To have or have not a blood bank wristband

[SantaFe Jane]

My lab director wants to do away with a unique bb armband altogether (who wouldn't when it's the crappy Securline), a notion that apparently has worked for many facilities, but one I've had no experience with. The biggest advantage I see with the Biologics method, where the 5 digit number is embossed on a card and new labels are printed directly at the patient's bedside, is that labeling the specimen AT THE PATIENT'S BEDSIDE is built into the system. It forces the nurses (not so much trained phlebotomists) to realize that the number they are putting on the specimen is really from this patient. Another alternative I would argue for is where a phleb or nurse would obtain a label, for a bb clot, after scanning the hospital id band bar code, at the patient's bedside.

Can anyone give me your arguments for doing away with unique bb id numbers/armbands? What are the advantages?

[Jane]

I wouldn't mind doing away with our BB armband (Typhenex) if it meant going to one of the systems you mentioned. I feel like it gives us another layer of security right now because we require nursing to bring us the armband number when they sign out a unit and they have no where to get the number except the patient's arm. If we didn't have the armband we wouldn't have to worry about the scenario any longer where the patient or nursing has removed the BB armband and we have to start everything all over again. That would certainly be nice!

[SantaFe Jane]

Jane,

This is true. Nurses with scissors--look out.

Thank you.

[John C. Staley]

I've been using the biologics system since 1979 in 2 different facility. It is simple and it works. I have asked for scissor proof bands but haven't seen them yet. The system works very well as long as everyone fully understands the principle of DON'T CUT OFF THE ARMBAND. I have not seen any significant problems in all of these years but then it could happen tomorrow. Remember a system is only as good as the people using it make it.

[SantaFe Jane]

John,

It's good to hear your confirmation of Biologics and your idea of scissor proof bands is excellent!

I fear that my lab director (she is not a blood banker, she is an administrator) has her mind made up and is convinced that it's OK to blindly accept the DOB, MRN and name as the bottom line in patient identification. Seems benign enough in theory, but if you go just with the hospital armband as the means of labeling a blood bank clot, then I fear that there is a greater probablility for a sample to be labeled away from the bedside. Going directly to the band and printing a label ATTACHED to the patient has more safety built into the system. I hope I can persuade, but I am a solo anal BBer here. Yes, educating staff and relearning is paramount for any system.

[korchek]

Has your administrator looked at barcoded systems at the bedside?

[SantaFe Jane]

korchek,

I think this is the right alternative. Scan the bar code, preferably the one from admitting, and get labels for the BB specimen.

THank you.

[bbkdiane]

This may sound twisted, but we do the following:

• Phlebotomists are Lab Trained AND must take a short special "Meet the Old Smiling Blonde in BBK" who will give you a friendly inservice and quiz (inter-active so it's not too threatening). She will be attentive to your questions, will show you exactly what is expected and will be your mentor as you encounter situations that are gray area. Hint: You do not want to screw up..you do not want to go there...it's not pretty.
• Phlebs can use the Misys pre-printed labels for BBK samples as long as they copy the special account number from the patient's armband onto the label. This must be done at bedside. There is no other easy access to this number. Phlebs carry Typenex bands on their carts for instances where there is no ID band on a patient and no time to get one made.
• Nursing is also inserviced by yours truly. The inservice includes some legal facts and scenarios whereby they come to understand that a untoward patient event due to mislabeling will result in a non-defenseable legal issue that will most likely result in the loss of their license and possible personal lawsuit for gross negligence. I created a special bright yellow label for nursing to use just for BBK samples: all information prompts are on the label along with the statement that only information from the armband is used. Nurses sign an affadavit that they understand the policy.
• Samples must be 100% El-Perfecto or they are trashed.
• Patient armbands are barcoded and have a small color picture of the patient. Nursing can download a new band on their unit computer; no more dependency on the Admitting Dept. for a new armband. We don't have the barcode readers yet; we will switch to Meditech next year and will wait to spend the money when the new system is up. Once the barcode system is in place, labels for samples will only print at the bedside when positive contact is made with the band to the scanner. The patient ID band will have a special check digit so nursing can only get labels at the bedside.
• Nursing is under the same disciplinary guidelines as the Phlebs. This was a special moment in time when nursing administration agreed to this one! Mislabeled samples (usually core lab samples where nursing can use pre-printed Standard Register patient labels) result in a written disciplinary action as a first line penalty. Since nursing has to hand label all BBK samples, it slows them down a little and they 'think' about it more.
• We have administrative support for this patient safety issue. This is very important to the success of any program. We sponsor a committee called the "ILS" for "Inappropriately Labeled Samples". Mislabeled samples of any type are documented by a Risk Management Variance and a root cause analysis follows. The person or persons involved must attend this monthly meeting with their nurse manager to explain just how the accident happened. These meetings have resulted in process changes throughout the organization to further the cause of patient safety. Mislabelings happen two or three times per month in the core lab where nursing samples can have pre-printed stickers on them. (This is a 600 bed hospital)
• I know nurses still cut off ID bands routinely in surgery and during the start of IVs if necessary. The phlebs document any patient without a band and this is also followed up. Phlebs are not allowed to stick anyone without a band. Either the nurse takes a minute to get one and place it on the patient, or the phleb writes up a chit that says "We couldn't obtain a sample because.......".
• If the situation is super stat, the phleb puts a Typenex on the patient.
• I would really like to have the rule that if there is no blood type history and the patient is non-O, a second sample would have to be procured by a different person and rechecked before the release of blood. Right now, enacting this policy would cause such hassles that I fear other more serious mistakes would be made by my already stressed staff. If we were in the core lab close to Hematology, I would consider using a properly labeled, phlebotomy drawn sample as a recheck to our BBK sample on patients for whom no history exists. Unfortunately, we are a long way down the hall, and when you work alone, running up and down the hall while phones are ringing is just not doable.
• I've been in the field over 35 years..have done plenty of inspections and have not seen one armband system that is any better than good inservice and use of the patient armband that exists. Specialized armbands for routine use are very expensive and the effect of one pair of scissors = double work and double time. We Type and Screen most of our surgical patients and all of our Labor Room patients: Most of our patients that are Typed and Screened do not receive blood. I know that when we used the emergency armbands for all patients during a hospital admitting computer change (for two weeks) it cost us close to $1000. I am comfortable with the phlebotomist rule of adding the account number from the existing regular patient ID band. The nurses still make me a little nervous, but our approach of inservice, inservice, and more inservice followed by root cause analysis and finally disciplinary action with termination hanging at the end seem to be working. Again, I have had only 3 mislabeled BBK samples in 6 years; all by new phlebs; all caught at specimen log in because the account number did not match. I have had one mislabeled sample by nursing in the same time frame; the nurse looked at the armband and wrote the physician's name instead of the patient name. Sorry to be long winded, but this is my first day off for a long time and I couldn't help myself.

