This is the regulation. Not room temp open system. If unit issued from Blood bank at 1PM, then transfusion needs to be concluded no later than 5PM. HOWEVEDR, cooler situation is different because the COOLER is now considered storage (1-6 degrees C). So issuing from the cooler (from whatever dept) is considered the same as when you take it out of refrigerator... Spike time for practicle purposes... Take out of cooler, spike, ok for 4 hours. Just write a note in training and procedures this is how the time is documented. Problems I HAVE found is in OR units being removed from cooler, laid on counter, and then put back into cooler.. OR transfused (not spike time). This requires training. And only reason I found out this practice occurred was on RETURNED units. They put the units back in the cooler, units came back cool. We would not have been wiser... except for the SAVE T VUE on the back of the unit was RED. Why I instituted all units being dispensed to coolers MUST have safe t vues. OR They cannot be returned to be reissued.