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Pre-Transfusion Two-Blood Group Policy


Kellimq
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Hello From Down Under, 

My hospital has implemented the two blood group policy for giving group specific red cells. I have had a question from our head anaesthetist about evidence that this practice is safer?  Does anyone have any links to evidence or where it is written in any other guidelines around the world?

Thanks!

Kelli Quantock - Mater Hospital Brisbane, Australia

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I always 'balk' at this idea because as we all know, the probability of two patients having the same blood type is high.  We have had a few instances over the past few years where a wrong patient was drawn (we use BB Bands so it's very obvious) and they were the same blood type but one had antibodies and the other didn't.  

And yes, there are those who have had to come up with 'defensive measures' to 'assure' that there is no 'cheating', e.g. RN draws 2 samples and holds one in case the BB asks for a second, a witness (do you really think that happens as intended?), different colored tubes for the second draw (assuming they don't draw the wrong patient twice).

I could go on and on about this ... but that wasn't your question, was it?

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As Joanne mentioned above, no system is fool proof and there are lots of creative, inventive fools to prove it.  Keep your system as simple as possible which should minimize the need for creative people to find ways around it.  Now to your question, does it actually help prevent problems?  Probably a few but certainly not all!  I've seen people become lax in their diligence when they assume they are protected by the system.  They seem to assume that if they make a mistake someone down the line with catch it.  This is something to be avoided if possible.  The only way that I know of to prevent this type of mind set from developing is through education and convincing everyone involved in the process that their step is critical and by keeping it simple they will be more likely to perform their step as instructed.  

:coffeecup:

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On 10/14/2021 at 9:07 AM, John C. Staley said:

As Joanne mentioned above, no system is fool proof and there are lots of creative, inventive fools to prove it.  Keep your system as simple as possible which should minimize the need for creative people to find ways around it.  Now to your question, does it actually help prevent problems?  Probably a few but certainly not all!  I've seen people become lax in their diligence when they assume they are protected by the system.  They seem to assume that if they make a mistake someone down the line with catch it.  This is something to be avoided if possible.  The only way that I know of to prevent this type of mind set from developing is through education and convincing everyone involved in the process that their step is critical and by keeping it simple they will be more likely to perform their step as instructed.  

:coffeecup:

We used to have sign in our BB:  The Buck Stops Here.  Of course someone altered the posters to "The Buick stops here".  My boss was pissed off about that.  The concept being that if you have a system of multiple checks and balances you better make sure the first one works.  I have seen this concept evidenced too many times in my career.  People get complacent. 

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I did a swiss cheese diagram after the fatality in the US a few years ago to hit home what COULD happen.

Attaching, feel free to tweak for your use. It speaks to just one of the reasons why we require the sample confirmatory sample, and probably the most important one, WBIT.

Swiss cheese TX incompatible transfusions patient death1.pptx

Edited by cthherbal
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  • 3 weeks later...

Does anyone charge for a 2nd blood type?  We have it set as no charge but since it is an important safety step, recognized by Joint Commission and AABB, the question was should not this be a chargeable event?  If you do charge for a second blood type, is there an insurance code or CPT that applies to a 2nd blood type test? thanks. John V

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