Trm. 30575

[San]

How are facilities handling the plan to reduce the risk of mistransfusion for non-emergent red cells transfusions as stated in the new CAP checklist for 10-31-06

[ABQ bloodbanker]

We had our AABB/CAP inspection in August and all of our facilities got dinged on this one. What we proposed to CAP and they agreed is that when we do our history check to see if a patient needs to be drawn, we will document if they have a prior history with us, and if not, we send 2 individuals if possible to identify the patient and both sign the requisiton and tube. If only one person is available, they grab a nurse to double identify patient. I stated in our policy that two "individuals" identify the patient, not necessarily licensed personnel.

ABQ bloodbanker

[cmiller]

If we do not have a history of ABO/Rh we are having a second sample collected to verify the patient type. We are accepting fingerstick samples b/c it takes so little to do a quick "stick type" with Anti-A, Anti-B and Anti-D.

If it is a trauma situation, etc and we can't get a second sample to confirm type, we transfuse group O rbcs.

So far, this has worked well for us. The only problems we ran into were with our Pre Admits for Out Patient Surgery. For these patients, if we have a type on file, we add a comment to the Type and Screen results that says so. When the nurse reviews the chart on the day of surgery, if they see the comment they know everything is good. If they don't see the comment they call the lab and we collect the retype sample.

Hope this helps.

[hmust1]

At our institution, lab based phlebotomists still draw 99% of our bloodwork. So, we insituted a "self-audit" procedure in phlebotomy. We have an audit sheet, similar to our unit audit sheets, whereby the phlebotomists and/or supervisors perform a pre-determined number of audits per month. The checklist items include "at the bedside" items and "requisition & LIS entry" items.

These audits are collected and reviewed monthly and serve to document our patient identification and order entry practices are designed to "reduce the risk of mistransfusion..." I believe the previous BBK supervisor who began this practice cleared it with CAP first. Of course, this idea is probably self-limiting depending on how much control you have over who's drawing your blood and how large of a facility you are in.

Heather

[Mary]

Have you reviewed the 9/27/07 CAP revision of this question? It is a somewhat relaxed revision.

[Franklyn]

We have multiple systems starting with the Bloodloc at specimen draw, moving through history checks of ABOs in the system and ending with two health care providers (one being the transfusionist) verifying patient ID at the bed side.

The Bloodloc is a pain, and we have WAY tweaked the system to fit a facility our size, but we have actively identified and prevented multiple possible mis-transfusions through patient mis-identifications. So it has done it's job.

[GilTphoto]

We started using a Phlebotomist Witness Statement, that 2 people have to sign that they checked that the right patient was drawn, and they reviewed the labelling of the specimen and Typenex armband. Could be 2 Phleb, or Phleb and nurse, or 2 nurses if drawn from CVP. 2 signatures is a lot easier than 2 samples drawn by diff phleb and 2 ABO + Rh, which is what CAP recommends. We were just inspected by CAP + AABB last month, and the inspector liked our procedure. We also have a history check in computer. The only thing we were cited for was not having a ISBT 128 plan.