AABB Standard 5.11.2 refers to blood samples being labeled with two independent identifiers. We use Meditech and all of our specimens have the patient's full name, date of birth, medical record number, date and time of collection, and the initials of the person drawing the specimen. Which of these identifiers, in accordance with the standard, are needed on the blood bank wristband (we use the Hollister system)? Right now, we put all of the above info on the bands, but it seems like overkill. At the same time, how safe is too safe? As long as there is a mechanism to assure the blood bank that the correct patient has been drawn, we should be in compliance. I just can't find a standard regarding blood bank wristbands.

After asking the patient their name and DOB, we confirm that with the labels in our hand and the admission bracelet on their wrist. After drawing the blood bank specimen, we have a red wristband which we attach one of the patient's labels and a BB # sticker to it.

The labels have the patients name, DOB, medical record # combined with the BB # and we have more than enough information.

You specify which two (or more) identifiers you wish to use. We use full name and MRN for inpatients, and full name and DOB for outpatients. You are also required to have a system to identify the collector and the date of draw. Most people also include a time requirement. We do not use a special armband. The most important thing is to not use the patient's room or bed number as one of the identifiers. The patient's doctor would also not be worth warm spit as an identifier.

BC

We use typenex band system. We require pt's full name as it appears on the chart/addressograph label, MR#, date of collection and initial/signature of the person drawing the specimen.

BTW- I am glad you noticed that the requirement is "independent" identifiers rather than "unique" identifiers. I hear the latter term misapplied to the requirement too often. Not even "patient name" qualifies as a unique identifier. I have at least 10 people in my hospital right now who share the same first and last names with other patients currently inhouse. Not even MRNs are unique- we recycle those as patients die and their records are closed.

BC

AABB standards mandate proper identification of patients when samples are drawn. There is no specific requirement for use of a wristband, although many people use them.

It's up to use a system that allows you to sleep at night ...

We don't use a separate blood bank band because it was poorly respected by nursing personnel. It was the first band to be cut off in OR so they could start an IV. It was the first band to be cut off in the room when the IV started in OR infiltrated 2 days later. So on, and so forth. They didn't care about that blood bank band because they didn't have to put it on. Now the only armband is the one put on by them, and they can't transfuse without it. It puts a whole nuther perspective on it, and suddenly patient ID compliance is up.

BC

Sometimes by adding requirements, be they bands or identifiers, we just create more things to check and more ways to make mistakes.

Case in point: we recently ceased providing a transfusion slip with our units. Now we don't have to check that against the unit when we "dress" it or issue it. Nursing makes up their own forms for the chart with the info that used to be documented on the slip. We no longer get back a copy of anything and the computer puts the units in as "presumed transfused." The nurses were kind of confused by not having more paper to check at the bedside with another nurse, but I think it puts the focus in the right place--does this unit match this patient?

Sorry, bit of a tangent. Hope someone besides me can see how it relates.

Has anyone looked at CAP's "new" (phase I) requirement to have a method to reduce misidentifications? It states that a blood bank armband system is not sufficient.

I hadn't seen the new CAP phase I requirement, but I guess we have it covered by having two people identify the patient at the time of draw. I'm sure what they are leaning toward is performing a second blood type, from a new draw, on the patient if you don't have any history.

We have the patient state their name and DOB prior to draw. We use the Hollister Ident-a-band system and only write the patients full name and MR# on it as it appears on their hospital band and the date. All of the other required information is on the requisition and tubes. (Patient's full name, MR#, Collector, second ID person's initials, date and time of draw.

I agree that there are no specific requirements for the information on the BB band, since a separate band is not required they can't really insist on specific requirements to be on it.

where do they document that two people identified the patient? on the requisition or specimen label? DO you make them sign ? initial? Is this rule applies to all patient emergency and non emergency patients?

I interpreted the new CAP standard to mean that you are currently evaluating/planning other systems to aid in patient id for the future. Such as the bar coded patient id systems that are out.

I interpreted the new CAP standard to mean that you are currently evaluating/planning other systems to aid in patient id for the future. Such as the bar coded patient id systems that are out.

Yep. That's the literal meaning Why, shore we got a plan to implement a system. I'm plannin' on doin' all kinds'a stuff before I die. Hopefully I will get a round toit.

BC

I listened to a CAP teleconference today talking about the new CAP question. They said "your plan" may turn into mandatory in about 18 months. Who has/is allowed that much time to get the rest of the hospital to buy into some potentially very high cost products?

