Confirmation of ABO/Rh Type

[rcurrie]

I'm assuming that the computer module that is required is the "education" portion of your plan. What is the "reporting" and "corrective action" part? What is done for each individual mislabeled specimen--phlebotomist, nurse, etc. counseled? documented in a database?

Reporting part?----report to the transfusion committee? QA team?

Just interested. I really like this idea.

The computer module is just part of the education part. We also have team members do training for each unit that draws specimens. If you send me an email request to rcurrie@swmail.sw.org I will send you the Powerpoint presentation we present to the individual units. The computer module is proprietary and contains data we do not wish to be made public, so I can't send that.

Reporting is through the Adverse Event Reporting system, and goes first to Risk Management. A root cause analysis is performed for each event. Results of all investigations go to the institutional QI committee.

The persons involved in the events are retrained as necessary, counseled, given 3 days off for a second offense, and terminated for a third offense.

BC

[Brenda K Hutson]

I have done it "all" of those ways at previous Hospitals. For patients with no historical type, one place I worked required that 2 different Techs., type the same specimen. However this will only capture mis-typing the the Tech., not a misdraw. At another place, they required a type be performed on 2 separate specimens, drawn at separate times. That is obviously more time-consuming, but much more helpful in preventing risk to patients due to misdraws. From what I have read, the latter is "becoming" the standard of practice.

Hope that helps,

Brenda

[LABKING]

is there a list or source of information to confirm the standard of practice for 2 specimens when there is no blood type history,

is there any information concerning retyping versus immediate spin xmatch when there is no blood type history

[Mabel Adams]

Are there any centralized transfusion services that have found a good way to draw a second sample on a patient at a remote hospital 20+ minutes away? Does someone research which BB patients need a second sample drawn before the first is sent or do the couriers make 2 trips?

[jcdayaz]

Just to be clear about what is up for discussion, you are only talking about the requirement for retyping when a computer crossmatch is used and there is no patient history, aren't you? There is no retyping requirement unless you are performing computer crossmatches.

BC

We do computer crossmatches. It is an on-going dilemma about the 2nd blood type requirement. AABB allows for 2 types on the same specimen. Apparently it is Joint Commision that requires a 2nd draw. Does anyone have any information on this requirement?

When, by the way, did Joint Commision EVER have stricter standards than AABB???

[L106]

I was not under the impression that Joint Commission actually required a 2nd draw. (Can you give me information where I could find that?)

Why would a 2nd type be any less important if you are doing standard crossmatching (rather computer crossmatching?)

[jcdayaz]

I seems like they are asking the Blood Bank to solve a problem that is in most cases external to the Blood Bank. I believe there is an underlying motive behind this CAP question. Most facilities will implement the second draw causing complaints from patients, nurses, and physicians. This in turn will speed up the process of implementing bedside scanning. If Blood Banks were the ones requesting administration to come up with the funds for bedside scanning, little would be done. Complaints from other medical staff and patients will move bedsise scanning up the priority list.

I find this rather annoying. If bedside scanning is what the powers that be want, then say so and give us a deadline to comply. I bet once we all implement a barrier or second draw system that is exactly what will happen.

YES, YES, YES!!! It is most assuredly not the blood bank that messes up...

[jcdayaz]

I was not under the impression that Joint Commission actually required a 2nd draw. (Can you give me information where I could find that?)

Why would a 2nd type be any less important if you are doing standard crossmatching (rather computer crossmatching?)

Sorry, I don't have the information you requested. That is what I was trying to "pick" all of your brains to get!!

[jcdayaz]

So the bottom line is... CAP and AABB have requirements for retyping only if the blood bank performs electronic crossmatches, and if the blood bank performs a serologic crossmatch, there is no specific requirement for a retype.

My understanding is that this a new requirement made by JCHO. Not by CAP or AABB. ?? Supposedly it is now required by JCHO to do a second blood type off a specimen on the patient drawn seperately from the crossmatch specimen. We tried to implement this....and needless to say, it didn't go over too well. I have not been successful at locating the specific JCHO standard that relates to this topic.

Any ideas???

[yiams]

We were inspected by AABB in March 2009 and by CAP about a month later. CAP allowed the AABB inspection of our Transfusion Service to work for them as well. We have NO blood bank computer of any sort; we remain with paper records.

We adopted a policy to have a second person from the nursing unit identify the patient along with our lab assistant/phlebotomist. We wish the second ID person to be someone working with or who has worked with the patient. That second ID is then recorded on the patient tube as well as on the paper drawing record for that crossmatch/type and screen/ABORh for plasma or platelet transfusion. some RNs/LPNs have balked but our lab assistants have relayed that to us and our lab director has contacted the nursing supervisor of the unit to set things right.

Both groups were a little skeptical but allowed this. As others have mentioned in this forum, there are "work arounds" with the requirement of two separate specimens. We're also of the opinion that you do it right the first time with our small group of well-trained lab assistants.

[jcdayaz]

Why would a 2nd type be any less important if you are doing standard crossmatching (rather computer crossmatching?)

I believe the theory is to help alleviate the possibility of the wrong patient being drawn the first time. I agree with you, if it is so important when doing computer crossmatches why is it less important if doing standard crossmatches?!

I am determined to get to the bottom of this!!!

[jcdayaz]

I agree completely!!! Unfortunately that does not always seem to happen!!

