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We used to have sign in our BB: The Buck Stops Here. Of course someone altered the posters to "The Buick stops here". My boss was pissed off about that. The concept being that if you have a system of multiple checks and balances you better make sure the first one works. I have seen this concept evidenced too many times in my career. People get complacent.

As Joanne mentioned above, no system is fool proof and there are lots of creative, inventive fools to prove it. Keep your system as simple as possible which should minimize the need for creative people to find ways around it. Now to your question, does it actually help prevent problems? Probably a few but certainly not all! I've seen people become lax in their diligence when they assume they are protected by the system. They seem to assume that if they make a mistake someone down the line with catch it. This is something to be avoided if possible. The only way that I know of to prevent this type of mind set from developing is through education and convincing everyone involved in the process that their step is critical and by keeping it simple they will be more likely to perform their step as instructed.

So sorry to hear this. My condolences.

Unless things have changed, I would consider the length of time from issue to completion of the transfusion more important than the time from issue to start. I'm assuming that a unit still has to have the transfusion completed within 4 hours. As for start time, that was initially instituted for returned units to be placed back in the refrigerator for reissue and as stated above 30 minutes is way too long. The 30 minute rule was instituted when blood was issued as whole blood in glass bottles and I doubt in anyone currently following this website ever saw that, me included! Time to drag a few nursing protocols into the 21st century!

If you set a time, such as less than 30 minutes, and they start the transfusion at 30 minutes, you can be cited by Joint Commission or FDA if they do a trace of that unit - unless there is a deviation from policy report on file. The 30 minute start time may be in the nursing policy, but when a tracer is performed, the deviation will fall back on the transfusion service to correct. Although we did ask that the nurses do the preparation before picking up the unit, there would be a phone call saying the start of the transfusion was delayed for some reason. (IV infiltrated while picking up blood is one I remember). When we started taking temperatures of returned units, we learned they were usually only acceptable to be returned for 15-20 minutes, depending on how they were handled after leaving the Blood Bank. After much debate, we changed the policy to start the transfusion as soon as possible with the emphasis on completing the transfusion within four hours of leaving the Blood Bank. We did require them to return the unit to the Blood Bank immediately if, for some reason, the transfusion were cancelled.

We use started within 15 minutes of release. Our experience is that after 15 minutes, rbc temps are too high to return to inventory. We do the same as far as if Nursing wants to return but will continue the infusion as soon as they fix "whatever",i.e., keep the unit on the floor.

That is not unique to north of the border

I just answered this question. My Score PASS  

Guidelines in Australia are pretty similar to the UK guidelines as far as I can see. https://anzsbt.org.au/wp-content/uploads/2018/06/GuidelinesforTransfusionandImmunohaematologyLaboratoryPractice_1ed_Nov20_.pdf They require as well a second ABO typing.

I always 'balk' at this idea because as we all know, the probability of two patients having the same blood type is high. We have had a few instances over the past few years where a wrong patient was drawn (we use BB Bands so it's very obvious) and they were the same blood type but one had antibodies and the other didn't. And yes, there are those who have had to come up with 'defensive measures' to 'assure' that there is no 'cheating', e.g. RN draws 2 samples and holds one in case the BB asks for a second, a witness (do you really think that happens as intended?), different colored tubes for the second draw (assuming they don't draw the wrong patient twice). I could go on and on about this ... but that wasn't your question, was it?

The US has many different organizational blood suppliers. While some organizations are national like the American Rec Cross (ARC) there are many regional and even local organizations. In my experience, each center has their own screening policy, which is determined by their hospitals requirements. A region with a high sickle cell population may send all (or most) new African American donors for molecular testing, while other regions may only screen units when specificities are needed. So, when a blood center has an aggressive screening policy, or when they are looking for specific phenotype may affect the frequencies hospitals encounter. This explains Cliff’s and my experience described above. Also, the local donor population, and/or if (and when) the blood center imports units from a different region may impact the antigen frequencies hospitals encounter . As described by other posters above, I use the antigen frequencies to primarily determine the order in which to screen antigens and to manage expectations. For example, when I need to screen for R2R2 K- units there is an approximate expectation of 2%. I would therefore screen batches of 100 units; on one occasion I found zero units, on another 9 units with the norm being between 1 and 3 units. I am jealous screening for R2R2 K- units (or any Rh combo) would not be needed in the UK!!

I agree with those who 'don't bother' with the actual math ... between 'natural selection' and blood suppliers 'holding' certain antigen types, exact math is just an academic exercise. To be practical (considering tech time and reagents are valuable commodities): If the patient's plasma contains demonstrable antibody, crossmatch a batch or two of units then do the antigen typing on the compatible units only. No luck = order antigen-neg from the supplier. If the patient's plasma is negative, then screen (highest frequency first) a batch or two of units. Again, No luck = order antigen-neg from the supplier.

Thanks, Sandra. As I'm sure you knew, I am aware of the answer - no way, no how are blood suppliers going to "discard" ~10% of their product. But I think it's important to consider the consequences of some of the now routine testing algorithms. No testing mean results are unknown, but once one has information, one may be required to take action. Many transfusion protocols for chronic users involve Rh (C/E) and K matching - there's another batch of donors whose (partial) phenotype is known and considered to be quite immunogenic. It goes on. I do find it interesting that your system "hides" the K+ status, but openly prints the K- attribute on the label. Another thought: If the K type of all of the patients were known, they could get the K+ units. The antigen frequencies should match up.

As David said there isn't a BB standard for time frame a transfusion needs to be started but for some reason this time frame is in the nursing policy, theirs is 20 minutes. Where they got this information I don't know. Anyway if blood is sent to the floor and it isn't going to be started in 20 minutes and the floor asked calls the BB (before they actually return it) we tell them if they are going to transfuse and it is will be completed within the 4 hours that it was issued to the floor keep it, otherwise it will be discarded (if temp is greater than 10 degrees)

There is no standard that requires a transfusion to be started within a certain time frame from release. the only timing that is critical is that the unit needs to be complete within 4 hours of release.

If we are giving out blood tagged for a specific patient they are expected to do 2 person ID and they do it without complaint. It's very quick, but it's done. Anesthesia is very good about participating in the process if they are present. We do skip the FinalCheck locks for mass transfusion protocol, so there is one step in our normal process that is skipped. If at all possible we are hand delivering the blood to the patient location. (3 techs on during the evenings and 2 techs on at night to cover the entire lab, but they will call in help if they think they need it.) If we are sending blood to ER for more than one patient, we will post someone in the ER, outside the door to the treatment room, to ensure that blood is going to the correct patient. On evenings and nights that will be someone who has been called in to help. It might be our medical director - he's very good about coming in to make sure that everything is going well. He even answers the phone. (Yes, I do know how lucky we are to have that kind of support!)

This may shock anyone using Meditech TAR at their hospital but we have successfully implemented TAR in ED and OR (i.e. anesthesiologists) this year !

It is with enormous sadness that I have to tell you that, having just arrived back from a short break, I have been informed of the death of Prof. Dave Anstee - one of the greats of the world of Blood Transfusion and Blood Group Serology. I am devastated.

I am so sorry to hear this

Thanks for the update, and very sorry to hear this.