I think what the Standard is referring to is a system such as bar wanding the patient's band and then the unit - with the unit label having a bar code that matches the patient's bar code. If things match, then the IS allows the nurse to proceed with the other aspects (s)he needs to continue with infusing the unit. Or perhaps RFID??

where do they document that two people identified the patient? on the requisition or specimen label? DO you make them sign ? initial? Is this rule applies to all patient emergency and non emergency patients?

We document the initials on the requisition. This rule is for all patients. Of course with emergency release it would be done post the patient getting the O Neg units-as soon as the specimen is drawn.

This system has provided our Techs with a much better sense of security that the specimens are from the correct patient.

Is there any data on the effectiveness of two people doing the ID? I seem to remember reading once that it didn't improve much because each person figured the other one was paying attention and taking responsibility.

Like everything, I suppose it is in the details: understanding of the need, training, adherence to the intent of the policy and reduction of factors increasing the odds of human error (fatigue, distraction). Get those right and any policy will work better.

We require that 2 people id the patient at draw time. One of the 2 has to be an RN. Our specimen label prints with a line for the person drawing and a line for the RN witness to sign. It states that the specimen was drawn properly according to our policy.

There is also a list of 5 items that cover the id steps spelled out in our policy. Each must be marked as yes. If any are not checked or if either signature is missing the specimen is rejected and must be drawn over.

We place a barcoded armband on the patient and a barcoded label that matches on the specimen tube. They use this number along with name, dob and mr# to id the patient at transfusion time.

This system works very well for us.

We record the following:

• Name
• DOB
• Date and time of draw
• Phlebotomist initials (all trained phlebotomists are on file)

We have just recently changed our policy to delete the MR# from the required information. This was done to standardize the banded info between inpatients and outpatients. I have to admit, I was quite distressed about this. I've since decided however, as we use the typenex system, that in itself is a unique identifier. I'll live...

We use typenex band system. We require pt's full name as it appears on the chart/addressograph label, MR#, date of collection and initial/signature of the person drawing the specimen.

Ditto!

We also use the Typenex system, however we have found that when nursing staff collects specimens, they often try to find a way around the system. We explain it to them, show them how to use them, explain our zero-tolerance policy, etc. each month at nursing orientation. We even give examples of how using the system correctly has prevented us from transfusing ABO incompatible blood, and had the system not been in place the blood would most certainly have been transfused. But when they get to their floors they are told by other nurses to do it differently.

We reject any specimen that gives us the slightest pause. That seems to just inspire them to come up with more ways to "cheat".

It would seem that the safest way would be for a second specimen to be tested but I see from other posters here that their nurses got wise quickly and just draw a second tube at the same time, hold it, place a later collection time on it and submit it to the lab. I'm sure our nurses could figure that out just as easily.

someone had a reply about not using a tx slip from the BB

that is amazing, we would like to know more about that, who thought of it, how was it implemented, validated, etc This appears to be a big time and paper saver. what systems are involved

Edited November 13, 200816 yr by LABKING

At my prior workplace when we decided not to have nursing return a copy of the transfusion slip to us, I started wondering why we were providing them with a piece of paper for their charting when they had to turn around and put most of it in the chart on some other form anyway. Why not just have them have a form for their chart on which they document vitals, ID checks etc. to which they added the unit number? We worked with them to modify their existing transfusion flowsheet form to have all the stuff that was on the transfusion slip. Part of it included trx info. Then they have to send us a copy of the form with that section completed as well.

There wasn't much to validate since the form contained all needed info. Training was pretty easy. A couple of issues came to mind afterwards. We issued almost all blood via pneumatic tube; checking the unit with 2 people as was done at face-to-face issue when the tube was down and by the 2 nurses at the bedside, required both people to look at the unit and the compatibility tag on it to check those parts that were common to both. It could get a little cozy. Also, they sometimes sent the original for trx which took all of their documentation of the transfusion out of the chart. We had to make a copy and return it. They liked not having BB checking their paperwork for completion and breathing down their necks about it never being right. We liked not expending our energies on such a futile endeavor with so little patient care impact. There are more important things for us to monitor. Hope that answers your questions.

One more point. It seems like this will be an easier transition when nurses start recording transfusions in the computer system.

I am jealous of the fact that you do not have to monitor the nursing practice of transfusion. The State Board of Health in Indiana holds the Blood Bank responsible for the nursing documentation of transfusions. You can imagine how that goes over with nursing. :bonk:It has becaome a hugh labor expense to monitor 4000+ transfusion tags annually. We also have to notify them when anything is wrong or missing and they have to return documentation of the action on the matter. You are fortunate.