Eagle Eye

i am in for cofee John.

You are to be commended for going the extra mile to ensure safe patient care.
Like others here, i would suggest at this point that you put all of this stuff into a document (impassionately written of course).  End with your concerns about patient safety, corporate compliance, etc.  Be sure to list all of the management people you have alerted with dates.  Then send the email it to all management and administrators above the BB and Lab (including directors and V.P.s)   You should have a corporate compliance officer you need to send a copy to as well.
Hopefully some responsible person will realize that they can no longer ignore a disaster waiting to happen, as you will have created proof that all responsible parties were alerted.  
Scott

Send him on his way now, while he is in his six month probationary period.  It will be much harder to do later.  You cannot manage an employee whom you cannot trust.

John, it's hard to believe that you have to explain who you are after all these years but I guess there are lots of newbies and you aren't on here as much as you were "back in the day."   We've probably been talking online for over 20 years now.  Wow!  Remember Y2K???  We probably hashed that out together online. 

I want to preface the following remarks by saying that I am, or at least spent over 35 years, a blood banker in various capacities.  I am one of you. 
Blood bankers, with good reason, can generally be described as untrusting to the point of paranoia.  No one can do the job as well as we can and that includes other blood bankers.  I have never known one of us who would willingly trust a sample drawn at another facility.  It's hard enough to trust our own phlebotomy staff!  I don't even want to get into nurse draws!  We are this way because we understand the potential dangers and in all honesty most of this comes from a true concern for patients we never personally see.  I had one staff member quit a blood bank day shift to work as a generalist on the night shift because she was convinced that the use of the new automated analyzer would result in the death of all of her patients because she would not personally be doing the testing.  Granted that's a little extreme but it is an example.  
So to answer the original question of this thread, I am fairly confident you will find little or no support for "using a blood bank sample drawn and tested from another facility".

I agree entirely David, for the USA and others, BUT, have a look at the flag besides gagpinks' name; it is the Union Flag.  This means that she is working in the UK.  In the UK, all of the units are typed for ABO, D, C, c, E, e, K and, now, Hep E by the various blood services, so there is no added cost to selecting Rh and Kell antigen matched units of blood.

In my experience, there have been a few occasions through the years where "added" labels (i.e. Antigen Negative; CMV-; Sickle Cell Negative; Unit Number labels on back of bags) get stuck onto a unit that they are stored next to.  Obviously, it would be very dangerous to have a unit with an Antigen status that did not belong to that actual unit.  So, that is just where I am coming from.  Right now, we are writing the Unit# on the label, but that is wasting space.   I did work at a place where there was a spot on the label for the Unit# (for that exact reason), but it was a long time ago and can't recall now if they were commercial labels.....or special order.
Thanks,
Brenda

As stated above, we use IS XM for ABO compatibility check only when the computer is down.  We have passed several TJC and AABB inspections since starting this. Here is a quote from my crossmatch procedure:
Whereas:
Sensitivity: Immediate Spin crossmatch will not detect 100% of ABO incompatible units due to low titer of antibodies or weak expression of the antigens.
Specificity: Immediate Spin crossmatch gives some false positive results (cold agglutinins, rouleaux etc.).
Cold antibodies can cause false positives with immediate spin crossmatches, presenting a quandary on how to manage a unit that is incompatible at IS and compatible at AHG. Warming the sample to avoid the cold antibody might reduce the reactivity of the ABO antibodies as well. This false positive could happen even with an O unit when ABO incompatibility is not even possible.
The BBIS contains algorithms that verify the ABO compatibility of all products selected and our validation shows this to have 100% sensitivity for detecting ABO incompatible units and 100% specificity for avoiding false positive results—both an improvement over immediate spin testing.

This depends where you are located......Try removing IS in NJ? You will not pass your inspection

I can understand that.
In the UK, if the ever pedantic MHRA see that a test should be incubated at 37oC, they will give you a non-conformance if your incubator is at 37.1oC on the day of the inspection.  If, on the other hand, you say in your SOP that the test should be incubated at 37oC, +/- 2oC, they are more than happy (despite the fact that we ALWAYS run positive and negative controls with EVERY test).  As it is nearing Christmas, I will not write down my true feelings about the MHRA.

Our computer system is validated to detect ABO incompatibility before we do any kind of crossmatch.  If I pull out an A Pos PRBC for an O Pos patient and scan the unit, Meditech will tell me the unit is not ABO compatible whether I am performing an electronic crossmatch, immediate spin crossmatch, or an AHG crossmatch.

