mar Mar Mar Apr Apr Apr Apr May May May May May Jun Jun Jun Jun Jul Jul Jul

X492

X494

X496

X500

VCH – Noise Rates for 2 Cell Screens

Lot Feb Feb Feb Feb Mar Mar Mar Mar Mar Apr Apr Apr Apr May May May May May Jun Jun Jun Jun Jul Jul Jul

R030

R031

R044

R055

R068

R069

R084


Data Analytics

Not all flagged results are due to reagents

Dried red spot on flatfield causing positive reactions at location D2

Due to how plates are loaded for screens, it would only occur if minimum of 6

samples were run from fresh plate


Summary

ImmuLINKTM is a web-based middleware application which links all

regional Immucor Transfusion Medicine Analyzers (NEO® & ECHO®)

Bi-directional interface with hospital LIS

Receives all test data including reagent lot numbers, reaction images, log files

Sample specific result reports can be printed

Integrated into Referral AI Process at VCH

Awaiting integrated panel reports or antibody identification methodology within

ImmuLINKTM

ImmuLINKTM is also a data warehouse for all testing performed

Data extraction tool built within ImmuLINK to export results

Potential for data analytics to assist in identifying and troubleshooting instrument

and reagent issues

Integrated into troubleshooting workflow at VCH, performed as needed



Continuing Education

• PACE, Florida and California DHS

• 1.0 Contact Hours

• Each attendee must register to receive CE at: https://www.surveymonkey.com/r/ImmuLINKforLaboratories

• Registration deadline is 27 September 2019

• Certificates will be sent via email only to those

who have registered 11 October 2019




Thank you!

Documents

2019 Advanced Track Webinars Program... · Transfusion Medicine VGH: Supports transfusion testing for 4 satellite hospitals including BC Cancer – Vancouver Center Performs 47,000