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Same Day Survery ABO Confirmation process


RRay

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Just wondering how everyone else takes care of these. 
 

Currently if a patient will need blood sent up for a procedure there is a T&S and prepare RBC order ordered and drawn at a preop appt. The clinic team calls the blood bank to see if there’s a type on file and if not, they place a confirmation order to be drawn at IV placement on day of surgery. 
 

This process had been working fine until same day started ordering confirmations on every person that had a T&S ordered. This lead to a lot of misdraws (same collect time as T&S) and unnecessary samples. The push back I’m getting now while trying to correct this, is that same day wants everyone going into surgery to be confirmed, regardless of surgery, regardless of set up order or not. I’ve never worked at a place that confirmed everyone and I’m worried about the amount of reagent we will lose to all of these unbillable confirmations. I’ll have to up my standing orders too.
 

How do you folks manage this? List of procedures to confirm? A Surgical T&S order?  

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We order and perform ABORH confirmations as needed. 

In your situation, I would probably discuss with the preop team that any ABORH confirmation drawn that is not required will be cancelled by our blood bank team to avoid wasting reagents and time. If they insist that they want it done on all patients, perhaps a discussion with the person driving that decision is necessary. It could be that the person had an experience at another facility where a mistype happened and is now being overly cautious. That may not be a bad thing.

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We used the rate of transfused patients for each type of procedure. We carried out a survey of more than 5 years to identify the frequency of use of concentrated red blood cells for each procedure, including the immediate postoperative period (up to 48 hours). With this data, we define the reservation request guideline. When the doctor requests a reservation, he needs to select the type of procedure, and when doing so, the system fills the request according to the guidelines. For frequencies of use below 10%, zero red blood cell concentrate will appear and the blood therapy service will only perform T&S. We recommend that patients with requests a reservation whose frequency is greater than 10% have an ABO confirmation prior to the transfusion if they do not have at least two concordant ABO records in our system.

Edited by mpmiola
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2 hours ago, jayinsat said:

In your situation, I would probably discuss with the preop team that any ABORH confirmation drawn that is not required will be cancelled by our blood bank team to avoid wasting reagents and time. If they insist that they want it done on all patients, perhaps a discussion with the person driving that decision is necessary. It could be that the person had an experience at another facility where a mistype happened and is now being overly cautious. That may not be a bad thing.

We are not able to see the confirmation order in time to cancel it unfortunately.  We use epic with Safetrace 3.13, moving to Softbank.  We don't have a notification or continuously updated pending worklist.  Softbank will.  However, when the nurses put in these orders unnecessarily, they are drawing right away.  It's a narrow window.

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54 minutes ago, MAGNUM said:

We, the blood bank, generates the confirmation types depending on previous history, the units have NO say in the matter. If it is determined that the patient does not have a history, a confirmation order is generated by the LIS,  A phlebotomist then goes to the floor and collects another specimen.

This has been the process at other places I've worked and did fine.  Here, the OR refuses to draw the confirmation and I think that's why I've never had an issue with the process anywhere else.  So we have a T&S (with or without prepare) done at arrival, and not even 30min passes and they are in the OR.  We don't have the notice to get it drawn and the OR wants everything to be done pre-op.  Often by the time we receive the T&S sample, the patient is under and open.

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If they want RBCs without a confirmation, they will get uncrossmatched RBCs.   I think an immediate spin crossmatch for an unconfirmed blood type is not useful.  

 

Our same day surgery order extended type and screens if needed.  They are good for 30 days out, just as long as the patient hasn't had a transfusion in the last 3 months.  If the patient need a confirmation, a 2nd specimen will be collected prior to or on the day of surgery. 

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I suggest discussing this with the powers to be, QA, and any committee involved in transfusions, budgets, unnecessary, wrong collections etc. Present your concerns and suggestions and if you are overruled you have evidence of your due diligence.

While I see arguments for both sides; finding the most efficient and safe process that everyone can agree with is the important concern. If this means extra draws, cost and BB time so be it. 

Biggest risk maybe drawing two tubes at the same time (one draw) and writing different times (two separate draws)!!

Edited by Ensis01
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We have the ABO/Rh confirmation order built so that it can only be ordered by lab staff when needed. We don't allow surgery staff to put the order in. Blood Bank knows when we get an order if a second type is needed and this prevents OR staff from drawing two tubes at the same time and trying to say they were drawn at different draws.

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