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Trm.40500


Nancy L.
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If I am interpreting this CAP requirement correctly, in addition to having the 72 hour maximum interval between specimen draw and crossmatching for patients with previous txn or pregnancy within last 3 mos or unknown history, there is also a requirement for a maximum interval to be set for all patients that do not fall in these categories. I do not however, find anywhere that states any limit to that maximum interval. We currently allow a week. That seems to be adequate time for preop testing, etc. We occassionally have requests to extend this over a longer period of time, mainly for patient's convenience in not having to make an additional trip to our facility. What do any of the rest of you do? What do you set for a limit and how stringently do you enforce it?

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We use 1 week for not transfused, not pregnant in 90 days. We strictly enforce it.

However.......if we have a patient that we will not see within that one week period, we draw a specimen anyway and do a type and screen, no charge, to make sure there will be no surprises the day of surgery. Any patient that is drawn greater than 72 hours prior to surgery gets redraw so we have a fresh specimen for crossmatching. If we need to crossmatch, we repeat type and screen (as it is a different specimen), but this rarely happens. We do not use electronic crossmatch, so this puts us in compliance with Joint Commission.

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:)We use 10 days if the patient has not been transfused or pregnant in the past 3 months. We used to use 14 days, but many of the reagent package inserts limit the life of a specimen to 10 days. This works well for our pre-admission department who likes to bring patients in 7-10 days before surgery for their blood draws, etc.

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Recently my department had this same discussion. We perform the IAT on all preadmission samples and is recorded on the patients order request. The day before the secheduled OR a Type is performed and the IAT results are recorded. The IAT results are footnoted with a comment (Tech/DATE results when performed). Our computer system does not let us cross over the drawn date sample to the admit date. It does not drop the correct billing account. Supposedly the system is not able to merge the account numbers. I think there may be some compliance issues with our process. According to AABB guidelines : read , record , result when testing... entering results thats was not performed by the tech introduces error. We have Cerner Millenieunm and it has been an ongoing problem. I am not comfortable entering results that I have not done. Just another source of error. I would like to change this process to avoid data entry problems . Any suggestions!

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If you use the pre-admission sample, what method do you use to verify patient ID when the patient is admitted for surgery? Does the billing account number stay the same or do you (or billing) have to do an account merge?

When our preop patients come through the outpatient laboratory, they are given a wristband for identification. We use the patient's name, DOB, and Medical Record number (which does not change). They must have the wristband on when they come in for surgery or it is a redraw and all testing must be repeated. We do not use the billing account number for any identification purposes as that does change. At this point, the blood bank charges are billed to the preop lab account. The accounts are not merged. We are looking at implementing electronic barriers including barcoding the wristband and unit before transfusion. This may make us rethink our process as billing questions will arise with that change.

I sure am appreciating all the insights from everyone!

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We currently use 10 days for not pregnant or transfused in last 3 months and strictly enforce it. I have used as high as 14 days in the past.

We also give our pre-op patients a band with their identifiers (name, DOB, medical record number) and they must be wearing it when they come back or they are redrawn. Any crossmatches performed on the pre-op sample at the time of the pre-op visit are charged to the pre-op number (crossmatch expiration is extended in the computer to 3 days after surgery or 10 days after specimen collection whichever comes first). If the units are transfused, they are charged to the new finiancial number. Additional crossmatches are charged to the new financial number.

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There is probably no tecnical reason for a time limit on the crossmatch when there has been no transfusion or pregnancy. There is a requirement to hold samples for seven days post transfusion; so most places have set up a protocol to store samples ten days or more. We set the limit for crossmatches to be 3 days, and the maximum for extending the crossmatch (with approval by the Medical Director) at 7 days. Then we set up a retention system of 14 days for pre-transfusion samples, which covers even the extended crossmatches without our having to retrieve individual specimens and store them separately. As for the Arm Band, the Patient is required to retain the Identi-Print card to be re-attached to an ID bracelet on re-admission. No card, we release the crossmatched units and re-do (and charge for the work). All this is spelled out in the crossmatch procedure (which the Techs see) and the Specimen Collection for Pre-Transfusion Testing procedure (which Processing and Admitting Personnel see). You should also define the limit for performing antibody screens (48 hours) and for elutions in case of Positive DAT and history of recent transfusions. For the latter we use 90 days mostly based on tradition.

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What are your thoughts on age of specimen for compatibility test, 72 hours vs. 3 days, day 0 as the collection day. We used to be 3 days and then changed to 72 hours. Now new QA Supervisor wants to change back to 3 days. Any pros and cons? I know standard requires 3 days, so does CFR.

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Any thoughts on the age of specimen for compatibility testing? 72 hours or 3 days, collection day as day 0. AABB Standard, CFR all says 3 days. We used to keep for 3 days then switched to 72 hours years ago, now new QA Supervisor wants to switch to 3 days. Wonder how others are doing.

