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Typenex Bands: Should They Stay or Should they Go?

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I have a dilemma across my hospital system and wondering if there's any insight here.  Half of our 42 labs use Typenex bands, while the other half does not.  There seem to be very entrenched positions on both sides, but I'm trying to achieve a standardization across the system.  Anyone here with some recent experience on this?  I appreciate your feedback!

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You might consider offering an alternative to the Typenex bands that would satisfy both sides by offering an electronic system that mimics the rationale for the Typenex system. The current Typenex system is based the use of bar coded blood sample container labels that can only be sourced from the patient identification band.  An electronic mimic of Typenex can be used for identification and labeling of all laboratory specimen containers.

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We haven't used any Typenex type band in over 20 years.  If they are used correctly, they add value.  If they are not used correctly, all they do is give a false sense of security.  We do require two samples, and have done since about 2005.  We are often able to get a sample from Hematology that meets our criteria, and so save the patient a stick.

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We used to have Typenex but we removed them since they were causing more problems than anything. We collect two specimens to verify we have the correct patient, if only one sample is drawn, we give group O until we have a second sample collection. We also allow for the use of a hematology specimen to verify our blood type. 

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Our current policy is the same as yours and we haven't had any problems. Our new supervisor is thinking about using them, citing safety, but I can imagine a whole host of problems: nursing education, bulkiness of multiple labels without covering vital info, not being able to see the sample, etc.

I'm wondering what your issues were, specifically?

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I understand the logic of the Typenex as a 3rd or 4th identifier that links that specimen to the unit of blood. But, I am living with the issue of getting 10,000 nurses to be able to complete a Typenex specimen label and Typenex bracelet correctly. It just is a problem.  Biggest issue with specimen labeling is forgetting to add the Typenex label that says "Place patient information below this line and attach to specimen" - it just doesn't happen.  I don't know why it's so hard, we have powerpoint education, it's a class in Orientation where they hear it and see it then do it and the report back is that, even after just talking about it, 75% of orientees fail the test of labeling a specimen and bracelet correctly.

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31 minutes ago, applejw said:

I understand the logic of the Typenex as a 3rd or 4th identifier that links that specimen to the unit of blood. But, I am living with the issue of getting 10,000 nurses to be able to complete a Typenex specimen label and Typenex bracelet correctly. It just is a problem.  Biggest issue with specimen labeling is forgetting to add the Typenex label that says "Place patient information below this line and attach to specimen" - it just doesn't happen.  I don't know why it's so hard, we have powerpoint education, it's a class in Orientation where they hear it and see it then do it and the report back is that, even after just talking about it, 75% of orientees fail the test of labeling a specimen and bracelet correctly.

Just a thought that maybe your process is more complicated than it really needs to be and the nursing staff fail to see the need for it to be so complicated beyond you telling them that's how is has to be done.  Sorry but I have never been a fan of blood bank specific arm bands or blood samples (pink top tubes).  If I said it once I've said it hundreds of times, complicating a process NEVER makes it better.  My first blood bank supervisor, bless her heart, instilled in me the importance of the KISS principle:  Keep It Simple Stupid!  and I tried my best to adhere to it even in the face of adversity (corporate Transfusion QA)!!  

OK, I'll get off my soap box before I fall off.  :coffeecup:

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3 hours ago, applejw said:

I understand the logic of the Typenex as a 3rd or 4th identifier that links that specimen to the unit of blood. 

We trained Nursing that the Typenex band was the only means of identifying a transfusion recipient.  That statement was preprinted on the compatibility tag attached to the blood container and had to be signed by two Nursing personnel.  Nursing was instructed that If a mismatch between letter-number code on Typenex band and the Typenex label on the compatibility tag was detected, do not transfuse regardless of any other band on the patient.

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We use the Typenex bands. I guess the scaredy-cat in me feels safer using the bands. Our current transfusion program, Bridge, requires the use of a barcoded band.

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When we went live with a better electronic ID patient ID system, I considered giving up a separate BB band.  We didn't because of OP transfusions and pre-ops who aren't wearing a scannable ID band when their specimen is drawn.  It also matters a lot how compliant everyone is with proper scanning of patient before drawing/labeling specimens on those patients who are wearing ID bands. If there are a lot of workarounds, then the system may not be too safe.  Read up on the Baylor-St Luke's transfusion fatality and figure out if anything like that could happen at your sites.

