We deliver approx 700 babies per year on average. We used to do about 98% of all Prenatals for our deliveries, now we're down to about 80%. Because of that decrease, we are seeing more and more patients for the first time, when they come in to deliver. OB nursing service has a policy that says they are supposed to make sure that there is a blood type on the chart. This usually takes the form of patient notes from the physician's office, not a copy of a lab report from a CLIA licensed laboratory. IF they don't have a type on the chart and can't get the notes from the office, they ask for an order for a blood type (doesn't happen often). They also remind the physician that a cord blood should be collected. Two big sources of errors right there - the notes from the office could have the wrong type and it puts a burden on nursing service to remind the doc to collect the cord blood - they could forget the reminder on a busy day. If we don't receive a cord blood, we have no way of knowing that someone has delivered. Actually, we don't even know who is in labor. We thought we were doing doing a good job with this, but we had a recent incident where a physican declined to collect a cord blood specimen on an Rh neg mom after several reminders from a nurse. We picked up the omission because mom had a Type and Screen order (these are done only when ordered, not as a routine order upon admission) and an alert tech noted that they never received a cord blood post delivery. She inquired about the missing cord blood and was told the Dr did not collect. This was referred to a pathologist, who called the Dr in question. The answer - " Why, yes, of course the patient should get RhoGAM!" Don't know what happened there, it's still under investigation. We are now questioning our system, obviously!!! Has this happened before? Gives me the willies thinking about it. We need to make sure it doesn't happen again. So...here's the question. What do you do to meet CAP TRM.40780 - is there a system to identify all potential Rh immune globulin candidates? Do you have written policies for physicians at your institution that require a cord blood on all Rh neg mom's? or an order set for physicians that requires a cord blood on all Rh neg mom's? If yes, how do you know who the Rh neg mom's are so you can verify that you have them all covered? Is an office note acceptable on the chart? Is a lab report from a CLIA licensed lab required for mom's chart type? Does lab get a report of who is in labor? or make a report of Rh neg mom's in labor somehow? I know this is a problem many of us struggle with. Has anyone got a really good system? Thanks for your help!