Nurse access to emergency units in blood bank fridge

[TMGal]

I have a site where the lab is not staffed 24/7 but they do retain emergency units in the blood bank fridge. The units have a red tag and are stored on a shelf labelled "emergency units". We have provided training for nurses on how to access and sign out the units but it is becoming a challenge to maintain this due to staffing (clinical and lab). We need to allow nursing to come in and retrieve emergency units after hours. Does anyone else have this type of situation? Our current training is proving to be unmanageable due to the change over in nursing staff and Agency nurses. Sometimes I think we make it harder than it has to be - thoughts?

[Malcolm Needs ☆]

Have you thought about training porters?  I know that sounds a bit "Left field", but it worked for us in the UK in a couple of hospitals where I worked.  You have to be pretty strict, but it does mean that nursing and lab staff can get on with other things.

[SbbPerson ☆]

Do you have an on-call lab person?  Most hospitals with an emergency room have a lab person on-call when the lab is closed.  They can come in and issue the blood. If not, call the lab manager/supervisor and make them come in and issue you the blood.

There is the HaemoBank that is fairly easy to use and perhaps can be used to store just uncrossmatched emergency blood.  Maybe you can get one of those. I know some smaller hospitals that use it.  It's like a small refrigerator/vending machine for blood products.  Good luck

[Bet'naSBB]

Would you consider a remote refrigerator in your ED?  you can get small ones and then they could access it at any time IN the ED?  Might be a big expense upfront - but, in the long run it would be much easier!

[AMcCord]

Can you use the nursing service charge nurse on duty - less turnover in that position possibly so better training opportunities?

[Mr Wayne Govender]

It would be helpful if you could to briefly explain what the issues/problems you're experiencing, it would be helpful to look into the Forum finding or suggesting solutions or current practice/procedures we have in place. 

[TMGal]

Thank you all for the feedback. This site does not have porters - the nurses typically come to the blood bank to pick up blood. We do have staff on-call, but the ED is not willing to wait the 20 minutes it may take for lab staff to be on-site - which can be an eternity if the patient is actively bleeding...we will be moving to smart fridges but that is still a couple of years away...

[SbbPerson ☆]

Why not just put a lab tech on night shift?  That solves all your problems.  You got to weigh your options and what do your prefer, a patient having life saving blood, or going over budget on salary/employee expenses. Good luck

Edited April 5, 2023 by SbbPerson

[AMcCord]

On 4/5/2023 at 9:27 AM, SbbPerson said:

Why not just put a lab tech on night shift?  That solves all your problems.  You got to weigh your options and what do your prefer, a patient having life saving blood, or going over budget on salary/employee expenses. Good luck

They probably barely have enough staff to cover what they cover now if they are a small enough facility to not have a night shift. 

[SbbPerson ☆]

15 hours ago, AMcCord said:

They probably barely have enough staff to cover what they cover now if they are a small enough facility to not have a night shift. 

I am sorry, but I think that is a poor excuse.  "I am sorry, your son died because we are under staffed." If a service is not available, do not offer it.  Personally I think if a facility is not equipped to take care of a bleeding patient, they should not accept that patient in the first place.  Especially for an ED that can't wait 20 minutes for blood. They do more harm than good. This just has lawsuit written all over it. I don't mean to offend anyone, this is just my opinion. Thank you

[AMcCord]

7 hours ago, SbbPerson said:

I am sorry, but I think that is a poor excuse.  "I am sorry, your son died because we are under staffed." If a service is not available, do not offer it.  Personally I think if a facility is not equipped to take care of a bleeding patient, they should not accept that patient in the first place.  Especially for an ED that can't wait 20 minutes for blood. They do more harm than good. This just has lawsuit written all over it. I don't mean to offend anyone, this is just my opinion. Thank you

Small rural critical access hospitals operate under very tough conditions. If they close their doors the next closest facility, which may also be a critical access hospital, might be an hour or more away. It's a world I am thankful I am not working in, though my facility is one that receives transfers from critical access hospitals after they stabilize and ship.

[jayinsat]

I think the only real option in this case is to place 2 units of O neg in a monitored fridge or validated cooler for emergency use only. We have MAX Q blood bank coolers which we validated and hold temp between 2-6 C for 24 hours. They could rotate the blood and cooler daily until they get a blood bank fridge to put in the ER. You will need to come up with a process for them to manually document the transfusion and provide notification to the lab when someone is on duty. 

We have freestanding ER's (FSER) in our area that are not staffed with labs at all. All testing is POC performed by nurses. There is a blood fridge located there with 2 units O neg that we rotate regularly. That was our solution. Not perfect but it works.

[John C. Staley]

8 hours ago, SbbPerson said:

I am sorry, but I think that is a poor excuse.  "I am sorry, your son died because we are under staffed." If a service is not available, do not offer it.  Personally I think if a facility is not equipped to take care of a bleeding patient, they should not accept that patient in the first place.  Especially for an ED that can't wait 20 minutes for blood. They do more harm than good. This just has lawsuit written all over it. I don't mean to offend anyone, this is just my opinion. Thank you

You may not "mean to offend" but that does not make it any less offensive.  If you have nothing helpful to contribute it's best not to. 

