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Retype on 2nd sample


bmarotto

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For those of you that require a confirmatory blood type on a 2nd sample for patients with no historical type on file...

1. I assume you give Group O red cells if the second sample does not arrive before blood has to be issued (traumas, OR's, etc)? Has this had a substantial impact on your Group O inventory?

2. How has this system worked for other facilities you serve, such as dialysis centers or rehab hospitals?

3. Have you seen evidence that staff responsible for drawing samples have found a way around having to stick the patient twice by drawing two samples and holding one back to send later in case the Blood Bank asks for a confirmatory sample?

My concern about implementing this is that it may do no more than give everyone a false sense of security. It seems to me the root cause of many mislabeled samples is that confirming patient/sample identification and labeling of samples was not done AT THE BEDSIDE. Call me old fashioned, but I am a firm believer in training staff to do it right the first time with consequences for those who do not follow proper procedure.

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I completely agree with your last statement. We do not require two separate draws at this time. We do, can you believe it, hand label our transfusion samples from the patient's armband. We also spend a lot of time on training and competency of all those who draw transfusion specimens. In addition we have two people identify the patient prior to drawing and document such. We have avoided the 2 separate draws so far due to the issues you raised in your post. I am hoping for an electronic solution soon.

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I ditto Karen. We do the same; we still require hand-labeling from the ID band and 2 sets of initials on the blood bank specimens. The other adult hospitals in my city have all gone to 2 separate draws and computer labels, but one of the supervisors told me she strongly suspects that their E.R. is drawing both specimens at the same time and holding one at the desk, re-ordering, then labeling the 2nd one with a later draw time. We are a pediatric hospital, so getting separate specimens drawn on our little ones at 2 different times is like asking for the impossible. I'm debating on whether to go to issuing only O units until we see a 2nd separate blood specimen on the patient and retype it for ABO/Rh (either a transported cord blood, CBC, or another BBK specimen). The hassle factor of tracking down specimens from different departments is the major reason why I have not done this, and I agree that teaching the people drawing the specimens to properly ID the patient and specimen is a better way to go. Once we go to bedside scanning, I imagine the hand-labeling will stop... but even then, I worry that some creative nursing staff will come up with ways to work-around the safe-guards.

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We instituted a second sample at the time of RBC request in patients whose first (and only) type in our system is not O. The second sample is collected with a fingerstick collection device with EDTA, in order for us to be sure we are getting an actual second sample. The ER will double draw every time, and if a mistake is made, it's just duplicated. We send a "packet" including the device, an alcohol prep pad, sterile gauze packet, bandage, and complete INSTRUCTIONS on how to collect & label. A quick ABO/Rh confirmation is done on this, if all is OK, the crossmatched blood is released.

Predictably, the only area from which we have had any pushback with this was the area that caused the protocol to be put in place in the first place, the ER. :mad: (We had 2 ABO mistransfusions due to WBIT samples from the ER in the space of 24 hours, a couple of year). Fine, you don't want to give us a fingerstick sample, we'll supply type O blood and ask the OR to do it for you! I have had to encourage the creativity of the anesthesiologists on where to obtain "fingerstick" samples when fingers may not be available. Earlobe, shoulder, upper arm, etc, are all fine. In the 2 1/2 years we have had the protocol in place, we have "caught" at least 6 wrong types where patients initially typed non-O were actually O. So it still happens.

I would love to be sure that everyone drawing blood was trained to do it the right way, every time. But the lab in our facility no longer has jurisdiction over phlebotomy, and there are too darned many people, who turn over too often, doing blood draws for this to be practical.

We have not seen a great deal of "excess" type O use waiting for fingerstick samples. The blood bank leadership enforces the policy with applicable department heads, as needed. We will never withhold blood from any patient for the lack of a fingerstick, type O is always available. Once the applicable staff get this thru their heads, we see no trouble with compliance. I try to regularly reinforce good inventory management with appropriate areas.

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MJ,

I truly sympathize with your ER situation. We went through all of that many years ago (without the mistransfusions, thank goodness), and finally got control back to lab staff or staff trained under our supervision.

With all of the new emphasis on patient safety, 100K Lives programs, RFID patient identification, sentinal events, root cause analysis, and so on, when are they going to listen? Maybe if your could expose them to the new "vein to vein" safety, they might listen.

Best of luck.

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