amym1586

you can always just do a forward type in emergencies. I use stick blood for the ABD and then spin the specimen.  Actually found some interesting D variants doing that (typed as Rh Neg with tubes but weak 1+ in gel). 

So you do the forward group using whole blood; then you spin the sample to do your reverse and antibody screen?.  Well, nothing wrong with it but it sounds like a very roundabout way of doing things!

Or the wrong armband is put on the patient in the first place. If the patient is not IDed by asking them their name and birthdate, or if a nurse who knows that patient doesn't ID them when they can't ID themselves, you can still get WBIT.
 
We do use the mobile devices and have had some mislabeled specimens - thankfully not blood bank. The phleb IDed the patient verbally, scanned the patient's armband and printed the labels at bedside for the tests to be drawn - so far so good and following policy. She then failed to get a sample from the patient and left to draw the next patient. What she did not do was tear off and discard the labels she'd printed after IDing the previous patient, so the next patient's samples got labeled with those. She managed to do it twice in one week. She's now working in another department of our facility - not because of the labeling errors, but because she felt that phleb was not a good fit for her (Ya think?!!). After that a 'final check' policy was put in place. Before the phleb leaves the bedside, the tube labels are supposed to be compared to the patient's armband. Still not foolproof if the step is ignored or done casually.
 
Could we still have a labeling error - absolutely! The whole house of cards is totally dependent upon everyone following policy. If one person decides one of those steps is silly or they 'don't have time', then the cards come tumbling down and we have WBIT. The Swiss cheese principle also applies. Do I think the mobile devices are an improvement? Yes, they are. We definitely have fewer issues, but we police the heck out of the process. Someone follows every phleb to the floor twice a month and watches their process for drawing blood bank samples. Keeps them from developing their own shortcuts or inadvertently changing the process. Doesn't mean that someone won't freelance when we're not watching them. Bottom line...you cannot blindly trust that device alone.
 
Nurses give meds scanning those armbands, except that sometimes they find it a bit tricky to get the barcode to read. Guess what they do? They put a chart sticker with that barcode on a paper towel, a piece of scrap paper or the back of their hand and scan that. They get reported when anyone from lab spots it, but how often is it not spotted and/or reported? People can always circumnavigate your process.
 
They want to give blood without a second person checking patient ID and using only an armband scan for patient ID. Gives me the shivers just thinking about it! (And since we don't have a blood bank computer system, it's a non-issue right now.) We do use the Final Check blood lock system as an additional part of the safety process and I suspect that we will continue to do so if and when we issue blood that will be matched to the patient by a bar code scan. (And we police the proper use of the lock as well. Strong disciplinary action would be applied to offenders.)
 
Whew! where did all that come from ?  As they say in the arms control business...'Trust, but verify.'

Column agglutination technology (Gel) does a superior job of detecting mixed populations of red cells in a blood sample compared to standard tube technology.  Having done ABO/Rh typing on ProVue since 2004, I've seen dozens of samples with dual population due to transfusion of a single unit of RBC that was not ABO/Rh identical to the recipient.  I think these mixed-field reactions (typically be missed in tube) are clearly visible in Gel.
 
Using an unspun sample of blood to do a forward ABO grouping isn't wrong, but is it really necessary to do this routinely on all blood samples?  Does the SOP give any explanation for this approach?

you could use a specimen from Hematology that is drawn at a different time for your retype.  The policy should be for all patients and not a certain age.  Most preemies and babies get O Neg so then your policy could address that they only need 1 blood type if they are receiving O neg or a quick heelstick if you are doing type compatible.

I am the BB lead here and we are using the product for traumas and MTPs. The liquid plasma has up to a 26 day outdate and is ready for issue with no modification. It is FDA licensed as of this June 2015 and stability of coag factors are very similar to FFP. Very nice product, sent 3 units out the door today within 5 min of the request for a GI bleed. So far, no issues. The American Red Cross blood centers are now processing this product as well as Blood Works NorthWest. American Red Cross requires a standing order. The product is approximately half the price of a unit of FFP. We pay $xx/unit. Since we have started carrying it, we have wasted about 8-12 units using only 4 so far. The challenge has been to get our docs on board with any new product or process because we also only carry A in the liquid plasma. Hope this helps.