I should really have posted this before, but tomorrow, my colleague Malcolm Robinson (who, some of you will have heard of through the charity "Harvey's Gang" - and, for those of you who haven't, look it up on your search engine, but only after you have armed yourselves with copious amounts of absorbent tissue for your tears) and I are flying over to Dublin in Eire to give lectures and Case Studies at the first BGS Dublin Meeting, together with a host of excellent speakers.  Great respect must go to John Quigley, who has been instrumental (well, he has been hugely instrumental in organising it), and I just hope that, when it all comes to fruition on Friday, he gets the respect he deserves.
In the evening, after the meeting on Friday, I am being FORCED to attend a pub to take part in a quiz and, maybe, drink the odd alcoholic beverage (purely for medicinal reasons, you understand)!

What other compatible IV solutions?  I think 0.9% saline is the only one.

yeeeee

Our only concern: patient must be monitored against base line vitals once they start transfusion. Eg. They can start trnasfusion with temp. of 102 and if the temp. does not spike above 104, they can complete transfusion.
Clinically the vitals may be abnormal but if the patient need transfusion, we can not hold transfusion due to abnormal vitals...that is clinical judgement.

Perhaps there was confusion between training and competency.  CAP requires training: TRM.40900, Blood/Tissue Sign-Out 
The procedure for signing blood and tissue out of the laboratory provides adequate protection for the potential recipient.
NOTE:  A person authorized by the transfusion medicine service must perform a clerical and visual inspection of each component immediately before it is issued. Transporters of blood components and tissue must be trained in prompt delivery. Training may consist of instruction at the time the procedure is dispensed.
Evidence of Compliance:
Written  procedures for the issue of blood components and tissue AND
Written policy for the instruction of transporters on the proper handling of the product
 
 

That is almost exactly what I meant exlimey.  One or other should take FULL responsibility, and given that it is blood, it should be the Blood Bank.

I got bored watching day time television and so, after I had brought my lectures up-to-date, and taken them off the blood service's PowerPoint background, and put it on my own, I decided to become a locum, and Zoe is now my boss for a while.

Our paper manuals are almost gone, but we have something similar to you.  Each SOP has it's initial approvals documents on the last page, then we have an annual sign off sheet for each SOP.
We switched to every two years for a brief period, only to learn that our DPH requires every year.

If I am not mistaken, when a Bloodsafe unit is used, the system automatically records who the unit is being released to, as opposed to simply taking a unit out of a cooler or refrigerator.  For look-back and other purposes, identification information must be reliably retrievable afterwards as well.
Scott

If the blood is labeled as uncrossmatched and placed in a cooler or monitored refrigerator, it should be acceptable to apply the patient's name and MRN at the bedside just before transfusion, in an emergency situation. If anyone is using a Bloodsafe refrigerator to store emergency uncrossmatched blood in an ER, the patient identity is established in the clinical area by clinical personnel. I do not see how this is different. Having a made up dummy name complicates the process if the name is not being assigned by patient registration. In a true emergency situation or mass casualty situation occurs, the most accurate means of identifying who received what would be at the bedside, especially if there are multiple patients receiving transfusions. A patient chart label could be applied to the Transfusion tag prior to start of the unit.

It has always been my understanding that you can not issue blood based on previous history!  I don't have the reference available but that was a standard we lived by for my entire 35+ years in the blood bank.  All too often we had people come in sharing ID/Insurance information and the first way we were alerted was when the blood types didn't match with the history we had.

When we had our shooting here two years ago, we just handed out emergency release OP and ON PRBCs to the ER.  There was no documentation regarding these units, and we still don't know which patients received which units.  They did not ask for blood for a certain patient, just that they needed units.  One doctor charted that he gave a unit of platelets to a patient-we didn't issue any platelets.... To comment on Carolyn's post, if we have another mass casualty, we will send a med tech down to the ER with the products in boxes with ice, and the tech will coordinate with the nursing supervisor to make sure when we hand out a unit that a sticker gets put on that patient's chart.

I do not see anyone here defending the idea that you need to know, with absolute certainty, where each human blood product goes and who ends up with the transfusion.  Every transfusion is a transplant.  Do we really need to review why we cannot issue products willy-nilly no matter how 'universal donor' they are?
There are several suggestions here already for policies to ID John/Jane Does and the units they receive.  It takes consultation and cooperation between multiple departments; and yes, its going to take some work.  Once implemented, an appropriate system will satisfy regulators without any loss to patient care. (Blaming regulations that may be "inconvenient" when pointing out our deficiencies does little to help our patients.)
Scott

I'm stretching the old memory cells here but I'm going to try.  We had a number of arm bands pre-made for trauma and disaster patients as well as a few of OB bleeding emergencies.  These arm bands resided in the Emergency Room and L&D to be used for identification purposes when needed.  In this manner we were able to maintain our normal routine with very minor modifications. These arm bands stayed attached to the patient through out their hospital stay.  When the dust cleared all records for these patients contained both their emergency ID as well as their "real" one.  This system seemed to work very well the times we needed it.  It was practiced a couple of times each year with disaster drills to keep everyone involved current on the procedures.