tms8313

I was wondering how other facilities are meeting the requirements for CAP TRM.41300 and AABB BBTS 5.28.3 regarding the bedside verification performed by nursing staff before transfusion. We were recently cited for no documentation that nursing staff was reviewing the interpretation of crossmatch testing and if special transfusion requirements are met (CMV, Irradiated, etc). We have that information included on the transfusion report that goes with the product to the nursing unit. We use the Bridge administration system and it records all of the other required information by scanning the patient armband and the blood product. Also the nurses have to answer questions in Bridge before they start the transfusion, such as 1. consent form signed? 2. physician order reviewed? along with some other information. I am wondering how other facilities document what information the nurses are checking. I can add an additional question in Bridge to document that the nurse has checked for special transfusion requirements ordered by the physician but I am not sure how to proceed with the crossmatch interpretation. Nearly all of our crosssmatches are compatible and the RN could document that in Bridge, however what do you all do if you have to give least incompatible units as in the cases of warm autos? It is marked that way on our transfusion reports but I am imagining some of the nurses not understanding the situation and not wanting to take responsibility for giving the unit. Any suggestions, advice or how you handle these situations is greatly appreciated!

I was curious about the transfusion practice of other facilities when presented with a patient that has autoantibodies (excluding warm autos with specificities). If the patient has autoantibodies NOT associated with a warm auto with Rh-specificity what are your protocols for giving antigen negative units? Example: if a patient is identified with an auto-M or an auto-Jka, what units would you crossmatch for transfusion? Our policy states to give antigen negative units if the auto antibody is currently reactive, however our reference lab (who is a certified IRL) does not give the recommendation of giving antigen negative units to patients with any autoantibodies. This can be quite confusing for transfusion service staff who are 90% crosstrainers and usually follows what the reference lab recommends. I am looking for references to present to our medical director to determine what our policy should be.

we have a strict policy about NEVER cutting open a bloodloc bag. I only saw it happen a few times in the first month or so after we started using them many years ago. there was public shaming involved (haha) and reeducation done. I am not aware of it happening again. If for some reason they can't get it open, they return it to us for investigation. This has happened several times and they are good about returning it to us.

We use the BloodLoc system on all of our blood products. When we issue products to surgery, sometimes they go straight to the surgical room in a cooler and sometimes they go to the OR refrigerator. The units are always locked up inside a BloodLoc bag. Transfusing staff must take the products to the bedside where they get the Bloodloc code from the patient's wristband that they have to dial in to the lock on the top of the bag. if they don't dial in the correct code then it doesn't open. this is how we help ensure the patient's safety when products for multiple patients are stored in the OR refrigerator.

we do not want "extra" Blood Bank tubes drawn unless it is a critical patient situation. We made a new policy: If the patient is critical, we hold the tube for 60 minutes to allow the orders to be written and placed in the computer. If no orders are received, then the tube is discarded and a new specimen is collected when orders are placed. The problem we had in the past was either 1) when the "extra" BB specimen was drawn, a BB armband was not issued to the patient (as required at the time of specimen collection). When orders were received, testing done, and products issued, then everything had to be redone because there was no corresponding armband on the patient or 2) a BB armband was issued, but no orders were ever placed so no testing was performed. This confused the OR staff when they saw a pink armband on the patient and assumed a type and screen/crossmatch had been done.

We are also a busy Level 1 trauma center and were cited by CAP and AABB for allowing nurses to sign the emergency release forms. We had to change our policy to only allow physicians to sign the form. We try to get the signature at the time of delivery but patient needs supersede our form so we sometimes have to follow up later. The doc may physically sign the form or more commonly will electronically sign the form which we can print from the patient's chart. We don't specify a specific time limit, but they rarely need a reminder phone call from us, it's usually pretty quick.

that's interesting that everyone has mentioned Helmer i series. That is the freezer that we are having such problems with. We have had it for exactly 3 years and it has been down 6 times in those 3 years. Once it went down in the middle of our CAP/AABB on-site inspection. That was fun.

We have had repeated problems with our Helmer freezer (iPF 125-8). It's been down 5 times in 3 years for various problems. I am completely dissatisfied and would not recommend it. We have other Helmer equipment (double door refrig, cell washer, 2 plasma thawers, platelet incubator and agitator) and haven't had problems.

I was wondering if anyone could give me a recommendation on the type of plasma freezer they are currently using. Also let me know about problems they have had with specific freezers. We are having repeated problems with our current freezer and I am completely dissatisfied. We are researching a replacement. Thanks for your responses!

We are trying to finalize our SOP and I wondered what other places are doing about these questions. 1. What is the maximum number of 5 day Thawed Plasma that you give to a rapidly bleeding patient before switching them back to 24 hour fresh thawed plasma? 2. What is the lower age cutoff to give the 5 day Thawed Plasma and at what age would you NOT give the 5 day plasma? We are wondering what our age cutoff should be for pediatric trauma patients that need plasma emergently. Thanks for any and all responses!!

this was my thought also. thanks!

Just wondering what other hospitals do.... We are a Level 1 Trauma Center. We give one set of O= (consisting of 6 units) to all Level 1 trauma patients. If another set is requested, we switch all male patients and females over the age of 50 to O+ in order to conserve the O= inventory. Now we will be treating pediatric trauma patients which we haven't routinely done in the past. When you are switching types on pediatric male patients, does anyone have a lower age limit to switch these boys over to O+? If the pedi male is 3 years old, would you still switch him to O+ without confirming his type first? What if he is confirmed to be Rh=, would you switch him to Rh+ at any point? Please respond, we are actively discussing our options.

If a patient at our hospital has a blood type, type and screen, or type and crossmatch performed for transfusion of any blood products they must be issued a Transfusion Service armband. For plasma or platelet transfusions, as long as the patient is wearing this armband, they can receive the products since a blood type was confirmed. They may wear this armband for the entire admission. If the armband gets removed for any reason, then the patient must have a blood type reconfirmed again and the patient is given a new armband. Patients are retested every 72 hours if red cells are given and a new armband is issued each time.

I was curious how other places are titering prenatal patients with multiple Rh antibodies (antiE,c or anti-e,C). I "thought" I had read somewhere that multiple Rh antibodies should be titered together for these prenatal patients to get a better indicator of how the baby might be affected. However, when I am trying to find the reference now, I can't find it. Does anyone titer the Rh combo antibodies together or do you perform each Rh antibody titer separately?

Just wondering what other places do...... we have a patient with a previously reacting Lua. It is no longer detectable, but now she has built a Kpa. We are screening units for the Kpa and doing coombs crossmatches but there is a question whether we still need to screen these units for the Lua antigen as well. In The Blood Group Antigen Facts Book it states that Lua is not implicated in transfusion reactions or HDN.