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ABO verification process with the use of SOFTID


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Hi,

Anyone out there using SOFTID (or any other electronic identification system) and still requesting a separate sample for ABO verification?  We have an incident where a nurse sent the lab a WBIT sample with SOFTID.  I have used WBIT data, potential patient outcomes, patient safety, etc to support the idea of getting a second sample for ABO verification.  However, I am still getting major push back from nursing not wanting to do it.  Can anyone share your experience?  

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        We have always asked for another tube when a patient doesn't have history when using electronic ID. We know that the electronic ID is good but there are ways to trick it so they can san something besides the bracelet. I have used 3 different systems with electronic ID and nurses still try to get around using the proper scanning technique. We got support from our Medical Director and we just did it        We also have a second person draw the tube, not the same nurse or phlebotomist.

 

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Thank you @Kathyang!!  Nurses doing short cuts to get around the system is my biggest concern.  With the short 3 months that I am in my current hospitals, I already have multiple proofs that nurses are doing short cuts (preprint label, scanning chart instead of waistbands…) and not closing the loop of verifying the patient before sending down the samples.  I think I have built my case well citing standards and etc.  But my lab director was holding onto the statement that as long as we have an electronic identification system, we do not require a second sample.  My “argument” with her was what good does the electronic identification system do if no one follows the rule and uses it accordingly.  

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I use SCC. Our process currently is using the CBC with a different collection time. If the TS and CBC was collected at the same time, then we request another sample to be drawn. It sounds to me like you have nurses collect most specimens? Do you currently do an electronic crossmatch? This typically fulfills the requirement for the ELXM. 

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I am so glad to see another place using electronic identification system to require a separate sample for ABO verification. 

Yes, we do ELXM.  We only have a few units that are nurse draw.  Actually majority of the samples are collected by our phlebotomy team.  However, I have several nursing leaders having very strong opinions with not wanting to draw the extra sample.  

I have started using the CBC with a different collection time as soon as I have identified the issue.  But it is not a good solution due relabeling.  My lab director is saying that BB don’t have to spend time to retrieve the CBC sample and a second sample is not needed since we have electronic identification system.  Therefore, she along with the nurses are giving me pushback.  I just don’t know what else I need to do to proof that the system is not the only thing we should do to prevent transfusion error. 

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You could use a barrier method like FinalCheck armbands and locks for patient safety. If the band is applied to the patient when the specimen is drawn and then the armband code opens the lock on the bag the unit is issued in, then at least you know that the specimen came from the patient who is going to be transfused. Code doesn't match = wrong patient. We use both electronic ID and the FinalCheck system and do two types on one specimen. We closely monitor phleb performance with direct observation multiple times per year to make sure their process isn't creeping from policy. We have buy in from nursing management and administration which means there is disciplinary action if the barrier system is bypassed (armband removed, armband code found written down somewhere, bags cut, etc.). The only patient specimens that aren't lab draw are from the OR and those are collected by anesthesia with banding and proper labeling required or the ED where collection has to be directly observed by a tech or phleb or we won't accept it.

The big IF would be whether or not the nurses would use the lock system correctly and since you can't get them to use the electronic ID system correctly it doesn't sound like a good bet. If you can't enforce correct use - patient banded when drawn and locks opened at bedside from the band instead of cutting the bag, then it gets you nowhere. It sounds like there is a culture change needed, top down, if safety practices are routinely ignored. That's a huge lawsuit waiting to happen. Do you have a quality department that could intervene? Can you get your medical director involved?

Edited by AMcCord
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Thank you @AMcCord. That’s very good information. I am fairly new to the hospital and I am just now discovering their culture. The entire hospital share one person for quality. And this person is also taking care of infectious control. We also do not have a BB medical director.  Though, I am going to take your recommendation and approach lab director and hopefully he would stand his ground for patient safety.  My next step would be reaching out to the quality person. 

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