Confirmatory test for ABO groups in first attend patients

[Malcolm Needs ★ 4,933]

11 hours ago, BldBnker said:

We also have computer confirmation with barcoding of units but that doesn't always catch WBIT samples.

It will NEVER catch WBIT episodes.  It is just that, coincidentally, the ABO and D type of the wrong patient is the same as the right patient.

[SMILLER 870]

I am not sure that there is a fool-proof way to detect WBIT, but checking the ABO at the bedside will, at the least, help avoid death by ABO incompatibility, even if the T&S testing was done on a different patient.

Scott

[BldBnker 36]

That was my point.  Yes, if the sample is the same type as the patient in the bed but wrong patient's sample, it won't catch WBIT.  However, it has saved us several ABO HTR's in my career (30+ years).  I call that a good catch! 

[SMILLER 870]

Yikes!  I would hope that your facility's patient and specimen ID policies have improved since those days!

Scott

[BldBnker 36]

There have been many improvements over my career.  Now, of course, we have barcode scanners being used by our phlebotomists which have greatly decreased the number of mislabeled samples.  We also have Epic BPAM for transfusions.  However, we are all human and we still have the rare specimen error, usually in a hurried/emergent situation (when SOP's sometime go out the window, unfortunately).  A bedside ABO slide type would have saved the patient in Texas that recently passed from an ABO HTR. 

 

[Karen knight 4]

As per CAP standards TRM.30575 Misidentification risk: Verify ABO/Rh on second sample prior to transfusion and TRM.40670 ABO Group and Rh(D) type verification,  we order a non-billable TYPE2/WEAKD and result to meet the requirement for electronic crossmatch and/or type specific blood to be issued on a patient with no historical data.  This a new order/draw.. specimen must have blood bank id documented on tube by collector at time of collection in the presence of patient. if a second sample cannot be obtained and there is no documented previous ABO/Rh, immediate spin crossmatch performed using non type specific blood. if the phlebotomist is still on duty and has a clear recollection of patient they may be allowed to take tubes from earlier draw to patients bedside to re-identify patient and sample, placing blood bank id sticker on that tube. we usually use CBC tube from am draw. anytime a type and screen ordered on hosp patient the phleb asks the bb tech if a prev type exists if not a type2 is ordered on new order number requiring second venipuncture.

are your bedside test cards properly labeled date/time/init blood bank id, patient LIS label /order label to compare to patient wristband? are the results entered into patient chart?

 

 

[Ensis01 131]

A policy of nurses doing an ABO test at the bedside prior to transfusion makes me uneasy and it has taken a while to figure out and try to articulate why. Fundamentally it seems to me that if this policy is needed then the hospitals system of blood collection needs a total overhaul.

To put it another way having nurses do an ABO test at the bedside prior to transfusion creates an extra layer in the transfusion process that will inevitably (in my opinion) cause delays, create confusion and problems that will need to be resolved by the bloodbank. Plus there is the need for training, validating the kit, monitoring etc.

There are several threads (and lots of discussion) on this site expanding on different and effective ways to implement the second ABO check. There are also several treads on efficiently, and safely getting blood to patients emergently in different and difficult situations. Designing a robust process from the ground up would, in my opinion, be more efficient, safer and easier to control, audit and hold those that make errors accountable.

So am I being paranoid, short sighted or just do not like change. Thoughts anyone

[Malcolm Needs ★ 4,933]

Ensis01, I think you are absolutely correct.

In the UK, the MHRA (a Bengal tiger of an accrediting agency) have all but banned Quality from introducing another layer of checking in any process, on the grounds that this just introduces another point at which something can go wrong.  As you articulated, it is better to tighten up on the process already in place.  As I mentioned above, allowing nurses to check the ABO type at the bed is highly dangerous in my opinion.  The test is almost too easy and, as a result, could lead to complacency, particularly when they are busy (or should be) doing the job for which they HAVE been trained.

[srichar3 22]

I remember when I was in the UK a rep showing me a device they have for such a purpose, would have either been from Immucore or Ortho but cannot say for definite which one. If I remember correctly he said they were aimed at countries that require bedside checking of ABO prior to transfusion so there must be some countries out there where this is a requirement and there is a market for it. The device he showed me looked very much like the Diamed malaria strip test, a Elisa in a clear plastic case that gave bands for the positive reactions. 

[srichar3 22]

http://grifols.com/documents/10192/4198468/brochure-mdmulticard-en/fc571fca-f5e0-4b8c-97de-502b9a75f947

[mcgouc 64]

On 3/28/2019 at 3:11 PM, mpmiola said:

We have already thought about releasing red blood cells from group O until a confirmation, but it was not well accepted at the time. Do you have problems with stock due to red blood cell release "O" until confirmation? How do you do for underweight children? Do you wash the red blood cells to remove antibodies?

Surprisingly, the change had little effect on our group O usage. We did not wash cells.  We were allowed to use properly identified Hematology samples collected in the last 24 hours, at a different time from the BB sample, for the second type. We started a blood management program about the same time where Hgbs or Hcts had to be documented prior to issuing blood so Hematology samples were usually available, even on children.  We did the second sample type on all type and screens so if they decided to transfuse we were ready.  Different areas of the hospital had to be treated differently. For example, when we had a pre admit patient who needed a second sample, we did a type and screen on the preadmit sample,  ordered the second ABO, called and had a note placed on the chart not to send patient to surgery until that was collected, and left a note in Blood Bank.  By working with surgery, ER, and the floors, the change was not nearly as bad as I had feared.  

[mpmiola 28]

8 hours ago, srichar3 said:

http://grifols.com/documents/10192/4198468/brochure-mdmulticard-pt/fc571fca-f5e0-4b8c-97de-502b9a75f947

That's exactly the card.

[mpmiola 28]

On 08/04/2019 at 14:27, BldBnker said:

Houve muitas melhorias em minha carreira. Agora, é claro, temos scanners de código de barras sendo usados por nossos flebotomistas que diminuíram muito o número de amostras erroneamente rotuladas. Nós também temos Epic BPAM para transfusões. No entanto, somos todos humanos e ainda temos o raro erro de espécime, geralmente em uma situação apressada / emergente (quando os SOPs às vezes saem pela janela, infelizmente). Um tipo de slide ABO de cabeceira teria salvado o paciente no Texas que recentemente passou de um ABO HTR. 

 

I'm very afraid of this happening here.