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I have worked in hospitals that use them, and in other hospitals that did not use them.  I have to say, I am not a fan of them (for some of the reasons stated above).  That being said, I know of at least one instance where they saved a patient from being transfused with incompatible blood.  Sadly, it involved me in my college days!  I was working as a phlebotomist and instead of going in the room and asking the patient to state their name, I asked them if their name was "so and so."  It was a little old lady and she replied "yes."  Well, turns out she probably didn't know what I asked her.  The paperwork had that room number on it so that is where I went and that is who I drew blood on.  Later that evening, I received a call at home from the Lab stating that the nurse wanted to transfuse the patient (who was supposed to have been drawn) but that she didn't have the blood bank armband on.  I drove down to the hospital and entered the room where I had drawn a patient.  She still had the blood bank armband on.....problem is, the name did not match her hospital armband!  I had drawn the wrong patient because I did not ask her to state her name rather than asking her if she was "so and so."  The patient I was supposed to draw had been moved to a different room.  Fortunately they did not transfuse the crossmatched blood to the intended recipient, as she was in a coma and it was ABO incompatible......would likely have been a very bad outcome.  I learned a valuable lesson and ironically, went on to become a Blood Banker. :o Go figure......

Brenda Hutson, MT(ASCP)SBB

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We also prevented a mistransfusion event and potential ABO HTR because we use Typenex bands. Ours was an ER admit with identification issues that hadn't been detected. We insisted on transfusing with the matching band, not who ED thought they had and prevented the transfusion. We use the Typenex BloodLock system. All blood bank specimens w/ rare exceptions in the OR are drawn by lab. We have total buy-in from nursing management and education. We lose an armband on rare occasion and when that happens I usually get a call from a nurse reporting it immediately and stating that 'he/she has educated the nurse who cut it off so it will not happen again!'. I have not yet had a bag cut to remove a unit and we've been using the system for several years. We are one facility w/ about 300 nurses trained.

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On ‎07‎/‎24‎/‎2019 at 1:13 PM, applejw said:

I understand the logic of the Typenex as a 3rd or 4th identifier that links that specimen to the unit of blood. But, I am living with the issue of getting 10,000 nurses to be able to complete a Typenex specimen label and Typenex bracelet correctly. It just is a problem.  Biggest issue with specimen labeling is forgetting to add the Typenex label that says "Place patient information below this line and attach to specimen" - it just doesn't happen.  I don't know why it's so hard, we have powerpoint education, it's a class in Orientation where they hear it and see it then do it and the report back is that, even after just talking about it, 75% of orientees fail the test of labeling a specimen and bracelet correctly.

I have a hard time just getting nurses to put the label on the tube so it is usable.  I use bloodlocs and Nursing Admin loves them, so the nurses use them correctly.  But labeling a tube - - - I could be talking Greek!

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On ‎07‎/‎24‎/‎2019 at 1:13 PM, applejw said:

I understand the logic of the Typenex as a 3rd or 4th identifier that links that specimen to the unit of blood. But, I am living with the issue of getting 10,000 nurses to be able to complete a Typenex specimen label and Typenex bracelet correctly. It just is a problem.  Biggest issue with specimen labeling is forgetting to add the Typenex label that says "Place patient information below this line and attach to specimen" - it just doesn't happen.  I don't know why it's so hard, we have powerpoint education, it's a class in Orientation where they hear it and see it then do it and the report back is that, even after just talking about it, 75% of orientees fail the test of labeling a specimen and bracelet correctly.

Fortunately, we have phlebotomists that collect 99% of our samples. I can't get them to use the sticker that says " place patient information below...." either. So, I've just resolved myself to accept any of the barcoded stickers. We have bands that also have the BBID on little stickers on the tail that do not have a barcode. I haven't rejected it if that sticker is on it, but we do prefer a barcoded sticker. With the use of Bridge, nurses have to scan the patient's BB armband and then scan a 4D box the product tag, and the info has to match. We won't be going away from Typenex as long as we're using Bridge-- and that was implemented in October 2018.

My issue does stem mostly from the nursing units (L&D mainly) who will armband their own patients and leave the date off the tube.....I could scream. I wish they would teach these nurses in orientation how to label bb tubes.

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