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I tried searching but this is a tricky one to find. 

What are your policies regarding collection of a 2nd blood type specimen in OR, especially during an emergency or really urgent case?  Our OR wants to substitute the "timeout" where they double-check patient ID for a second blood type and I was tasked with finding out what others do.  We currently  request a repeat type only on non-O patients with no historic type or separate specimen to test. We stick with O blood until we can get the 2nd type.  If you allow them to not collect the second type, do you issue type-specific blood once the T&S is done?

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      We get a second type on all our patients that have no history. Our computer system requires this to be able to do electronic crossmatches. We keep the patient on type O like you. I also wait until the patient comes out of the OR to get the second type since they don't draw BB tubes very often and we need then=m drawn correctly even for the second type.

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1 hour ago, Kathyang said:

   We keep the patient on type O like you. I also wait until the patient comes out of the OR to get the second type since they don't draw BB tubes very often and we need them drawn correctly even for the second type.

Thanks for the response.

Doesn't this negatively impact your O blood supply?  We can do it for a while but keeping them on O through a bad MTP in OR would deplete our O red cells and our supplier is often running short (and is hours away), especially at this time of canceled blood drives.  It's bad enough for the O patients. 

It really is a hardship for them to draw patients in OR  during a bad case and then when they have to do it twice they are beside themselves.  Mistakes occur for sure.  But we need to have a correct blood type too.

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15 hours ago, Mabel Adams said:

Thanks for the response.

Doesn't this negatively impact your O blood supply?  We can do it for a while but keeping them on O through a bad MTP in OR would deplete our O red cells and our supplier is often running short (and is hours away), especially at this time of canceled blood drives.  It's bad enough for the O patients. 

It really is a hardship for them to draw patients in OR  during a bad case and then when they have to do it twice they are beside themselves.  Mistakes occur for sure.  But we need to have a correct blood type too.

If you follow AABB guidelines, you have to keep them on O until the second type has been performed.  However, if the first sample is drawn using an electronic positive identification system, it can also be used to perform the retype.  We try our best to get the initial blood sample drawn using our Mobilab system to positively ID the patient.  We perform the Type and Screen on our Echo and the second type by tube.  The rare times a patient goes bad in the OR and we need that second sample, we require them to draw it.

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Our Blood bank Medical Director has realized that this can happen in the OR. We try our best to get that 2nd type but if we cannot, he will sign a deviation of policy for that event. Post OR we will then get the 2nd type. We do have an electronic ID system but anything can happen in an emergency or MTP going right up to the OR so we have this in place.

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We always require a second confirmatory sample before issuing group specific units if there is no historical group. We request this as soon as we know the patient has not been seen by us before.

This doesn't impact on the speed of providing cross matched blood due to the shorter test time for a forward group compared to a full group, antibody screen and cross match.

The units are selected based on a rapid tube spin group and set up with the first sample group and screen.

We do not do electronic issue for any patients.

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Just for sake of argument, why is this a big deal???  You don't find a patient in a more controlled environment than an OR suite.  If the original sample is drawn  in the OR and is delivered directly to the blood bank where is the opportunity for mixing up the sample if it was labeled correctly in the OR?  What, exactly are you trying to accomplish here?  At some point is any process involving humans you will have to have a little faith that the others in the process are doing their part as it should be done.  In emergency situations you need to make allowances.  Which is the higher risk, running out of type O and not having it available for those who can have nothing else or the off chance of a patient getting the wrong type in this situation for any of the many reasons you can imagine?   Just a little food for thought.     :coffeecup:

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Posted (edited)
1 hour ago, John C. Staley said:

 If the original sample is drawn  in the OR and is delivered directly to the blood bank where is the opportunity for mixing up the sample if it was labeled correctly in the OR?  What, exactly are you trying to accomplish here?  

John, very good questions.  

Very difficult to scan patient hospital band and specimen labels per Epic specimen collection protocol in the OR.  Here's one worrying scenario:  Label printed for wrong patient (printed outside room and brought in, printed to wrong room, left in room from prior case) > T&S collected with wrong ID > Pt in room would have no testing being done and we would do it on the one the label/order is for.  Caught (eventually) when they call for blood for different patient?   They could send the ID card (proxy for blood bank band under drapes) they made out for wrong patient to pick up blood and we would issue it.  ID would match on ID card and unit. Unit would not scan in Epic on real patient but they could override or give anyway.  Hopefully they would check it against the big display screen in OR which has the right patient on it. Also, could issue blood later for other patient (whose label was used) based on wrong blood in tube.  

Scenario #2:  

T&S drawn in pre-op or ED is wrong blood in tube.  Let’s say BB banding was also improper so band is on patient going to OR.  Tube & band have patient going to OR ID on them (but someone else’s blood in tube).  ID Card is made up in OR.  Timeout is performed.  All will match but still wrong blood in tube.  Nothing will catch error until ABO-incompatible transfusion reaction.  A VTYPE drawn in the room would catch the error.   Evidence: Baylor NW transfusion fatality last year.

If we could make it so labels couldn't print easily except in right room that would probably move #1 into the acceptable risk realm.  If we could tighten up the electronic documentation of collection in scenario #2, that could probably be brought into a reasonable risk realm.  One of our problems is the blood bankers being able to tell for certain where the specimen was drawn and whether the patient was scanned to collect it.  I think this is mostly learning curve but we would need to make sure that our people could (and would remember to) do it.

I greatly appreciate your thoughts and suggestions.  Please add any unfortunate scenarios I have overlooked.

 

Edited by Mabel Adams

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We require a second type no matter where the patient is.  We rarely get push back even during an MTP or ECMO cannulation.  We've been doing it  this way for more than 15 years.  We also don't require them to place an order or use Epic printed labels.  We have them label with a demographics label on the lavender top and our processors know if they don't have an order they immediately bring it to the blood bank.  Unfortunately working in a children's hospital we give a lot more O RBCs due to our patient population and the fact that we don't have the moms at all.  We will also take a verbal second type from another hospital blood bank if we know where the patient was transferred from.  Luckily most of the hospitals in San Diego county have Epic Care Everywhere and/or their NICUs and PICUs are run by my institution anyway so we can access the patient record if we know the MRN.

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Forgot to mention that all our transfusion lab samples must be handwritten at the bedside with no amendments or missing details and signed/dated/timed with matching printed form.

As you can imagine we reject lots of samples.

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3 hours ago, RichU said:

Forgot to mention that all our transfusion lab samples must be handwritten at the bedside with no amendments or missing details and signed/dated/timed with matching printed form.

As you can imagine we reject lots of samples.

We used to require this as well, but as you said, we rejected many samples due to missing initials, mispelled names, missed numbers in the MRN, etc.  When we went with Electronic patient verification we had to change that policy for phlebotomy to use the new system, and things improved dramatically.  No one has the Mobilab scanners except our phlebotomists, so the number of people we have to educate is kept at a minimum.  This is not to say they never cheat the system--they have--but it is much easier to manage 20 phlebotomists than 1000 nurses, specialty techs and anesthesia staff, so we feel pretty confident in our system.

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