To Use a Unique Blood Bank Identifier or Not...

[Laurie Gillard]

What are your feelings about using a unique indentifier (in our case, "R" number) for blood bank specimens? The Standards require 2 unique identifiers and the Joint Commission (in a 1999 article) recommended a third identifier but in the 2007 Patient Safety Goals (Requirement 1A) recommends using two identifiers when administering blood products...I'm in the middle of proposing improvements in blood collection policies, frankly I don't feel a third identifier is necessary as long as the patient is properly indentified at the bedside and the specimen is collected and label in the presence of the patient. I would appreciate any thoughts on this issue. Thanks.

[Mary]

I consider using a unique Blood Bank number to be essential. Our nurses refuse to transfuse even if they are only giving plasma products.

We also require that a nurse identify a patient who is unable to tell the phlebotomist his/her name and DOB. This rules out the possibility that an unconscience patient is wearing the wrong armband.

The hospital armband, the Blood Bank armband, Name, and DOB adds up to 4 identifiers. You cna never be too safe with patient identification.

[Lcsmrz]

While I've always felt more comfortable using a third, BB-specific identifier, many places I've recently worked go with just the Hospital ID band only.

The thinking is that if the nurses can't get two identifiers right, a third one won't help either ...

[Jane]

We use the Typhenex armband and the nurses have to bring the armband # when they come to sign out blood. The only place they can get the number is from the patient's arm. I do feel like it gives another layer of security.

[jhaig]

We have used the Hollister R# system for many years now and do not transfuse any blood products (except albumin) without the R# wristband being present on the patient. The hospital armband includes the patient's full name, medical record number, and date of birth. I do not accept any specimens into the blood bank without the tubes having the R# on them. This gives the patient an extra identifier which also gives the blood bank an extra layer of security. You can't ever be too careful.

[Eagle Eye]

We use typenex band system. We require typenex number at the time of picking up the blood. If typenex numer is not written on the pick up slip we do not issue blood and usually pick up person will call the floor and ask the RN to give him her the typenex band and they have to write the number on the pick up slip.

[Cathy]

We also use the "R" number. It makes me feel more comfortable. We always used a different band for outpatients and ED. We used the medical record number for inpatient transfusions. When we asked for the medical record number to issue products, they weren't sure if it was the big number or the little number, or the top or the bottom number (on the registration card or on the chart). We also have a fair number of medical record number updates because we have so many people performing registrations.

So when a patient is banded and the T+S drawn, we have the floor send down the card with the rest of the sticky labels. (We just check them and throw the card away.) Although we cannot guarantee that it doesn't end up on the chart somewhere, it makes it a little harder for them.

[Cliff]

What about clinic patients and pre-op patient? For those of you that use an additional band, do you use one for these patient types also? We take pre-op samples up to 28 days. I can't imagine a patient wearing a bracelet for a month.

[Laurie Gillard]

Currently we use an R number, as well as the name and MRN. We treat pre-op patients as we do our inpatients and outpatients. The thing is, the patient is drawn in pre-op. The band is put in the patient's chart. When the patient is admitted, he/she gets banded at that time. What bothers me is, the person who drew the initial sample isn't necessarily the same person who will band the patient when the patient returns. This is part of the reason I'm not a big fan of a 3rd identifier, or at least a separate bb identifier. I think you can use the DOB as a third identifier if you really feel you need one. I also would like to propose involving the patient (as long as the patient is conscious) by having them say their name and give their birth date. In addition to checking the wrist band, you can add the patient's response as another safety check in the transfusion process. I also think (I'm on a roll now!) getting the patient to participate is important from the patient stand point, they can free confident that the phlebotomist/transfusionist is being extra careful with their medical treatment.

[John C. Staley]

I think this is one of those situations where "one size fits nobody". I personally am very much against a second, blood bank specific arm band. I feel it causes more problems than it's worth. I think that each facility needs to evaluate what is out there, how each system is used and then try to come up with something that fits their specific circumstances. A lot of this is driven by the comfort level of the medical director and their experiences. When it comes to patient identification, the simpler the better. The more compicated we make things the less likely they are to work effectively every time. If the system becomes too complicated the folks using it (nurses) will find a better way to get around it or simply ignore it and we never know until something terrible happens.

