Tissue Storage in the Blood Bank

[Joyce Gacek]

Our Surgical Services Dept is insisting that the Blood Bank take over the Tissue Process for the hospital by storing bone, tendons, etc and issuing the tissue to them on the day of implantation. We contend that no lab testing needs performed and putting this program in the Lab instead of keeping it contained in the OR Dept is inefficent and unnecessary. Does anyone know of resources or have experience with this that could help support our claim that the Lab does not need involved?

For those of you in the Blood Bank that are performing this function, are you FDA registered? Do you actually order the tissues and keep inside your BB area?

Thanks for your timely responses.

[David Saikin]

Our OR wanted us to perform the same function. My Medical Director adamantly refused. In most places I have assessed, the surgical suite maintains their own tissues - from ordering to storage, complete with records. Only rarely have I seen the blood bank as the repository for such.

[Sue Miller]

How is everyone interpreting the new JCAHO guidelines on bone and tissue? Do these guidelines say that the laboratory should oversee the bone and tissue program in a hospital?

[S.Hunt]

Overseeing the "Tissue/Bone" program is the interpretation that our Medical Director has chosen. Not Responsible for the program. The reason for this is a practical one. We currently only store and issue Bone/Tissue, as we have the only freezer that gets cold enough to store it and comply with that need. Also the blood bank computer system module allows for the "Birth to Death" tracking needed, especially if there is a recall

Storage and issuing was all we wanted to do, however, the new JCAHO guidelines came out and the OR, needless to say was no where neer compliant. Training? Competency checks? ANNUALLY - what do you mean by a monitored storage device? Acceptable supplier? The only part that hey were familiar with was the Acceptance protocol for the receipt of the ordered products before giving them to us to store. Our acceptance check list was modified for the receipt of Bone/Tissue and the BB wil not accept a piece of Bone/tissue for storage unless a copy accompanies the product.

Thus at the request of our QA department, a Protocol delineating the responsibility of each party has been specifically stated and SOP's put in place to assure compliance.

Utilization review - amount and type used/outdated, storage problems etc - is put into a report and presented at OR meeting and semiannual Transfusion committee Meetings. Any SOP changes have to be reviewed and signed by responsible QA departmental committees.

Good Luck - This can of worms is bottomless and dealing with non-focused nursing staff is the biggest challenge. The not my job - your job, attitude wears thin and communication on all levels is needed.

[longmt]

Over two years ago following a JACHO review the Blood Bank was appointed caretaker of the Tissue products. We set it up so the Surgical staff orders what they want and have the items shipped directly to the blood bank. We receive them in to the Blood Bank LIS and issue them out to the specific patient when requested. The Surgical staff is responcible for billing for each tissue used. All tissue received are from approved licensed suppliers. We have one individual that over sees the tissue bank activities and all blood bank staff handle receiving and issuing product. This process required an additional FTE in the blood bank.

[CABMT]

We began a tissue harvest program back in the early 80's so we've stored frozen bone since then in Blood Bank. We've discontinued the bone harvesting program but still maintain the storage of commercially prepared frozen bones for the OR. I've tried for a number of years to transition this process to the OR but they have been unable and unwilling to assume the program. In light of the new JACHO rules, we're revitalizing the attempt to move it to the OR since this is far bigger than just frozen bone. The surgeons use many kinds of tissue including corneas, skin, dried lyophilized specimens, alloderm, and who knows what else! Since our Blood Bank does not order the bones, there's inherent problems with knowing what's on hand, minimizing wastage due to over ordering or product expiration, log keeping, justifying disposition, etc. I'm glad to hear we are not the only ones facing the problem and would be very interested to hear what others are doing to meet JACHO guidelines.

[cshipp]

This was a big topic at the AABB meeting with several sessions devoted to it. Check the AABB Live Learning Center (members only) for the handouts. 429-TC "Managing Tissue Within the Hospital" was particularly helpful.

This is an activity that our Transfusion Service will probably be assuming in the near future. I see this as a patient safety issue. Blood bankers already have the expertise necessary (resources are another issue!) and in our institution the computer programming to maintain the data.