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I just had to share this story...When I worked in a large teaching hospital we had a team of Transfusion Nurses who were responsible for drawing most samples and administering the transfusions. Occasionally, however, physicians (or interns/residents) would draw the samples. One afternoon we received an unlabeled sample drawn by a physician via courier. We contacted the physician and informed him a new sample would have to be drawn. He said he would come to the transfusion service and label it right away. We told him that was unacceptable, however, he insisted. While he was on his way, we put together several samples without labels and placed them in a rack. When he arrived, we presented the rack to him and told him to select the sample to label. He actually tried to feel each tube to find the warmest one and said that was the sample he sent. Obviously we did not allow the sample to be labeled. The story has been told many times!!!

We just switched to the MaxQ MTP coolers and love them! My validations showed it held temps for 24 hours, even when opening the lid every 15 minutes for the first 2 hours and hourly after that. Plus, we filled the cooler with warm FFP (4 units @37C) and cold RBC (4 units @4C). The cooler cooled down the FFP units to 6C within 3 hours. The RBC'S never went above 5C.

Just a thought. With an issue like this you have to come to a point of realizing that you can only do so much especially when much of the process is out of your control. You can drive yourself crazy playing the "what if " game! Once you've done the best you can for your situation then accept that there will probably be a fallible human somewhere in the process who will come up with a creative work around. A nurse will put a unit in the medication refrigerator until she's ready for it or they will put it back in the cooler in OR after it's been setting next to the patient during the procedure, just in case! Accept that you don't have complete control and never will, you'll live longer!

We use 1-6 for coolers, however, the BT-10 only shows breach above 10 so, there's that. We place a NIST certified thermometer in the cooler to show that it is 6 or below upon return. We do not scan these units with the temp gun. It's 1-10 for anything returned not in a cooler.

I'm also wondering how one manages to validate that all units of blood remain within temperature range when the ambient temperature and handling is not consistent. We can't even validate our coolers for the same reason ... and one never knows if the cooler is left open or the units are removed then replaced. Are you using 1-10oC or 1-6oC? FDA instructed us to use 1-6oC for the coolers because they are really 'in storage'. If not in a cooler, we can go up to 10oC because they are 'in transit'. I haven't implemented that part yet, but I will be soon.