jhaig Posted June 4, 2008 Share Posted June 4, 2008 To satisfy the CAP requirement on retyping, I recently changed my policy to include a second draw on a patient that does not have a previous blood type on file. If no retype can be obtained, the patient will receive group O blood.I had a situation come up yesterday where a patient had no previous blood type on file, but had been transfused at another hospital a month ago. Does a verified blood type from another institution qualify as a second 'type'? We stuck this patient again according to our procedure prior to transfusion, but I'm not sure if this is an acceptable alternative to get around another venipuncture. Suppose a patient has an antibody history and presents an antibody card given to them by the other hospital stating the patient's blood type and antibody history?Does this reasoning go against what CAP is trying to get at? Link to comment Share on other sites More sharing options...
rrcc1974 Posted June 4, 2008 Share Posted June 4, 2008 Our facility does not have a second draw policy unfortunately. We do receive a copy of prenatal testing from Canadian Blood Services (our reference lab). If a mom presents for a C-section, that prenatal result is used as "a previous blood type on file" for her type & screen. Link to comment Share on other sites More sharing options...
Franklyn Posted June 4, 2008 Share Posted June 4, 2008 We do not accept ABO/Rh results from outside our institution. The goal of the second type in either regulatory and electronic crossmatching is to have a high level of confidence that you have drawn the correct patient and have an accurate ABO/Rh etc. As institutions will vary on their policies surrounding weak D test (for example) or their methodology (Tube, Gel, Solid phase) we insist on two types in house. Link to comment Share on other sites More sharing options...
John C. Staley Posted June 5, 2008 Share Posted June 5, 2008 Our corporation consists of 22 facilities within the state of Utah and 1 in Idaho. We are in the process of implementing a new computer system that will be used at all facilities on a single server and sharing the data base. The current plan is to consider the work done at any of these facilities as historical info on the same level as anything done in-house. Better than 95% of our SOPs are corporate SOPs shared by all facilities and all of the pretransfusion testing sops are corporate sops. The facilities range from <25 beds to > 500 beds. My facility is planned as the first to go live next May/June with the final install occurring about 3 years later. It is truly interesting times in which we live. Link to comment Share on other sites More sharing options...
geekay Posted June 6, 2008 Share Posted June 6, 2008 Hi there,Ultimately what it matters is the safety of the patient and the safety of the staff employed. Let it be CAP or JCIA , I dont think that any accreditation agency is going to find fault with an institution or an employee, for becoming more duty conscious...and also aiming at the patient's safety !also, if the patient has come from an institution which is not accredited by CAP or JCIA ? and suppose if the patient has received a Transfusion from another place in between, which he/she has forgotten to mention during admission ?(if I were to be in the position, I will go for repeat grouping....)In Blood banking, lots of things are easy to preach about...! but not easy to practise.....as it involves safety.....Lots of ifs and buts are involved in this issue....best wishes ! Link to comment Share on other sites More sharing options...
Mabel Adams Posted June 6, 2008 Share Posted June 6, 2008 What if a patient presents a donor card with his blood type on it? Would we accept that? If so, how would we document it. In fact, documenting any outside type in your computer system might be what determines what you will accept. Computers often run out lives! Link to comment Share on other sites More sharing options...
geekay Posted June 6, 2008 Share Posted June 6, 2008 Hi Mabel Adams,I feel that we do get a better level of "reliabiliy and confidence" in that Donor card , if the card was issued from our organisation ?Because we dont know the standard of testing procedures on the other organisations.......If I had been in your position, I would definitely go for confirmation with a second sample , if the card has been issued from another organisation ! hope you agree ?best wishes... Link to comment Share on other sites More sharing options...