[bmarotto]

I agree with John. Adding another armband adds another layer of complexity and another potential source of error. I prefer a single method of patient ID used throughout the insitution with "zero tolerance" for deviation. Keep it simple...state that each patient must have an ID band with name and whatever you choose to use as the second unique identifier. The ID band must be attached to the patient, not to the bed or on the bulletin board in the patient's room. The information on the ID band MUST be used to confirm the identity of the patient prior to any procedure, medication, transfusion, etc. If you have barcodes on the ID bands and the technology to scan the band, so much the better. We are not all at that point, but it looks like that is the way things are headed.

[mwlister]

The following CAP requirement requires some type of barrier. It seems we will be forced to Barscan or RFID patient ID systems in the future however the BB armband will satisfy this NEW CAP requirement. So, I don't think we have a choice about having a second ID.

MWLister

**NEW** 12/29/2004

TRM.30550 Phase II N/A YES NO

Does the facility have a documented program to ensure that the risk of pretransfusion sample misidentification is monitored and subjected to continual process improvement?

NOTE: Mistransfusion occurs once every 12,000 units in the US. Although sample misidentification is a less common cause of mistransfusion than misidentification of a recipient, the former is an error in the transfusion process that the transfusion service may be able to detect, thus interdicting a mistransfusion. Studies from multiple developed countries indicate that approximately 1:1000 samples arriving in the transfusion service are labeled with the wrong patient’s identity. Samples with any incorrect or incomplete element are forty times more likely than correctly identified specimens to have the wrong patient’s identity on the label. The use of mechanical barrier systems or electronic sample labeling systems may help to reduce the risks associated with misidentification. Duplicate sampling of patients (or the transfusion of Group O red cells until this re-sampling is completed) may also reduce the risk. Key to improvement of the transfusion process, however, is active monitoring of the frequency of a failure of patient and sample identification and continual efforts dedicated to improving the process.

[John C. Staley]

I think you are reading much more into this CAP requirement than is there. My answer to this question is YES. We do have a program and we do monitor it, constantly in fact. Everything in the note is open to interpretation and suggestion. No where do I read that anything more than we are currently doing is required. No system will work if you can't convince nurses to leave the armband attached to the patient. The most dangerous creature in the world is a nurse with a pair of scissors. I do hope some one comes up with a better system but more complicated is not better.

[bmarotto]

Once again, I agree with you John. I also answered that question YES for the same reason you stated. Our CAP inspector also agreed with this interpretation.

[Kathy3171]

We use a Bloodloc system. A three letter code is attached to the patients ID bracelet. This code is handwritten and underlined on every specimen for Blood Bank. At the time of issue, we put the unit in a Bloodloc bag and lock a plastic lock that has been programmed with the three letter code. The nurse is unable to get to the unit unless she goes to the bedside, reads the code from the patient armband and opens the lock. If the lock won't open, there is a problem (this has happened when they go into the wrong room or have changed the code without telling us, etc.) Once the unit is out of the locked bag, they do the bedside checks for name and date of birth. They really objected to this extra step at first, but now they are not comfortable with anything else. The Bloodloc system is not a separate band as the code is placed on the patient's inpatient ID band. It is good for the patient's entire stay and does not have to be changed. We've used it for 4 years and have found it has prevented some identification problems.

[rsammis2]

I am also in the process of discontinuing use of the BB bands, mostly because of the OP issue since we accept pre-op draws up to 30 days before surgery. We will be checking name, DOB and MRN, asking the patient to state the first two and then also asking them to put their own initials on the BB tube immediately after it is drawn and labeled. We felt that if the patient ID'd the blood bank tube that both the patient and lab tech would feel confident that correct identification occurred. Still waiting for nursing approval but it makes sense to us.