[SantaFe Jane]

bbkdiane,

Your answer is awesome and a tour de force on the subject!!!!!!

Inservice, inservice, inservice and accountablility IS the answer. You've answered my question.

My lab director just thinks I'm too much of a bb fanatic and am not living in the real world. I hope this makes HER more realistic.

Thank you very much.

[Richard Kriozere]

There is some interesting work being done utilizing bar coded/RFID, ID bands and labels printed at bed-side ( see CAP TODAY article July 2005 feature article by Karen Lusky ). It features work done by Dr. Sandler at GeorgetownUniversity Hospital. There is also work being done by an AABB committee ( ATAG ) on a standardized ISBT128 Compatibility label/tag to be used in combination with a companion ISBT128 ID wristband format. This is an international effort.

There are bed-side portable systems existing and in the works to utilize this technology. Certainly training and in-servicing will not be lost and will continue to be indisposable, but this technology will enhance safety and promote efficiency.

If anyone desires more information or wishes to see samples of a bar coded or RFID ID Band or wants more information on the AABB, ISBT128 initiative they can contact me at rkriozere@digi-trax.com

[Kochman]

Manufacturers and users need to be aware that systems like those described by Richard Kriozere are medical devices because they are intended to prevent disease (transfusion reaction) by preventing incompatible transfusions. They also meet the definiton of Blood Establishment Computer Software. Therefore, any of these systems in interstate commerce or where there is interstate transfer of or access to the data requires a 510(k).

[Richard Kriozere]

I am aware that electronic PDT or other computer systems thet do transfusion verification now require a 510(K). I believe thta some companies have a 510(k) and that some have submitted. Can we have the names of those that have a 510(k) and those that have submitted? We have worked with some interesting ID band designs with bar code and/or RFID that might work well in conjunction with such bedside systems.

[Kochman]

Those devices that have already been cleared are posted at the CBER website:

http://www.fda.gov/cber/products/510ksoft.htm

FDA cannot disclose the existence of or discuss pending submissions as this information is considered confidential.

[macarton]

We use to use a Fenwal bracelet and wanted a bar codable one. We got together with our forms vendor and devised a label with four bar code labels, one to go on the arm, two or three for the tubes. Cost wise it is a lot less than we were paying for the commercial bracelets. The specimen and BB bar codes are scanned when specimen comes in. I wouldn't do without another bracelet, as our BB bracelet has saved our hides a couple of times. Mary C

[NedB]

We use Bio-Logics Identi-print (the label embossing cards). With this system you can let the nurse cut off the arm band to start her IVs or for whatever reason. Supply them with blank bands and they can re-attach a new band and move the card from the old band to the new. If the blank bands are kept handy all this can be done at bedside and no chance of the wrong card being used. We usually can keep the same arm band throughout a hospitalization - and beyond for our outpatient chemotherapy Patients. Requiring a copy of the arm band label to pick up blood satisfies the CAP question trm.41650.

[Likewine99]

:clap:Thank you bbkdiane, very well put and great idea on the legal ramifications to patient safety.

[rcurrie]

Anyone who thinks that a "scissor-proof" armband will slow down a nurse bent on removing that band is sadly mistaken. A cast remover makes short work of such.