Sara B Posted June 6, 2008 Share Posted June 6, 2008 I've been in the position of having a patient tell the treating physician that he was "A Pos" (before passing out from acute blood loss) and we typed the patient as "O Pos"! The treating physician was angry that we would not take the word of his patient and we insisted on giving "O Pos". Since this experience, I think the only result that I rely on is the one that I can verify is from a properly drawn and banded patient. Why risk it? Link to comment Share on other sites More sharing options...
missaddie Posted June 6, 2008 Share Posted June 6, 2008 We are a large university hospital. We often see patients with "different" blood types than their last visit because a relative or friend uses their insurance or Medicaid card to obtain treatment. I agree, I would only trust a result that comes from a sample that I know was drawn from a properly identified and armbanded patient, Link to comment Share on other sites More sharing options...
GilTphoto Posted June 7, 2008 Share Posted June 7, 2008 We often see patients with "different" blood types than their last visit because a relative or friend uses their insurance or Medicaid card to obtain treatment. We have had that happen twice this year. Link to comment Share on other sites More sharing options...
Franklyn Posted June 9, 2008 Share Posted June 9, 2008 About the only scenario I have seen so far where I feel accepting someone else's ABO results (presumably in emergencies only) would be in a network of hospitals all sharing common corporate level SOPs with documentation of training and competency. You have the best "bet" of getting consistently followed SOPs. Other than that, I would still prefer to do it myself for all the previously stated reasons.We, too, have had patients share insurance cards and end with more than two completely different ABO/Rhs on file for a single patient. It can be a real nightmare. Link to comment Share on other sites More sharing options...
John C. Staley Posted June 10, 2008 Share Posted June 10, 2008 Everyone, keep in mind that you will (at least I hope) never transfuse based solely on historical information regardless of where it comes from, even your own computer system. The question is how much weight you are willing to put on historical information, especially concerning first time patients. Will the historical info from outside count as one of your two types? If it matches your current type does it count for confirmation of what you are seeing? If it does not, how far do you go to resolve the discrepancy? I don't have the answers, just the questions.:fingerscr Link to comment Share on other sites More sharing options...
jhaig Posted June 10, 2008 Author Share Posted June 10, 2008 I guess my whole point was to try and save the patient an extra stick if possible. You can't transfuse based solely on what either the patient's card says or especially what the patient says. How do you know for sure they're right? We too, unfortunately, have had the Medicaid card issue hit us a couple of times. Upon further review, the call is overturned and we won't use a blood type from another institution (sorry, just getting ready for football season!):cool: Personally, I don't trust anything the patient says pertaining to what their blood type is. I want to see it for myself from a specimen that my institution has drawn.If the only thing standing between a mistransfusion is another venipuncture to confirm their blood type, then the patient will just have to deal with it. Link to comment Share on other sites More sharing options...
jamato Posted June 11, 2008 Share Posted June 11, 2008 At our hospital we accept results for prenatals and OR from reputable labs. We do not accept the chart copies but the actual reports from the labs. Then we will second type the specimen by another tech to make sure the type was put into the computer correctly. Link to comment Share on other sites More sharing options...
lkg1972 Posted June 11, 2008 Share Posted June 11, 2008 We have 13 hospitals that can see the patient histories from each other. My policy is 1 blood type must come from a current specimen. If the patient has a history at one of the other 12, that counts as a second blood type. If the patient is type O, we do not do a second blood type (no transfusion danger if given O). If the patient is not type O and does not have a blood type history in the computer, a second blood type on a specimen collected by a different phleb (at a different time) is required. That specimen may be one collected for another area of the lab (for a CBC or chem test as long as no gel). We do between 15-30 blood types/day. Only 1-3 require a second specimen and only about 1 patient needs to be re-stuck. We do not accept donor cards or patient statements for blood type verification. We have had instances when the current type does not match history. Another specimen is collected and tested - so far, all histories have been incorrect and the new specimen type matches the first current specimen type. Link to comment Share on other sites More sharing options...
David Saikin Posted June 11, 2008 Share Posted June 11, 2008 Would you accept the "donor" card as a type to issue uncrossmatched blood? I think not . . . Link to comment Share on other sites More sharing options...
Liz0316 Posted June 11, 2008 Share Posted June 11, 2008 I would have to suggest not accepting any ABO from another institution as your second or previous type. I is not a prudent practice Link to comment Share on other sites More sharing options...
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