Policy for OBs

[cmiller]

Hello All. I would like to get some feed back on policy for handling OB patients.

Do you peform ABO/Rh OR Type and Screens on all mothers at admission for delivery? Are Type and Screens only performed for C-sections?

If there is a known type/history on file, do you still perform the ABO/Rh on a current specimen?

Thanks and have a great day!

[Mary]

Type and sceen on C-Sections. Others if ordered.

[janet]

Our obs/gyn seem to order a g&s on every woman in labour.....midwives only if there is bleeding history or complications - those great midwives!

[Seveets]

We had one doctor with a bad experience so she always order Type and screen on all her OB patients.

We finally convinced her that as long as we had a Draw and Band on the patient we could have cross matched compatible blood in no time (plus we always have 2 O negs on the shelf just in case)

Now everyone gets a Draw and Band tube on admission and only those having a C-section get a type and screen added on.

[John C. Staley]

The policy is for us to get a "hold Clot" on all OB patients. The only testing performed is what ever the physician specifically orders and most don't order anything unless there is a problem. The only problem with this system is that all samples in L&D are "Nurse collects" and so it is not unusual for orders to come down for testing and we don't have a sample and the patient has been here for hours.

When it comes to patient ID and sample labeling L&D nurses don't get it more than any other nurses don't get it. My wife was a L&D nurse for many years and she agrees with me, they just don't understand why they have to label tubes immediately. It drove her crazy. Now I get to visit her on Sunday afternoons.

[galvania]

Sorry I have a language problem here (UK English as opposed to USA English). What is a 'Draw and Band' please? Thanks

[cmiller]

Thanks to everyone for your reply. One other thing I am interested in is: If an ABO/Rh is order on the mother at admission and there is an ABO/Rh on file for that patient, do you still perform the current ABO/Rh or do you cancel it with a comment that there is a "Type on file" and state the type?

Thanks again!

[Seveets]

"Draw and Band" = draw a specimen that testing can be done and put a separate Blood bank bracelet on the patient. routine sample could for 3 days.

[galvania]

OK - this is new to me. If you have time, can you explain how that works, please. Do I understand the patient gets a band with - what? - their blood group, any antibodies, date? And do you change it every time you get a repeat specimen? Sorry for my ignorance. It's amazing how different things can be from one country to the other

[John C. Staley]

To cmiller: If the doc orders it we generally do it unless it was performed during the current hospital stay. May be a new doc for the patient and they want their own results. Besides, we need the money!

To galvania: It is strictly a patient identification thing here in the states. We put an armband on the patient with at least two identifiers, usuall their full name and a unique number given to them by the facility. Some facilities also use a unique blood bank armband for patients that have samples drawn for blood bank testing or potential testing.

Personally, I hate blood bank specific armbands but that is just one of my little demons.

So, what I call a clot to hold and what they call draw and band is esentially the same thing. A sample has been collected, properly labeled for blood bank purposes and is stored just in case it is needed for some unforseen obstetrical emergency.

[Mabel Adams]

Do Europeans not use a separate Blood Bank banding system ever? Not everyone in the US uses one, and there are a couple of permutations of the concept (one band number per admission vs. one band number per specimen), but I would guess a small majority do use such a system--especially since the Joint Commission on Health Care Organizations came out in favor of them a few years ago.

BTW, we call it a Band Only.

[galvania]

Do Europeans not use a separate Blood Bank banding system ever? Not everyone in the US uses one, and there are a couple of permutations of the concept (one band number per admission vs. one band number per specimen), but I would guess a small majority do use such a system--especially since the Joint Commission on Health Care Organizations came out in favor of them a few years ago.

BTW, we call it a Band Only.

Well I can't speak for thw whole of Europe. Most countries that I know of use a band with the patient's name, date of birth and hospital number, but that is all. Sone places don't do that. For example here in Switzerland it is quite rare (in the UK it is obligatory). In parts of Switzerland, the patient's name goes on either the wall above the patient's bed, or the bed itself. This is perhaps the one thing that I am unhappy about in the swiss health system. In the UK anyone needing blood, or even a 'Group and Save serum' has a sample taken and the label will contain the name, date of birth and hospital number plus, usually the ward, maybe the requesting doctor, and probably the signature of the person who took the blood, maybe the time. (It varies a bit from place to place). I'm not aware of anyone then getting a second wristband specifically relating to blood transfusion. But that doesn't neccessarily mean it doesn't happen - maybe I just don't know about it

Anna

[bbbirder]

Here are a couple of links for this type of band if you want to check them out:

http://www.typenex.com/

http://www.pdcorp.com/healthcare/blood_bands.html

We use these in addition to the usual patient ID band. There are other designs, but both of these work essentially the same way: Band with a unique alpha-numeric number goes on patient arm, peel off portion goes on the tube, "tail" (with stickers with number) and tube goes to the transfusion service, stickers with the number go on unit along with compatibility tag, nurse checks this number in addition to everything else when hanging the unit. This way there is a complete link or chain back to the patient.