I have worked in two different trauma level I hospitals. In both places we kept nearly 1000 units of blood on the shelf and never expired anything except AB+ units. As soon as special blood bank armbands were no longer required, we discontinued the process at both institutions. I am against requiring a special blood bank armband. It is a hindrance in urgent need situations such as trauma centers. Do it right once and you don't need a second arm band.

Twice as an inspector I have found patients with arm bands with different names. Places like this couldn't get it right if they required 3 armbands. It's all in the training.

BC

[Franklyn]

The need for a separate "Blood Bank ID Bracelet" is total dependent on on your patient care culture. I have assessed institutions that used a single hospital ID band to great effect and in other institutions (like my own) we have to have a second system because the first one (hospital ID band) is not respected as concretely as it needs to be in our patient care culture.

Train your bedside transfusionists (e.g. nurses)

Train them well

Test them

Re-test

Repeat it every year as part of their annual competency testing.

My two cents worth...

[bpkelly]

We have standardized the ABO second check procedure across our 7 hospital system. As a result, the two remining facilities using BB armbands dropped them this year. I think a BB armband give you a false sense of security. The second check of the ABO either by historical record or a second venipuncture is a much better way to go.

[n.peters]

I would like to get rid of a second arm band eventually. I would rather replace it with a bar code system but that is far down the road. I am having trouble with traumas and the band system.

If you use the second blood bank band system and you receive a sample that is too short what do you allow for the recollect?

I know traumas are special but I feel they should be rebanded if it is another collection, seems this situations is even more dangerous than just going up to a room to collect. Do you allow recollection with a computer generated label and one of the little stickers with the BBID number so someone can save time and the patient can not have multiple bands?

What does everyone do for recollects and/or additional sample used for crossmatch testing, especially those of you in trauma settings?

[Penny Thiel]

Hi Troops!

Hope I'm replying in the correct place.

K, the whole Blood Bank Arm Band issue....sigh....I don't understand why everyone seems to be wanting to make it all so difficult. Why can't people just march in a straight line and do their jobs?

Our current plight is being spear headed by some nurses who think it would limit their mistakes if we went to computer generated labels on the patien and the tube....yeah, ON THE PATIENT for their BB armband. I don't understand what is so hard about Name, Med. Rec #, date, time and initials. Am I missing something here?

Oh my, and cord bloods? Please.

Can anyone give me one really solvent reason to get rid of the Blood Bank Armband?

Thanks for your time all!

With a smile,

Penny

[ABIDer]

For those of you who do use BB armbands, do you have a specific color that you have to use? Is the color mandated by your hospital?

[Penny Thiel]

Hi LucyLou!

We use yellow. In our hospital, a yellow armband indicates a Fall Risk, but there is really more white on the patient Blood Bank armband than yellow. The unigue number stickies are yellow and they come to us with the sample. The hospital did not mandate the color. We (nurses too) just all agreed that we had always used yellow so yellow it would be.

[adiescast]

Some hospitals have standardized their armband colors and require certain ones. Most of us just use what we have always used. We use red, but as Penny pointed out, the band itself is mostly white with a red border. It is just the labels that are fully red.

To Penny: the only solvent reason to get rid of the blood bank armband is if you can rely on all of your phlebotomists and transfusionists to accurately identify the patient and the sample and the blood product using only the hospital armband (preferably 100% of the time...). Our nurses have proven that they respect the blood bank armband slightly more than the hospital armband (which is to say not much), but with the blood bank band we have a somewhat better chance of catching them at it when they don't. We are going to 100% use of the blood bank armband because it helps us to catch more errors. We used to require that they hand write the medical record number on the tube from the hospital bracelet (the only place they could get it from in the room), but JC killed that process by announcing that we were causing them to make errors. In truth, we were catching WBIT by seeing the wrong medical record number on the label. This is not to say that they could not obtain the medical record number by returning to the nursing station and looking it up in the medical record or on the computer...

Nothing prevents terminal stupidity or the determined or clever fool who decides that rules do not apply to them. My apologies to all of the decent nurses/phlebotomists out there.

[Penny Thiel]

Hi Adiescast!

Finally! Someone who answered my original question! Thank you! I made a copy of your reply and plan to use it along with statements from some of our floor nurses who really do just happen to appreciate the band system. They feel it makes them more secure. Yeah, it's true.

With regards to your very well put together last sentence: I think it's tuly a symptom of a much greater disease - that being it sure appears doctors and nurses have no respect for the laboratory professional - something I never experienced until I came from California to Missouri. In California, the CLS most dreaded California State Exam. is required to practice there and Med. Techs are treated with the highest respect. At least this was so 5 years ago. I 've had a very hard time with being treated like I'm just some little high school graduate, pushing buttons or sending tests out. During National Lab week last year we put together these stand along cards for the cafeteria tables. Each one with a different Lab, employee - a picture and educational and professional history. The one most frequently stated thing to me after the week was nurses saying they had NO IDEA we had such an education. Imagine that. Course, this lasted maybe another week and they were back to treating us like they've always done.

Anyway, thank you so much for your response.

With a smile,

Penny