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Nurse access to emergency units in blood bank fridge


TMGal

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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?

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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

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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...

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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 by SbbPerson
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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. 

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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

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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.

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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.

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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. 

:coffeecup:

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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. 

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