Christy Spence

We also used to do electronic checks quarterly, but now that there is specific guidance to standard 3.7, we have reverted back to the old water/ice alarm check.  This is from the AABB portal on the guidance for standard 3.7 in the 31st edition - "An electronic alarm test that merely increases or decreases the electronic digital readout to determine if the audio alarm sounds, would not meet the intent of the Standards."  The full checklist item and guidance are attached.
 
AABB Standards 3.7 and guidance (31st edition April 2018).docx

This is our policy as well.

This is our policy as well.

We went with the second blood type but only on patients we are not giving group O blood to. Between that policy removing about half of the need, allowing use of another lab specimen from Hem or Coag and a lot of historical types on record, it hasn't been too bad.  We are AABB and TJC but not CAP inspected.  We made the change for patient safety at the time.  Now I think AABB is requiring something similar to CAP.

WE found bloodloc to be an acceptable alternative to typenex.  I have seen typenex fail.  BloodLoc requires a code attached to the pt sample.  The only place the code exists is on a separate bracelet attached at admission.  The blood is released with a combination lock.  The combination is the code.  IF the lock doesn't open either the xm is not on the correct patient sample or the tech entered the code incorrectly.  This is considered a barrier protection device.  Only requires one type.  Never had a problem.  Nursing has to buy into it and not cut open the bag if the lock doesn't open.

We follow the same practice as Mabel.  The second sample is required for all patients who do not type as Group O and we also use other lab specimens that were collected at different times than the original blood bank sample.

We used Typenex but also went to the second specimen drawn at a separate time or a historical record.  The transition was not as difficult as I had thought it was going to be. 

We were using Typenex bands with a very rigid policy and quality requirements. The band is not a barrier method, but with our quality program, we were passing CAP inspection for years. However, it was getting harder and harder to get through inspection with that, so we had to come up with a new game plan.
We've since added hand held devices to scan patient armbands at bedside for patient ID. Important for all specimens, not just Blood Bank. (And I will mention that we had a phleb, who no longer works for us, still manage to mislabel patient tubes with another name...twice...so don't think that is the solution that solves all problems.) Infusion clinic patients (some of whom are transfused) and some ER patients cannot be ID'd with the hand held device with our current computer system. Didn't solve our problem totally, but covered a lot of holes.
Next step was to add the FinalCheck bands/lock system, which is a barrier method similar to what David described above. The band is placed on the patient when the specimen is drawn.  Stickers with the code are placed on the specimen tubes when they are labeled at bedside. The stickers come directly from the patient's band which must be on an arm or leg at the time. The alpha code on the bracelet opens the lock on the bag the blood is placed in when we check it out for transfusion. Code appears only on the patient bracelet for nurse to see. Nursing staff was trained very specifically for the system before we rolled it out and it is a part of their annual and new employee training. Nursing service has a very clear cut and serious disciplinary action plan which would apply in any situation where a bag was cut open and they've made sure that all staff is very aware of it. I am happy to say that we have not had a single bag cut open since we started using the system over 2 years ago. Patient safety is a very important part of our culture, from the CEO down, so I think that helps.
Another bonus is that the alpha code also appears on the FinalCheck band as a bar code that is readable by the Echo. If we need to perform testing in emergency situations before we have orders in the system, we can use the FinalCheck barcode for testing.
I'm not going to suggest that this system is foolproof, because it's not, but we've closed a lot of holes. We've passed CAP and JC inspections since implementation with no concerns or issues.

Agreed; getting a second type confirmation is not the big deal that clinicians think it is.  We use CBC specimens drawn by our own phlebs using the hand-held device.

For you folks who use a second specimen - if you are unable to obtain one (and I am assuming from a separate phlebotomy event), are you only distributing group O red cells?  Seems this would be the case for the majority of traumas (esp after you've transfused 8-20+ rbcs)?  Just seems like a waste of valuable group Os.  Where I come from it is hard enough getting O+ let alone O=.  I have run across situations where they ask you to type the blood on the floor in the ED . . . 
 
 

The second type must be from a separate phlebotomy event.  If we are unable to get a second blood type, which is rare,  we do use Group O cells.  We very rarely have problems getting Group O cells.

My impression is Ortho used the "periodically" term as a CYA. I think it's sufficiently vague to be defensible by Ortho when there are problems with the reagent: "well, did you do your periodic QC?" and also vague enough that people like me can completely disregard it without being out of compliance, technically: "I define periodically as the 7th of never, unless inconsistencies are noted."

I wish CAP would put all 1 specimen results all together, then move on to the next specimen.  Doing all the ABO, then all the Rh, then ABS... THAT'S what causing all the clerical errors I've seen.  We're supposed to test and report just like a patient spec - and that isn't it!

I think that a lot of this "fixing problems that don't exist" stems from the change with CMS/CLIA when they combined all the subsections.  Immunohematology used to be separate, but now we are lumped in with Chemistry and Heme, and CMS can't quite get that blood bank is different.  Just my opinion.

Well I had my AABB/CAP inspection last week...did great, thank you, but she never once brought up the subject of expired panel cells....and neither did I.  LOL  

My AABB/CAP inspection is in 2 weeks...I'll let y'all know.  LOL

But...
Aren't we just saying that a system must be working OK because we like the results we get out of it?  If you are getting no reactivity or unknown reactivity on one or two or twenty panels, how do you know that the lack of a pattern is not due the panels being bad?
 
I think it is reasonable to say that the panels are OK as delivered due to the manufacturer's own quality program. (I just hope an inspector never asks for our proof of that!).  Having said that, the only "periodoc" QC that would seem to be needed is some sort of test before being used on patients (like that done with the screening cells - its a good point made above by Christy - if its good enough for those it should be good enouhg for panels).  This one-time QC on  panel would check that there was no deterioration in shipping.
 
Scott