Recently during an inspection process, the inspector was unsatisfied with our level of records/documentation of blood issued to the OR refrigerator. Our BB staff deliver to the OR site and OR staff have access to retrieve as needed. As I evaluate improving records of who and when the units were removed from the OR frig ,I am faced with some challenges.

I am rather sure a great many folks still issue blood to OR site , correct?

How have you addressed this documentation challenge?

I am very reluctant to complicate documentation via manual logs of Refrig access for OR staff but this is one option.

I will concede that issuing blood in coolers for specific cases is very appealing to me but will open up a political nightmare within my institution. BUT has anyone been challenged to the documentation of the cooler access? I mean... who goes in and out of the cooler is similar to who goes in and out of the Frig....right?

I would love to hear ideas both in public forum and private email

OR refrigerators have always been problematic. Anyone can grab any unit for any patient in an emergency, so coolers within the surgery suite has been my preference. The recent FDA clarification that these coolers are storage devices complicates the issue, though.

There is always the possibility that a unit can be removed, then returned to the refrig, hence the documentation that the handling was appropriately controlled.

Don't feel bad -- all of us struggle with this issue !

We went away from coolers several years ago because it is virtually impossible to control access. We now use magnetically locked refrigerators. The units are in a temperature controlled, alarmed environment and we control access from the blood bank. The person desiring blood from the refrigerator calls the blood bank. They must identify themselves and the patient before we release the lock. Once the door is opened, they tell us which unit(s) they are removing. I will not say there are no problems, but it is 100% better than before.

We have Referig. in OR but thinking to get rid of it. Eventhough we have referig in OR, some time in emergency situation they take cooler directly to room and after emergency is over they tend to forget about the cooler. We use to waste lots of unit like that.

We use a form to track the unit once it leaves the blood bank. OR staff needs to write the time they place unit in the referig, the time unit is taken out of referig, the time unit return to referig(if not transfused) and time unit return to blood bank. We also require date and signatures.

What an issue here at this hospital...no pun intended!!

OR & Cardiac each have their own OR refrigerators.

One is very compliant, the other is NOT. You guess which is which.

One doesnt care about forms, locks, safet vue, whatever it takes to achieve compliant .

The other is adamant againt all of them:we are causing them undo delay .

Administration would like us to somehow keep both frigs open for issue but whatever I implement for one will be opposed by the other. I fear I am in for a compliance nightmare.

One option would be to forget the frigs altogether and issue to coolers at time of OR but this option is not at all popular here since BB was deliberately redesigned and relocated to be smack in the middle of the 2 Main OR complexes primarily for easy blood availability 24/7.

We have refrigerators in both Surgery and CVSI. We use a documentation card that includes patient name, unit numbers, and then in and out times x2 and return to blood bank times. Surgery has been using this system for many many years and has it down pat with very few "issues". CVSI however always claims they are two short staffed and have multiple issues with getting the documentation when and where needed.

I am interested in the locked refrigerator idea!

I have never been a proponent of blood coolers because of the chance that one will be left in the OR room and blood used on the next case. I have heard too many horror stories. I think it probably works best to use whatever system the Surgery department is familiar with. You will get better compliance that way.

Good Luck - this is not an easy one!!

I have some questions for OR cooler users:

1) How do you label your cooler? Patient" name? Or #????

2) How do you account for all the cooler?

3) DO you reconcile all cooler after XX hours from the issue time?? or end of each shift?

4) Do you have any logsheet with each cooler to document if unit was taken out of the cooler and return to cooler?

5) For long cases (6 to 8 hrs) WHo is responsible for changing the ice pack?

6) Do you use wet ice or frozen ice pack?

We issue coolers with freezer packs. Each unit placed in the cooler has a temp indicator so we can assess suitable storage when cooler is returned. We use a grease board to record cooler number, patient name, issue location, time issued, and time due back in BB. Each cooler has a plastic envelope we use for patient identification. For long cases when cooler has been out 5 1/2 hours we call into the room and tell them that if cooler still has blood in it, we need to re-ice. We don't allow OR to transfer the cooler to the floor with the patient. It must come back to BB at the end of the case. Prior to implementation we did training at surgery staff meetings and have had excellent compliance. We've never had any problems with FDA over the cooler policy.

I would like to hear more about the controlled access refrigerator (manufacturer, etc.). I have been looking into such for my ER.

We have a full-size BB refrigerator in the OR, and although the control desk does a pretty good job of tracking the units, we have some rogue doctors who grab what they want when they want. We use temperature indicators also. We have a policy that requires blood not hung in the OR to be returned to the BB. We do that for tracking purposes. The nurses like that policy because it is one less thing to be responsible for when taking the patient to the floor after surgery.