I know many BBer's don't like these, but personally I do. I have worked in 4 different hospitals of various sizes and all have used a similar system. We are very strick about the labeling at the time of collection, no adding the band/ stickers later. If the nurse collects incorrectly, they must do it again. They whine, but they usually only make this error one time. (Also, when you ask them they actually like the system for their bedside checks.) Most examples of transfusion related death due to ABO incompatible transfusion that I have read about could probably have been prevented by using a similar system.

Back to the original question, we encourage the OB docs to get a "Band to hold" or whatever you want to call it on all of their OB admissions (especially the C-Sections), but it is up to them. Type & Screens not done routinely (even on C-Sections), it is up to the doc. We do not charge anything for the "Band" specimen.

Linda Frederick

( I don't know how I magically changed the font size and now can't change it back....hum.)

[jhaig]

Well I can't speak for thw whole of Europe. Most countries that I know of use a band with the patient's name, date of birth and hospital number, but that is all. Sone places don't do that. For example here in Switzerland it is quite rare (in the UK it is obligatory). In parts of Switzerland, the patient's name goes on either the wall above the patient's bed, or the bed itself. This is perhaps the one thing that I am unhappy about in the swiss health system. In the UK anyone needing blood, or even a 'Group and Save serum' has a sample taken and the label will contain the name, date of birth and hospital number plus, usually the ward, maybe the requesting doctor, and probably the signature of the person who took the blood, maybe the time. (It varies a bit from place to place). I'm not aware of anyone then getting a second wristband specifically relating to blood transfusion. But that doesn't neccessarily mean it doesn't happen - maybe I just don't know about it

Anna

I can see why you wouldn't be happy about this patient ID issue. I wouldn't want to be the one giving blood to a patient based on their properly identified bedrail:cool:

We do a type and screen on all OB patients going to surgery and also apply a specific blood bank wristband in case the need for transfusion arises. This way we've got a properly labeled specimen and the patient is identified for transfusion purposes in case something happens. Better safe than sorry.

[odif_begin@rogers.com]

We perform ABo/Rh & antibody screen on all Rh negative mothers. Rh positive mothers are tested if we have no previous testing done during the recent pregnancy or if they have an antibody.

Cord testing is performed on infants born to any Rh negative mothers and when Rh positive mothers have an antibody.

[Franklyn]

At my facility we call them "draw and hold"

We have no set parameter for deliveries as the anesthesia team and docs cannot agree on one that can be incorporated into our MSBOS. They, instead, have an algorithm they use to evaluate the patient and determine if a blood bank sample is needed and, if so, what kind.

I agree with Mr. Staley about the "separate blood bank bands" - they really complicate things and I don't believe they really improve patient safety.

We adopted the Bloodloc a while back and that made it even more complicated. If the transfusionist just follows SOP - the normal hospital ID band is more than sufficient! :fingerscr

[kmoremedtech]

We do a type and screen on ALL OB patients coming in for delivery. This way it allows us to deterine antibodies, Rhig evaluation, etc..while the patient is delivering. Saves a lot of time.

If we have a historic type, we do not require a second seperately drawn sample for confirm typing. If the patient does not have a historic type on file, then another type must be preformed on a sample collected at a different time than the TSOB sample.

Usually, we can pull a sample from hemotology seeing as it is also required to draw a CBC before the patient goes home.

[Mabel Adams]

Do you ever think about how we recheck the types of Rh neg OB patients over and over, but if we made a mistake and mistyped someone it would be the ones that are thought to be Rh pos that need to be rechecked to make sure we got it right.

Nowdays with the double-typing system this is probably less of a risk.

[bbbirder]

You are exactly right, Mabel. The Rh negatives who get mistyped as Rh positive are bigger problems than the other way around.

It can be difficult to get the OB docs to understand this, or think they should check the type a second time during the first pregnancy.

Linda F

[GilTphoto]

We do a Type & Screen on all Labor Room patients. If anti-D is detected it's titered IF it reacts in a phase other than IAT, or if the IAT phase reacts 3-4+, to distinguish an immune anti-D from passively acquired from RhIG. Identification of other significant antibodies that cause HDN alert us to phenotype the baby for the antigen. If the baby's DAT is positive and the baby is antigen positive, we will watch the bilirubin. If it goes >15 we will put in an order for the <5 day, CMV neg, irradiated, leukoreduced, sickle neg, antigen neg, O neg, collected in CPD blood quad pack. Sometimes it takes a full 24 hours to get this unit, so we like to stay ahead of the game.