OR/CV shared Fridge

[n.peters]

I am struggling with my OR fridge. My problem is we issue blood to the OR and it sits up there. When the procudure is over then the patient is sent to CVICU they go and get blood from the fridge whenever they like. I am struggling to stop this practice. CVICU believes they should be able to share the fridge with OR. I think this is dangerous plus I have lost all control in the tracking process. We p-tube to CVICU so they can get the products quickly. Does anyone know any regulations or recommendations I can use for back up (JCAHO, CAP, AABB)? Does anyone allow OR and ICU to share a fridge?

[KKidd]

I feel your pain. A number of years ago we had a refrigerator in the OR and had several associated issues. An inspector said that we did not have control of the blood that we issued from it. Now we use coolers. When the OR is ready to start a procedure they call for the blood. We issue the units in our computer, place an irreversible temperature monitor on the bags and place them in the cooler. The cooler is labeled with the patient's id and is validated for 6 hours. We get the cooler back at the end of the procedure. It may accompany the patient to recovery but no further. Hope this helps!

[Franklyn]

We have remotely placed refrigerators in four different OR areas and one in the ED Trauma room. We have experienced similar issues with three of them and decided to add a door monitor to the refrigerator. When someone opens the door, an alarm goes off in the Blood Bank. Policy dictates that the Nurse call the Blood Bank and tell them who they are removing blood for and, if they do not, we call and inquire. Perhaps not the best solution, but we no longer loose blood without at least having been warned that someone went into the refrigerator and the only item in the refrigerator is blood, so... We can increase our chances of tracking down the units and maintaining traceability.

[L106]

I know of other institutions that use coolers for blood in Surgery as you do. What problems have you (or anyone else who is reading this) encountered with your system of using coolers?

We have four satellite blood refrigerators (in Surgery and Cardiac areas) we now have those personnel pretty well-trained to return unused donor units to Blood Bank at the end of the day. (When they do slip up, I notify the appropriate Director/Supervisor and then things improve for several months.)

Has anyone using coolers ever had a problem with the cooler being left in the Surgery suite, then assumed to be for the next patient using the suite? Or maybe the cooler got transported with the wrong patient to ICU or CVU? (I worry about those problems.) Thanks in advance for any comments on your experiences.

I'd love to get rid of the satellite refrigerators (but it'll never happen here!!) But on the other hand, I think I'd rather have the continuous temperature recording charts from the refrigerators than the handwritten logs of the cooler temperatures.

[jcdayaz]

I know of other institutions that use coolers for blood in Surgery as you do. What problems have you (or anyone else who is reading this) encountered with your system of using coolers?

Has anyone using coolers ever had a problem with the cooler being left in the Surgery suite, then assumed to be for the next patient using the suite? Or maybe the cooler got transported with the wrong patient to ICU or CVU? (I worry about those problems.) Thanks in advance for any comments on your experiences.

I have worked in places that used both methods. In my experience the refrigerator in surgery has proven to be more problematic. There could be many different patients' blood in there at the same time. Who knows if they will grab the right unit for the right patient when they need one. At least with a cooler you issue one patient's blood at a time and it goes directly to the operating room for that patient.

We've never experienced any issues with a cooler being left in surgery and then assumed to be for the next case. We do, on occasion, have to call surgery and tell them we issued a cooler to them at XXX time and it needs to be returned. We tell them there is a 4 hour time limit on blood in a cooler, even though our coolers have been verified up to and exceeding 6 hours. If they still need product in the room with the patient we pack a new cooler with new ice packs and etc and send it back with them. We affix temperature labels (HemoTemps) to each unit. If the unit ever exceeds acceptable storage temperature we know it immediately by checking the label.

We do continue to have infrequently a cooler being sent with the patient to ICU post-op. We simply call ICU and tell them we need the cooler back. They bring it immediately. We've never had a problem with it going to the wrong patient's room.

The cooler works the best for us!

]

[EDibble]

We have used the cooler method for many years. The OR staff has gotten pretty good about keeping an eye on the cooler, and not "losing" it. Once in a great while we have to make a few phone calls, but we haven't had any problems with blood being returned that cannot be put back into the inventory.

:winner: :winner:

[Mabel Adams]

Does anyone allow coolers of blood or units of blood (not hanging) to be transferred from OR to ICU (or ED to OR) when a patient is transferred? If so, how do you adequately track the hand-off so that 1) you have properly documented tracking of the blood for each step of its movement per FDA, JC etc requirements and 2) you feel you have control of the blood to limit waste and mis-transfusion. I don't really want to allow this but I am being pressured so I need to know if anyplace actually is doing it satisfactorily.

[bduff]

We have actually stopped using coolers. I think it was a NYS thing that a cooler is storage and not transport and therefore there are tighter temperature limits. It has completely solved this issue! We sign out blood to the OR when they need it and that is it. We are one floor away and will sign out two units if we must. The docs have been OK with this. We haven't had to many complaints and NO deaths!!! I must say it simplifies it alot!!!

[BBK710]

Does anyone allow coolers of blood or units of blood (not hanging) to be transferred from OR to ICU (or ED to OR) when a patient is transferred? If so, how do you adequately track the hand-off so that 1) you have properly documented tracking of the blood for each step of its movement per FDA, JC etc requirements and 2) you feel you have control of the blood to limit waste and mis-transfusion. I don't really want to allow this but I am being pressured so I need to know if anyplace actually is doing it satisfactorily.

We do send blood to the OR in coolers although it is not done too often. We require that they return any unused blood in the cooler to us immediately after the procedure. Under no circumstances is it to be sent with the patient. We usually don't have any problem with this policy.