Red Cell coming from other institution with a patient

[simret]

Does anyone of you out there have encounter on how to manage units of RBCs that come to your Blood Bank from other institutions with a patient? Do you accept the units, or discard them? Are there any regulations that monitor this kind of event?

Thank you so much for your input!

Simret G

[Ensis01]

My experience is that When a patient is being transferred from another facility with cross matched RBC or other products; infusion should have started by the time they leave the ambulance. Products not being infused are discarded unless they have correct transfer paperwork, I.e. for antigen neg units. Crossmatching process begins again. To put it another way if you know the patient is coming; the other facility Dr. Orders enough products to cover the journey. If the patient is a hard work-up get all information and transfer antigen negative units. If worked up at a reference lab: Reference labs have a form that will allow transfer of results though receiving facility  do not always accept these results. 

[simret]

thank you for sharing your idea!

[AMcCord]

Patients coming in to us with blood products are coming from much smaller facilities w/ limited capabilities and inventory. I send any units that are not hanging back to them with the ambulance that brought the patient. They need that unit much more than I do.

If a provider here wants to infuse a unit that came with the patient, for whatever reason, that unit would have to meet shipping/transfer requirements, be inspected, processed and crossmatched prior to transfusion. I would enlist our pathologist on call for assistance if the provider wanted to give that unit straight out of the shipping container - our policy states that we would give uncrossmatched in that situation.

[tkakin]

We do not accept neither units cross-matched nor uncross-matched on patients from another facility.  If I have the testing facility info, I call them to let them know if the products were not used.  If they want them back I am happy to return.  However, no one has ever asked for the product back.  This is not something that happens very often here... maybe 3 times a year...

[BankerGirl]

This does not happen often at my facility, but our policy is similar to AMcCord's.  If already infusing, the nurses continue the transfusion and document that.  If not infusing on arrival, we are rarely notified prior to the ambulance departing, so we rarely get to send the units back.  If there were appropriate shipping conditions/paperwork, then we would accept into our inventory; if not then the units are discarded and the transferring facility notified.

[TreeMoss]

1 hour ago, BankerGirl said:

This does not happen often at my facility, but our policy is similar to AMcCord's.  If already infusing, the nurses continue the transfusion and document that.  If not infusing on arrival, we are rarely notified prior to the ambulance departing, so we rarely get to send the units back.  If there were appropriate shipping conditions/paperwork, then we would accept into our inventory; if not then the units are discarded and the transferring facility notified.

If the units are from our blood supplier (ARC) and we have the correct paperwork with correctly transported units, we will put the units into our inventory and use them.  Anything from another supplier gets discarded.  ED folks are instructed to bring any blood products transported with a patient directly to the Blood Bank.  If necessary, we will issue units as "Uncrossmatched"; otherwise, we collect a new specimen and crossmatch needed units.  We will also let the original facility know if we discarded their units.

[simret]

thank you all for sharing your idea!