Issue from remote refrigerator

[Mabel Adams]

We serve as the lab and transfusion service for a small hospital 15 min. away. The "lab" at that hospital is a phlebotomy area with the blood fridge in it. We have a log book that units placed into the fridge are logged into by lab couriers or phlebotomists so we can track every step of the unit's life. The nurses add to this log when they take a unit out (or return and reissue). Two nurses check all ID etc. at the bedside. This hospital recently had a state surveyor say that they need to have two people there in the lab to issue the blood from the fridge. They could bring two nurses down to sign out blood, but that is a staffing issue. We could train phlebotomists to sign out blood but I am not comfortable due to the training process, "culture" and high turnover.

We think of their fridge as a remote fridge (not part of the transfusion service) so in our minds "issue" (with all its regualatory requirements) happens when we send the blood over there. We issue from the computer system here which is not available to them over there. All documentation there is on paper. What do others with remote refrigerators do to 1) meet regulatory requirements and 2) assure that the right blood is being taken to transfuse?

[bmarotto]

Mabel, why would the state surveyor say two people have to be in the lab to issue from the fridge? Would they say the same for blood issued from a cooler or fridge in the OR or ED? It looks to me like they are missing the point. You have already done the required checks when you issued the blood to the small hospital. We all know the most important check is the one done at the bedside. Patient care would be better served if the surveyor focused on that. Insisting on a two person sign-out in the lab (especially if it turns out to be two nurses) is only going to shift the focus away from the bedside ID. It reminds me of years ago when we had a WBIT nursing collect incident. Instead of focusing on proper patient ID and labeling of the sample at the bedside, nursing decided they would require two nurses to sign Blood Bank samples. I was against it but they went ahead anyway. Well, guess what? The nurses became so fixated on getting two signatures on Blood Bank tubes that at times they forgot to put the patient name and Med rec # on the tube!

Can you ask the state to provide you with documentation the regulation? Maybe the surveyor was stating his/her own opinion or interpretation of the regulation.

Good luck. Let us know what happens.

[Franklyn]

I have remote refrigerators all over campus, but they are monitored by the blood bank remotely. When we place products in those refrigerators they are "issued" to the units in our computer system, so if we discover an error on a unit placed remotely it is FDA reportable.

I am surprised the state inspector had anything to say about it. I don't live in Idaho, but two person confirmation is typically a bedside task and is required by regulatory agencies like the JC and CAP or the AABB. Granted, their may be such regulation in Idaho (I wouldn't know) but my first reaction would be to request the exact citation. I have had way too many inspectors try to force compliance with their "opinion" rather than what the actual requirements are.

[BBKT]

Several years ago, we had a remote refrigerator at an outpatient cancer center. Our computer system allowed us to transfer blood to the remote location. We required an RN to call the blood bank to check out a unit of blood over the phone. We would dispense the unit to the RN during the phone conversation. This allowed us to track when blood was removed from the refrigerator and who the blood was issued to without having a paper log. We no longer have this remote location refrigerator but this process worked very well for many years.