electronic crossmatch

[bevydawn]

At the facility I currently work, we were prepared to start utuilizing electronic crossmatches, the validation was complete and competencies were completed. Then I began reading CAP's guidelines more thoroughly, having relied mostly on AABB's guidelines to get us to this point. Here is the problem I am having:

TRM.40670 Phase II N/A YES NO

Has the recipient's ABO blood group been verified by repeat testing of the same sample, a different sample, or by performing a historical search of laboratory records?

NOTE: Verification of the patient's ABO blood group must be performed by repeat testing of the same sample, a different sample, or a historical search of laboratory records for that patient. Repeat testing of the same sample may be inadequate unless the sample has been drawn using a mechanical barrier system or digital bedside patient identification system.

This facility did away with BB armbands a while ago, before I was here so we strictly use the patients hospital armband. We do use a digital bedside patient id system, unfortunately it is not used 100% of the time. Can anyone give me some pointers as to products to utilize for the mechanical barrier system as our digital bedside system will never be 100% that can help us get this up and running??

[kelliott]

I believe the mechanical barrier system is the Blood Loc system. No armband system will be 100%. Your current system does not preclude implementation of electronic crossmatch. However, you might consider implementing collecting a blood type using a 2nd sample collected by a different phleb at a different time. We implemented this 11 months ago. and have prevented 2 mistransfusions. Implementation went smoothly with transfusion committee and medical staff support. I had much guidance and support from two facilities with successful implementation.

[bmarotto]

We have been doing electronic crossmatch since 1995. We perform the 2nd blood type on the same sample, but it must be performed by a different tech. We perform a second blood type on all patients without an historical type on file. If you are considering requiring a new sample for the second blood type, would you do this for all newly typed patients or only those that qualify for electronic crossmatch? Think about why you would require a second sample: to prevent an ABO incompatible transfusion resulting from a sample collection error (wrong patient, mislabeled, etc). If you decide to go with a new sample, beware of setting a double standard unless you require it for all crossmatch patients without an historical type. The sample on the new patient with anti-Kell is just as likely to be from the wrong patient as the one on the new patient with a negative antibody screen. How would you handle emergencies? Would you withhold issuing blood until a new sample is received to confirm the type? Would you issue Group O blood until the type is confirmed on a new sample? I am not saying which way is right; just throwing out some things to consider. Good luck.

[kelliott]

we require the typecheck on a 2nd sample for all crossmatch candidates for the sole reason of preventing an ABO hemolytic transfusion reaction. Despite focused attention to sample labeling since 1998 we still have an unacceptable number of WBIT (wrong blood in tube). That is why we moved to the practice of a 2nd sample. If we don't have the typecheck sample prior to the need for transfusion we crossmatch group O red cells. We are able to find a sample about 10% of the time in the main lab so spare the patient a 2nd stick. We rarely have to use group O for no group patients. Implementation went very smooth.Performing a 2nd blood type on the same sample does not protect against cases where the wrong patient was collected or the wrong labeled applied to the tube.

[Gloria]

I have recently joined an institution that does electronic x-matches. Specimens for blood bank are witnessed by a second person that also verifies patient ID. If there is not a previous blood type on the patient a retype is done on the same sample; only after the second type is done are patients with no history of antibodies candidates for electronic crossmatching.