kate murphy

We do much the same as most, but we prepare in advance. "Unknown, Patient" with a special ER-#### Medical record # in the lab system to allocate and print tags. 2 O Pos for males, 2 O Negs for females are kept on hand at all times. Unknown patients in the ER are banded with a trauma # only until they are identified. The emergency release form the ER sends to us has this #. All we need to do is hand write this number on the already printed tags and send to the ER. 30 seconds. When the patient is identified and we get a real medical record #, we either merge or re-allocate. Usually we can track/trace all units. Specimens with only a trauma # are good as long as that the is the identification the ER/OR is using. When name/MRN changes, we need a new spec. We do enough emergency issue, that having units tied up tagged is not a problem. This system works well for us. We need 2 specs to confirm ABO. We will issue group O rbc and AB plasma.

We did this a few years ago. Our medical director is conservative, and we sacrificed several FFP - thawed them and took samples for factor assays. Then repeated factor assays at 24 hrs, 48, 72... What you really just want to show is that x% of factors are still present at 5 days. So you just need to set what x% is acceptable. I think we set 80% of FVII and fibrinogen.

AABB Standards doesn't require much - 5.22.1 lists only patient's 2 identifiers, unit # and compatibility result. With more hospitals on elec medical records, you really only need that and a downtime way for double signatures. I've attached our unit tag - single ply pre-printed form in a dedicated printer for patient/unit info. We print 2 at allocation and keep one when we issue. Unit tag RBC 012417.pdf

Different photo-reactive chemicals. Intercept = amatosalen, Mirasol = riboflavin. Both activated by UV light to cross link DNA/RNA sections to inactivate proliferation of bugs/white cells. Lots of info with google...

We do 2 folks to id all specs. Phlebs use bedside scanning/printers. Phlebs draw about 70%. We firmly reject all non-signed specs. No exceptions. Especially from ED - every hospital I've been in, the ED is notorious for mislabeling, mis-identifying specs. We're slowly getting bedside scanning/printing to nursing. L/D and ER are the most common places for WBIT (wrong blood in tube) across the country. To drop your policy requiring positive id verification because people didn't like it, and then put your phleb staff in the middle is not right. If you cannot get phleb staff to not use these specs, then I'd suggest another system - bloodloc, typenex, etc. Safe transfusions begin with the spec.

Here in a transfusion service, we usually say discrepancies are due to either monoclonal vs human origin, or sensitivity of methods. It depends on strength of reaction (<2+), sex and age of the patient how we treat them. Women of child-bearing age (<50) we usually go with Rh neg.

Here's our Clerical Check procedure. No issues on any inspection, we've been doing EXM for 6 yrs. SOP II 004 Clerical Checks.docx

We only do once/yr.

We do the same as DPruden - no neg control following package insert. Your 1st negative patient is your control. No issues on any inspections for this.

Thinking logically - if you are already extending specs 10-14 days, what would be different to extend to 28-30 days? Yes they could go grab a pint (blood, not beer!) at another facility, but they could do that in the 10-14 day period, yes? Is it that patients will remember something 2 weeks ago, but not 4 weeks ago? Not likely. If someone in pre-op is documenting the answer to pregnant/transfusion in the past 3 months, that someone could also document patient understanding to report transfusion between sampling and surgery. So you just really need a 3rd question on whatever form/computer order (for us Epic folks).

Outside of the BB, there is the College of Trauma Surgeons and the Joint Commission. Both require a policy.

We have a Neo and a Tango. We run all automated surveys on Neo, and run instrument/instrument/manual/ comparisons quarterly. This has been acceptable to CAP for 10 yrs.

There is no requirement to have medical director or physician sign off. Any rules in place would be strictly internal policy. But once it's policy for your facility, you have to follow it. So it very much depends on the comfort of your pathologist/hematologist in charge. If he/she is conservative, they will probably want to know. if he/she is progressive, then not. Either way, I'd think is should be in a policy/procedure spelled out for your staff.

It's not required yet for 5 day platelets. That's coming soon, but the FDA is gathering comments and seeing what will happen with pathogen-reduction - how many blood centers will produce that and the cost. We are currently using Verax for 6 & 7 day platelets.

Yep, any time a "wrong unit" is out of your control, that is issued to nursing, that's reportable. Doesn't matter if it's for the "right" patient. If a mistake leaves the blood bank, it's reportable.