John C. Staley

I'm beginning to sound like a broken record but a second type on anything but a second sample collected at a different time is nothing more than smoke and mirrors to make someone feel like they are doing something. The primary concern is that the wrong patient is drawn and the sample mislabeled. Anything short of a second sample drawn at a different time will not address this concern. Of course the best option is to always get it right the first time. The key to this is simple. Make sure the patient is properly identified and the person drawing the blood follows the patient identification protocol, to the letter, every, single time!!!

Kathy, sounds like you've got a pretty good system in place. How often do you get a bag back that has been handled inappropriately? My concern is that we seem to spend a lot of time and effort policing other areas because they can't seem to figure out that following simple processes actually works and is safe.

I'm curious, is the use of the blood loc universal in your facility or are some areas such as ER and OR exempt from using it?

Bottom line folks, no system is fool proof. Too many fools out there. Compilcating a system does not make it better. Everytime you add a layer to checks and balances you give the previous layers less reason to be concerned because "some one else with catch it". Bed side identification only works at the bed side when the process if followed whether it is barcode or eye readable. If the identifying devise is not attached firmly to the patient it is of no value. The most dangerous person in the medical world is a patient care individual with a pair of scissors and a desire to use them. All that is happening is someone is attempting to create the illusion of caring and doing something about it. Even Bob's RFI chip in the the right eyebrow will have creative people find ways around it if they don't understand, accept, or buy into the need for "doing it right". In the words of my favorite ER nurse; "We don't have time to do it right!!!!"

Congratulations!! Did they mention anything about your plan to prevent "mis-transfusions?"

Bob, sometimes you scare me!!! Did you just come up with that off the top of your head or did you have to look it up? I have no problem transporting blood in bags but I think it sends a poor message to anyone who sees it, if it is a biohazard bag. Frankly, if you walked into my room to transfuse me and pulled the blood from a biohazard bag I would be quite concerned and would probably make quite a fuss. That's assuming I'm in any kind of condition to make quite a fuss. Rest assured my wife the nurse would certainly take notice and try to save me. At least I hope she would.

I've found that if you curl into the fetal position and hold real still they'll just sniff you a couple of times and then go away. That's always worked for me. :>)

Has any one else noticed that IS/IT has become the "tail wagging the dog"? They have gone from being support to being in charge. The past few years it has gone from me telling them what I needed and why followed by them miraculously making it happen to them telling me what I can or can not do or expect. There is no dialogue just dictates and they have the full support of administration becasue they have them terrified. IS has become an 800 lb gorrilla that sleeps anywhere it wants. There, that's my rant for the day. Now I'm off to do battle concerning the merging of patient information.

Here is our plan and a blank form we used. This is how we did it. I know others have done less and still others have done far more. Validation of Tube Transport of Blood blank form.doc Validation of Tube Transport of Blood.doc

I had to reformat the SOP. Here it is. ISSUING BLOOD AND BLOOD PRODUCTS VIA PNEUMATIC TUBE SYSTEM.doc

Here's my old SOP. Don't tell anyone where you got it. We've been "tubing" blood for 5 years now and can't imagine going back. We can send up to 4 RBCs at one time but don't let the nurses know. Never, never, never will we put more than one patient in the same carrier.

How often is the physician even notified? My guess is where you need to start is with some extensive re-education of the nursing staff as to what consitiutes a transfusion reaction and their responsibilities in managing the patient and notifying the physician and the transfusion service. A physician can't call it a transfusion reaction if they are not notified of the symptoms.

As a general rule, the nurse is supposed stop the transfusion at the first sign of problems. Then, they are to alert the physician of the problem and the physician determines if a transfusion reaction investigation is warranted. At least that's what is supposed to happen. Most of the time they call us and we tell them to call the physician if it is something that should be considered a transfusion reaction.

A question for you Helmer UltraCW cell washer users. In the preventive matintenance schedule it indicates that a rather extensive system flushing should be performed on a weekly basis. How many of you are actually flushing the system as described on a wekly basis and if not why not. I am having a battle with a corporate medical director over this. My contention is that, first off this is a recommendation based on heavy use of the machine and since we will not be using it heavily the flushing procedure is a lot of work for no benefit and quarterly or even semi-annual would be quite enough based on our use of cell washers. Her contention is that if the manufacturer recommends it we must follow it; end of discussion. To counter this my stand is that this is a machine, not an instrument or reagent that was processed through the FDA's 510K process. Anything the manufacturer suggests/recommends is simply that, a suggestion/recomendation. This came up because we use corporate wide, standardized SOPs and we are in the process of writing an SOP for the use and care of these machines.

I've got an even better idea. Most of the pumps I'm familiar with have an "infusion rate" setting. Based on how long the pump runs until the blood runs out will give them the exact amount transfused. They can know to the ml how much was infused by letting the pump tell them. It's really not all that hard but asking us to give them a number is much easier.

If I remember correctly Spock had quite a struggle with his human half so if he is T neg as Donellda has stated is the neg Rh neg from his human side or is he neg for some Volcan specific antigen? I do remember the transfusion but I don't recall if they addressed the compatibility issue of a half Volcan with a full Vulcan. That brings up another question. Was Spock a sterile hybred like a mule. Boy this thread is sure leading down strange paths. See what you've started Bob. Now it will never end. But it is kinda fun to get side tracked once in awhile ;>)

All I remember is Dr. McCoy referring to "green Volcan blood" but I don't remember a type. Bob, you need a hobby.

I'm afraid in my many years in the business I have never seen that statement. The 30 - 37oC is the only thing I remember ever seeing in reference to thawing plasma products. It's just a guess but I suspect that some one from the forgotten past in your facility thought it sounded good and kept them from over reacting if the thawing bath ever dropped below 30oC or (heaven forbid) went up to 37.1oC. It will be interesting if someone really can find a reference for it. Personally I kind of like it for the very reasons I have mentioned above.

Minor crossmatch????? Please tell me that you are not routinely doing minor crossmatches!

I think we do it semi-annualy. All I know is clinical engineering sends me up their forms to review and sign. I didn't even do that until a year or so ago. I have a real philisophical problem being held responsible for something completely out of my control that my staff never uses simply because it it used in conjunction with blood transfusion. I never really understood why we are the universal "blood police".

We do the same as Bob, day of use when it's first opened. We used to do "on receipt" testing but our QA gurus decided it was no longer required. I certainly didn't argue that one with them and I usually argue with everything they come up with.

I'm curious, why was an antibody screen performed 6 days after the RhIG injection?

We perform a type and screen on the baby. Cord blood is unacceptable due to nursings inability to ever get the correct label on a cord blood. We transfuse type specific for the baby. No crossmatches unless there in an antibody involved. Antibody is generally identified in mom and mom's serum used for the AHG crossmatch.