I have worked in level 2 trauma centers with 24 / 7 coverage in the blood bank.  I have also worked in a rural clinic in a Wyoming county the size of most states east of the Mississippi and there was not hospital in the county.  The closest hospital was 2 hours by ground and if we needed a trauma center it was at least 3 hours to get a helicopter or airplane in and out.  You do the best you can with what you have.  The people of the county realized that one of the prices they had to pay for living in one of the most beautiful areas in the world was limited access to health care.  They understood, accepted it and were actually grateful for the level we could provide!  They neither wanted nor needed ..........   I best stop now. 

[JJSPLAYHOUSE]

We have a remote fridge near our ORs on our heart campus. We stock the fridge with emergency units AND Emergency Release forms. If a unit is used, they complete the form and send it to the blood bank. The BB tech records the information from the form into the LIS system. Our lab is open 24/7. 

[San Diego Blood Banker ☆]

We have haemobank from haemonetics. It's in the trauma bay. The trauma nurses can access the refrigerator as long as they are registered in the system. 

[bblover]

The best solution is to get a smart fridge.  I worked at a busy hospital where they had one we used to store blood in it, daily. It looked a lot like the following picture. We used to put blue tags on O Positive and Pink tags on O negatives. The nurses did not have to think too much, just to grab the units with blue tags for boys and pink tags for girls.

[Mabel Adams]

Resurrecting this old thread to ask what problems you all find with either a simple blood fridge in ED or with a Haemobank.  We plan to get a Haemobank eventually but if we would just have the same problems with it that we would have with a simple fridge in ED with a few units in it, then the cost benefit ratio is poor.  I am most concerned with keeping nurses trained to use it in a not terribly busy level 2 trauma center.  We have an MTP that uses over 6 RBC units about once every 3 months.  I worry that they will take out O neg for males, take units out for too long then put them back or waste them, not label the units for the patient (with Haemobank) and that it will keep the units far from us so we can't use them up on other patients (mostly 5-day plasma for this concern) without a trek to the ED to swap them.

[jshepherd]

Hey Mabel!

We have a regular Helmer undercounter in our ER, as we can't afford a Haemobank, but we did put the access control on the fridge, so it is locked by a 4 digit code 24/7. Only nurses who are trained know how to open the fridge. We are a level 1 trauma center, so we limited the people trained on the fridge to just the ED Charge nurses. Keeps things secure, and ensures that we know when the fridge is opened and units are removed and for whom. The fridge has RFID shelves installed (Biolog ID), and each shelf contains either O pos reds, O neg reds or liquid plasma. Shelves are labeled, and we have long used a Flintstones system to ID male or female blood, Fred and Grandma Flintstone for O pos, and Wilma for O neg (we do females over 50 get O pos in emergencies). Utilizing a picture system we found helped the nurses with the O pos/O neg thing for red cells. 

We don't allow return privileges for units from the fridge. If they decide they don't need it, they have to run it back upstairs to us. We are directly above the ED, so not a long trek, but they definitely need to make a decision fast. They are good stewards of our blood, and have been great about not pulling out units unless they really need them and if docs change their mind they do physically run the unit up to us for a temp check so we can accept it back! 

Hope that helps! If you need more details I'm happy to share more of our process. 

 

[Mabel Adams]

7 hours ago, jshepherd said:

Hope that helps! If you need more details I'm happy to share more of our process. 

 

Thanks for the offer.  We have a meeting with Biolog ID soon.  Are the units emergency issued in your BBIS, or do they get assigned to the patient somehow with the RFID system?  Or is documentation all on paper?

[jshepherd]

With BiologID, there is an option to add an interface so that your BBLIS data adds to Biolog's data, which means that once you assign the units to the patient they were removed for, it will also show up in Biolog. We still have to issue the units in our BBLIS, they're not connected in that way. Our ED charge nurses call the BB with the patient MRN, we give them a code to access the fridge, and they take what they need. Yes, we basically emergency issue the units in Softbank with that MRN we are given, and use Biolog to know exactly which units were removed from the fridge for that patient.

I am actually working with Biolog to set up a system to remove that phone call to us, so that the RNs can enter the patient MRN on a tablet, it will give the fridge access code, and there is more streamlined access to the blood products, but we still get all the info we need for our tracking and systems. 

[Mabel Adams]

On 8/1/2024 at 10:26 AM, jshepherd said:

With BiologID, there is an option to add an interface so that your BBLIS data adds to Biolog's data, which means that once you assign the units to the patient they were removed for, it will also show up in Biolog. We still have to issue the units in our BBLIS, they're not connected in that way. Our ED charge nurses call the BB with the patient MRN, we give them a code to access the fridge, and they take what they need. Yes, we basically emergency issue the units in Softbank with that MRN we are given, and use Biolog to know exactly which units were removed from the fridge for that patient.

I am actually working with Biolog to set up a system to remove that phone call to us, so that the RNs can enter the patient MRN on a tablet, it will give the fridge access code, and there is more streamlined access to the blood products, but we still get all the info we need for our tracking and systems. 

Does the access code change every day or hour or...?

[jshepherd]

We have the Helmer HB105 undercounter fridge with Access Control, so the Access Control panel allows 100 codes to be pre-programmed. We have those in a list that we just keep on rotating which code is used. 

[bblover]

Does anyone in group have a hemobank?  Please can you share your views about the fridge. Would love to hear pros and cons.  My hospital is thinking of getting one for the cancer center.

[Mabel Adams]

On 8/5/2024 at 8:10 AM, BBlover said:

Does anyone in group have a hemobank?  Please can you share your views about the fridge. Would love to hear pros and cons.  My hospital is thinking of getting one for the cancer center.

Will you also get the BloodTrack software and interface to your BBIS?