QDeb

The AABB website (members section under Association Bulletins) has all the info on what products need machine readable labels. Basically, everything. If you modify it, you need to relabel it. At a minimum, the following must be machine readable: 1. Facility identifier 2. Unit number 3. Product code 4. ABO/Rh of the donor We have purchased software and a label printer (I believe it is a zebra label printer) to print all of our labels for modified products. This works great and we meet the requirement. Yipee!! This should work great whilst the computer is running. What about back-up? I firmly believe that our back-up plan (manually created label) should also meet this requirement. Makes sense doesn't it? Things to consider... 1. The purpose of this requirement is to provide a mechanism for positive patient/unit ID at the bedside. We don't have barcode reader technology at the bedside, at this time. Although we are still required to have machine readable labels on our modified products. 2. Even though the technology isn't quite there yet for bedside use, using the barcode reader within the Transfusion Services is beneficial to help catch errors. 3. If the computer is down and we are unable to print machine readable labels, you wouldn't be able to scan/read the barcode either. SOOO, would you think that using our manual label, that does NOT meet the machine readable requirements, would be acceptable during the occasional computer down times? What about if we relabel the products that are still in Transfusion Services when the computer comes back up? Thanks

Need your help... We are currently trying to decide between Mysis (lab and Transfusion Services), Soft (lab and Transfusion Services), Cerner (lab and Transfusion Services) and Mediware (Transfusion Services only). Can anyone give me feedback on any of these systems?? Of course I am most interested in the Transfusion Services piece. I will take your feedback to those individuals that are making the decision. Thanks

Hello to all, The hospitals in our system that use a independent "Blood Bank" bracelet in addition to the hospital patient ID band, are required to retest the front type of the sample, preferable by a different individual. If there is not a second or "independent BB bracelet" for ID then a second specimen, collected at a different time from the initial specimen is used to perform a blood type to validate the initial blood type. If the patient has historical results or has an autologous unit that can be used to validate the current results then that serves as the second check. This is our current process. Monitoring of the process has been in effect for a long time. The processing (specimen receipt) area checks specimen labels to be sure that the information in complete, if incomplete it is rejected and is counted as a mislabeled specimen. This data is tallied and monitored (lab services - not specific to Transfusion Services). Other ways to suggest mislabeled specimens: receipt of duplicate specimens (received close together), receipt of specimens for testing when blood is already set, receipt of specimens with a handwritten label (when there is no problem with the computer/printers), Testing - current results don't match historical results, testing requested when not indicated (i.e. immune globulin screen). The incidents when the mislabeled specimens actually reach the Transfusion Services and are determined to be wrong patient (not clerical - missing/wrong information) are presented to the Hospital Quality Executive meeting (Senior management/board member level) on a quarterly basis (they expect action from those areas where the incident occurred)... we are currently working on a barcoded system for Patient Identification. Remember they are looking for a process to prevent, catch and monitor, and show actions for improvement and then evaluate the effectiveness of that action regarding mislabeled incidents. Look to see what you are already doing and write it down. I am sure that you have procedures for specimen collection and acceptance, you have training, you have competencies, you have performance evaluations, you have unacceptable specimens (from time to time), and you may even find one or two of those specimens that were collected from the wrong patient (I'm sure that those get quite a bit of attention) - how do you deal with them?

I have not heard of such a requirement and would be surprised if they could pull that one off. But you have to admit, it would be a simple solution to distinguishing the copy form the original. Then the question would be...why is that important?

Another alternative MAY be to contact your local ASQ section - there may be someone there that would be interested in helping you. ASQ - American Association for Quality You can go to the national website www.asq.org and search for a local section or call the national office and request contact information for your local section ( 1-800-248-1946). They won't be listed in the yellow pages.

Our minimum testing requirement is an ABO and Rh before issuing RhIg. The Standards state that a patient shall be considered for RhIg administration if a woman is not actively immunized to the D antigen. So, unless there is evidence that the patient is actively immunized then we would administer RhIg. It is up to the physician's discretion if he/she wants to have an antibody screen at the time of or after delivery (it was thier insistance that they have this choice - they did not see the need to repeat the screen if prenatal records were available). An antibody screen is typically performed at the time of delivery if there is no prenatal record.

Wow, I would ask the assessor or group that the assessor came from to provide more information on what it is that they are looking for...specifically! Ask them to explain the intent of the standard or expectation. Until you know what it is that they are looking for, it would be hard to meet their requirement. Look at what you do and answer one thing...do you meet the standard/requirement? If you feel as if you do meet the standard/requirement then challenge it. Believe it or not assessors are human too...

Gloria, No!? No!? It's looks as if you have some first hand experience with this (home grown bar coding system)? Do you still have nightmares about it? Tell me all about it. Deb

The methods of verifying patient ID can be discussed and disputed at length. My question is...Why can't it be done correctly the first time, everytime, by a single individual??? Answer that, and come up with a solution, and you could retire a wealthy person. With that having been said...we are looking into creating a home-grown barcode method for the purpose of patient ID at the bedside. This will start off with a specimen labeling application but could take off to include many other applications including, of course, transfusion. Has anyone attempted this before? We have a six-hospital system - it will only be used within our corporation - Does anyone know what requirements (FDA, CMS, JCAHO, etc.) would be applicable? Thank You!!

Maybe, I'd be interested in learning more!

I am part of a 6-hospital system - Transfusion Services only. Only one of our facilities needs to be registered because they perform washing. The others do not need to be registered and they pool products. When in doubt call FDA and ask - that's what we did.

We document our QC manually. I am pretty sure that we have the capability to enter results of QC into our computer but opt not to. It was decided that it was easier to do it manually.

For our hospitals that do not use a Transfusion Service (TS) armband (in addition to the hospital ID band). All patient's for transfusion that do not have a historical result, or valid result from an alternate source (lab), or autologous blood, will get a second specimen collected, different time from the intial specimen, for a repeat ABO/Rh. If there is another acceptable specimen available in the lab, i.e. hematology, that was collected at a different time from the intial specimen then that specimen could be used without "re-sticking" the patient. For those hospitals that do use a TS armband in addition to the hospital armband for patient ID, The same specimen is retested if there is no historical or other acceptable means to compare the blood type. We have found that errors occur both at specimen collection and at testing, so we designed our safety intitiative to capture either case.

Our racks are stocked with reagents of the same lot numbers, so there is only one lot in use for any one particular reagent on any given day. We check each rack daily to ensure that the each rack has the same lot numbers in use, there is enough of that lot available to cover testing throughout the day (in storage or in the rack) and visually inspect the bottles. We only QC a single rack of reagents, thereby QCing the lot in use. If someone misjudges and a new lot of reagent needs to be opened, then it needs to be QC'd prior to use.

I would also be interested in seeing how someone has set up the access program. My current process is very labor intensive (I have been using a spreadsheet in Excell). One of my goals was to learn access this year. If willing to share, please send to dmmeeks@sentara.com. Thanx