BC

Bob, check out www.angelantoni.it

They have a system that I thought was remarkable (but then I'm a self confessed technophile) :pcproblem

They are computer controlled blood bank refrigerators. I would love to have them in my transfusion service but I can see how they could reduce the heartburn with having them in OR, ER or any place else that wants the blood stored next to the patients.

Bob, check out www.angelantoni.it

They have a system that I thought was remarkable (but then I'm a self confessed technophile) :pcproblem

John, the site is entirely in Italian. Although I took 2 years of Latin in elementary school and 12 years of Spanish, I can only translate about 1/4 of the Italian. I couldn't locate the product you mentioned. Do you know if they have a distributor whose website is in English?

Update: I found it- it is the Hemosafe refrigerator:

Nasce per essere collocata in tutte le strutture periferiche al SIMT in cui il sangue viene distribuito (su logica FIFO), consentendo l'immagazzinamento di sacche disponibili che vengono poi assegnate in remoto dai medici del centro trasfusionale operando direttamente sul gestionale.

Può trovare collocazione anche nel SIMT stesso consentendo un carico veloce degli eritrociti raccolti e una distribuzione, basata su logica LIFO , ai centri periferici rapido e vantaggioso, facendo tendere a zero gli sprechi di sangue.

La forza del sistema consta nel fatto che è concepito in modo tale da interfacciare tutti i più noti sistemi gestionali in uso. Le informazioni associate alle sacche provengono e restano di competenza del gestionale ospedaliero garantendo così sicurezza e affidabilità sui risultati delle operazioni e massima protezione su i dati sensibili.

Il sistema Hemosafe consente di r esponsabilizzare il singolo (medico, tecnico, inserviente,…), in quanto è accessibile attraverso una sezione di log-in, assicura la massima visibilità delle operazioni, è dotato di files di log sui quali rimane traccia di tutte le operazioni avvenute, velocizza e semplifica le operazioni di carico e scarico delle sacche, garantisce una totale sicurezza e affidabilità sui dati, trova una perfetta integrazione e completamento dei sistemi di assegnazione a distanza.

I couldn't have said it better myself.

BC

I will never need anything like this where I work now but, try this site instead:

http://www.neoterictech.com/BloodTrackHemosafe.html

Thanks, Linda.

BC

We almost never have more than one cooler out at once so we use a log sheet on a clipboard and leave the clipboard on the counter when a cooler is out. We enter on the log which patient, which cooler, times out and in, and the temp on return.

They are seldom out more than a few hours and we have a thermometer in the cooler for monitoring on return.

There is a plastic pocket on the cooler a for 4X6 card on which we write Name and Med Rec #.

We put temp indicators on the units for the first year, but never had any problems so deemed it unnecessary. They really don't take the units out unless they plan to give them.

We, likewise, don't let them send the coolers out of the OR with the patients.

On the website I posted above for Bob there are two buttons at the bottom right of the home page. One says Italian. The other says English. If you push the English button it will translate for you.

For those of you who use coolers as blood storage devices in the OR, how long can the cooler maintain the temperature between 1 and 6C? I would like to get an idea of how often I would have to change ice packs during some of our cardiac surgeries.

If you use an Igloo Elite with 2 quarts of wet ice on top of 2 units of blood, it is usually good for 2+ hours. I had one come back the other day at 9 C after 2 hours 30 minutes. The OR people said they didn't open the cooler (which cuts back on the time it will remain at 1-6C). We put a fluorescent "Return by" sticker on the outside of our coolers.

BC

I don't know why we are so lucky, but our cooler validation routinely shows they maintain 0-6C for 24 hours. (2 units plus equal volume of ice. We put absorbant 'paper' material on bottom, top, and between ice & blood.) Of course the validation is in our lab, and we don't open the coolers. We don't allow OR to keep them that long, and require new ice after 6 hours. (Fortunately, we don't have surgery cases that last that long.)

We have both Igloo and Coleman coolers.

Linda Frederick

Linda,

I test for 4 hours, then make the validation 2 hours to give that margin of error that comes from opening the cooler to check the blood. I stop at 4 hours because the regulations require that you take the temperature of the blood every 4 hours if the blood is not being continuously monitored. That is the storage requirement, not the shipping requirement. However, unless the blood is being toted round and round the nurses station, you would have a hard time showing that the blood is in transport if it is inside your facility. Rather, the storage rules (and thus the 4-hour limit) would apply.

BC

Yikes! Bob, you are absolutely right. No more 6 hours... down to 4 hours!

Thanks,

LF