A single donor platelet pheresis must have a final platelet count  between 3.0x1011 and 6.0x1011 to be considered a full platelet dose. If the final count is, say, 6.1x1011, that unit can be split and made into two separate units.  If the final platelet count is, say, 5.9x1011, the volume of the platelets and plasma may be too high to assure adequate oxygen exchange in one single bag but the count too low to make two separate units.  Therefore, the unit will be separated into two attached bags in a closed unit to allow maximum storage but is still only 1 unit.  Hope that helps AMYM1586
 
To all my BB Guru's here: If I am wrong, please feel free to correct my understanding.

Different SDP bags are manufactured to be within certain ranges of volume and certain ranges of platelet count per bag. Remember that the bags are designed to facilitate gaseous exchange.

Hi John,
 
Sorry for the confusion,. We only do the cord blood workup (ABO/Rh and DAT) on babies whose mother is Rh negative, blood group O or if the mother's plasma contains clinically significant antibody(ies).

When I review transfusions I indicate the time released and the time started.  It is up to the Nursing supv to investigate when the time between the 2 is excessive (>20 minutes, or so).  As long as the infusion is completed within 4 hrs of release this is a moot point for me.

I tend to agree with folks smarter than me (most of the time).
Thanks, I will recommend we do not order.

But my point is that we need to stop making excuses for them.

Thankfully our pneumatic tube has rigid dietary restrictions and this is not an issue.

A few years ago one of our Lab associates was getting lunch in the cafeteria when she noticed a RN with a blood tag hanging out of her scrubs.  Turns out the RN had picked up a unit of blood from the Lab and was "just stopping to pick up lunch" on her way back to the unit.
 
Scott

We do not allow food or drink in the lab proper.  Nursing would have to leave their consumables outside in order to p/u blood components

We do not issue out any products if they have food in there hands. It specifically states in the nursing policy for admin of blood products that they cannot pick up products with food. I have turned many away for doing this (i.e., eating an apple at our issue window). I tell them that I am just enforcing their policy.

I am not sure what exactly OSHA or JCAHO would say about it, BUT IT SURE LOOKS BAD!  Years ago (back in the last century, people used to eat, drink and smoke-if-you-gotum in the Lab, but those days are long gone.  We do have some posted "clean" areas off the Lab for coffee and such, but food or drink (or even cosmetic application) are banned anywhere near specimens or testing of same.
 
It seems like your institution should already have some Infection Control guidelines for you.
 
Scott

In any of your facilities do you allow nursing staff to pick up blood bank products if they have food or drink with them?  Is there a health and safety guideline that addresses this?

I'm with the 'one unit at a time for non-emergent cases' opinion. Too many ways for things to go wrong.

We routinely issue two units for outpatient transfusion in the hospital.  They have Safe-T-Vue devices (irreversible color change) on the units and I validate the coolers annually.  They document on the form or in the computer that the unit is acceptable before transfusing, indicating that the Safe-T-Vue device is still white.  The only other time we issue more than one is to ER for emergency release, massive transfusion or FFP.  These are issued in a box with ice that has been validated by our blood supplier.

In the AABB Technical Manual, 16th ed, page 617:
Usually, except in the case of an emergency, blood banks allow the issue of only 1 unit at a time.

We only do this if they are putting both in at the same time.

We do not issue multiple RBC units for non-emergency transfusion unless the units can be infused simultaneously, i.e., more than one existing IV line.

Just saw this from AABB:
The AABB has decided not to accept IQCP. You must follow the manufacturer's written instructions or follow the CFR regulations for quality control, whichever is more stringent

Strictly speaking (although I know exactly from where you are coming Auntie-D), it is the hospital's Caldicott Guardians who cause this problem, rather than the hospitals themselves in other words, even the Chief Executive cannot overrule these Guardians -  which rather suggests that the "Guardians" have far too much power for people with so little knowledge!
 
For those members who are not familiar with the term "Caldicott Guardian", Lord Caldicott came out with some laws (well, he didn't, but the results of his inquiries became Law, passed by the then Government) about what can and cannot be kept secret as far as computer records are concerned, and some of these "Guardians" (who know B****R all about blood transfusion and the dangers of alloantibodies) have decided that their own hospital's patient alloantibodies should be kept secret from other hospitals (despite the fact that this secrecy might kill the patient).
 
IDIOTS!!!!!!!!!!!!!!!!!