[Malcolm Needs ☆]

My understanding is that this a new requirement made by JCHO. Not by CAP or AABB. ?? Supposedly it is now required by JCHO to do a second blood type off a specimen on the patient drawn seperately from the crossmatch specimen. We tried to implement this....and needless to say, it didn't go over too well. I have not been successful at locating the specific JCHO standard that relates to this topic.

Any ideas???

You could try telling the physician that any blood issued to the patient is issued as uncross-matched if they do not provide a second sample, and that they are, therefore responsible if there is any reaction, and follow this up in writing so that you are legally covered. You may well have to have the backing of your Medical Director, but if he/she is worth his/her salt, you should get this without question.

My experience is that the very thought that the physician may actually be held responsible for their actions in relation to a blood transfusion, particularly one involving uncross-matched blood, works wonders!!!!!

:confused::confused:

[Malcolm Needs ☆]

I agree with you, if it is so important when doing computer crossmatches why is it less important if doing standard crossmatches?!

I am determined to get to the bottom of this!!!

I absolutely, utterly and completely agree with both you and L106 concerning these sentiments.

There is NO logic to this whatsoever.

:mad::mad::mad::mad::mad:

Edited January 2, 2010 by Malcolm Needs

[jcdayaz]

My experience is that the very thought that the physician may actually be held responsible for their actions in relation to a blood transfusion, particularly one involving uncross-matched blood, works wonders!!!!!

:confused::confused:

HaHa Malcolm, I have had the same experience with emergency release, uncrossmatched blood orders. It seems once you tell these DR's they have to sign for the blood (and therefore be responsible for it) they typically decide maybe the transfusion wasn't so urgent after-all.

[tcoyle]

I am curious to all that are doing this second sample process, how do you handle this with the computer system if you are using Safetrace TX?

Thanks.

[cmelloh]

We use a second ABORh typing rack with a different manufacturer of typing reagent. A second tech performs the type recheck using the different reagents. If only one tech is in Blood Bank (mostly midnight shift) then the same tech can retype the sample since a different set of reagent is used.

[Vic]

This is how we handle this issue: Our computer system is attached to 5 other hospitals in our system. First we do a history check by SSN to check at the other hospitals (one of which is very large) for any historical type. If there is not historical type and the patient is not group O AND red cells or FFP is ordered, then we have to have a second sample. We can have a sample that was collected up to 7 days prior as long as it was collected at a seperate time. If one is not available, we have the nurses collect a CBC tube (not a blood bank one, that just confuses them). If there is not time for a recollect then we opt to give type O. Our computer system allows us to order a ABO Second Sample test as well as stop units from being issued until this ABOSS test is done. If the patient is type O then we do not do any kind of confirmatory testing.

Now, We just had our CAP inspection in Feb. My inspector asked me "How do you know that the second sample is being collected from the right patient?". So, how exactly do you argue that? She was actually going to cite me because we, the lab, did not go to the floor and draw another specimen, regardless if we already had a seperate one in the lab. I took her to our QM department and discussed the education and training we perform and the corrective action taken when any specimen is mislabeled. She still wanted to cite me....so..luckily there was a CAP inspector with her and I asked her. She agree'd with me that what we were doing was sufficient. Apparently my inspector was cited because they did not draw the specimens and she wanted to get me for it to. So...beware!:tongue:

[L106]

So how do we absolutely know that any or our samples are drawn from the right patients (even if you send a lab tech up to draw another specimen?) Glad that there was another inspector with the team who voiced his/her opinion about the issue.

[JOANBALONE]

We use a second ABORh typing rack with a different manufacturer of typing reagent. A second tech performs the type recheck using the different reagents. If only one tech is in Blood Bank (mostly midnight shift) then the same tech can retype the sample since a different set of reagent is used.

I do not understand the logic in using a different manufacturer of typing reagent. It is like saying you have no confidence in your reagents. When was the last time your reagents were wrong? I would save the time and trouble of stocking different type of reagents, performing 2 different daily reagent QC etc and just stick to one typing method. Your bench techs will thank you.

JB

[reidhospbb]

We do computer crossmatches and electronically scan the patient's armband to assure identity of the patient. If a historical blood type is not in the system, a different technologist will perform a second ABO and Rh on the same tube if that is the only specimen available. If a different specimen is available from a separate draw a second technologist will perform the ABO and Rh recheck. I feel it is not always in the patient's best interest to require a separate specimen, e.g an infant or an emergency situation.

CM

[jmart]

We have 2 people identify all the patients(nursing, another phleb or tech). The second identifier is on the tube and entered into computer for all pink top tubes.

If the patient has a previous history,only one type is performed.

If the patient has no previous history, we created a test "history" and a retype is requested by reflex. The retype is performed by a different tech. On night shift the single tech performs their own retype and the tech on the next shift confirms the blood type with an entry in the computer stating this.

[PammyDQ]

Mabel, you are right. CAP item #30575 strongly suggests a second type. What I plan on doing is if we have a CBC or H/H sample in the lab then that sample will be used as the 2nd ABO provided that it is properly labeled. Other than that a second phlebotomist would have to be sent to the patient for a second sample.

This is what we do...in most cases we can find a hematology specimen from a different collection time. If not, as in new admits or ER patients, we will kindly ask for "a tiny bit" of blood in a lavender tube. For our pre-op patients that have no history, we call the pre-admission testing department the day before surgery and they collect a confirmation specimen when they start the patient's IV. In any case, if we're unable to confirm a non-O patient's type, we will transfuse O red cells. This happens RARELY.