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We use 3 days, and have for many years. AABB Standards allows 3 days. This give us until midnight on all specimens. Some patient's specimens are good for 72 hours and some are then good for almost 96. There are many patients we transfuse in that time between 72 hours and midnight. We have not seen any reactions as a result of a newly formed antibody.

(For pre-op patients with no history of recent (3 month) transfusion or pregnancy, we use 2 weeks.)

Linda Frederick

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  • 2 weeks later...

Ned,

At present we have a some what similar process like you at my present institute, we keep our PAT samples for 30 days pre-transfusion. On the day of surgery the patients are asked to bring a duplicate copy of arm band given to them at the time of sample collection back, as a verification process and a siganture that verifies that there was no transfusion or pregnancy within the last 3 months. After the receipt we change the sample outdate to 3 days.

If the patient forgets arm band we recollect the sample for compatibility tests.

I am new to this place, and position and still in the process of familiarizing myself with the required regulations. Our OR and anesthisia physicians are giving us a hard time with arm band check procedure in place. Their argument is why are we getting a new sample, if the patient forgets the armband and if they have performed the patient's identification by the drivers license and / or other means.

If you have any regulatory requirement relating to this, it will really help us tremendously.

Thank You for time and help,

Kashmira

There is probably no tecnical reason for a time limit on the crossmatch when there has been no transfusion or pregnancy. There is a requirement to hold samples for seven days post transfusion; so most places have set up a protocol to store samples ten days or more. We set the limit for crossmatches to be 3 days, and the maximum for extending the crossmatch (with approval by the Medical Director) at 7 days. Then we set up a retention system of 14 days for pre-transfusion samples, which covers even the extended crossmatches without our having to retrieve individual specimens and store them separately. As for the Arm Band, the Patient is required to retain the Identi-Print card to be re-attached to an ID bracelet on re-admission. No card, we release the crossmatched units and re-do (and charge for the work). All this is spelled out in the crossmatch procedure (which the Techs see) and the Specimen Collection for Pre-Transfusion Testing procedure (which Processing and Admitting Personnel see). You should also define the limit for performing antibody screens (48 hours) and for elutions in case of Positive DAT and history of recent transfusions. For the latter we use 90 days mostly based on tradition.
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Max time for specimen : 10 days if no red cells or preg previous 3 mths

Type and Screen billed on Pre op number

Day of Surgery: Misys allows the billing account number to be changed on that accession number in Gen Lab ... all subsequent testing like XM and actual products are billed on the new billing acct number

We issue BB armband at the time of preadmit testing and the patient must bring it back the Day of Surgery.

This policy has been a tremendous success and we only have a couple of AM surgery type and screens each morning. Also, antibody surprises or weird blood types can be resolved.

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  • 1 month later...
If I am interpreting this CAP requirement correctly, in addition to having the 72 hour maximum interval between specimen draw and crossmatching for patients with previous txn or pregnancy within last 3 mos or unknown history, there is also a requirement for a maximum interval to be set for all patients that do not fall in these categories. I do not however, find anywhere that states any limit to that maximum interval. We currently allow a week. That seems to be adequate time for preop testing, etc. We occassionally have requests to extend this over a longer period of time, mainly for patient's convenience in not having to make an additional trip to our facility. What do any of the rest of you do? What do you set for a limit and how stringently do you enforce it?

Hi Folks,

If you google; BCSH Guidelines- there are lots of UK transfusion guidelines that would help. Information below is from thecompatibility testing one.

Evidence from SHOT (Love et al., 2002) with respect to

delayed transfusion reactions has been influential in

providing evidence for timing of new samples when a transfusion

has been given more than 72 h earlier:

Patient transfused ............Sample to be taken

within

3–14 days .............................. 24 h before transfusion

15–28 days............................. 72 h before transfusion

29 days to 3 months............ 1 week before transfusion

Hope this is of use

Regards

Rashmi

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We use 72 hours.

Any thoughts on the age of specimen for compatibility testing? 72 hours or 3 days, collection day as day 0. AABB Standard, CFR all says 3 days. We used to keep for 3 days then switched to 72 hours years ago, now new QA Supervisor wants to switch to 3 days. Wonder how others are doing.
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  • 4 months later...
Guest Lynn R

So, does this mean you could do the TS 10 days pre-op and then would do the crossmatch the day of surgery( if they added one) on this specimen?

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Yes - we would use the pre-op sample for the crossmatch on the day of surgery, provided the antibody screen is negative. If the patient has an antibody requiring an AHG crossmatch, we do the crossmatch with the sampe while it is still fresh (less than 3 days) and hold the blood for the surgery. We then get a fresh sample on admit in case additional units are required beyond those crossmatched before the surgery.

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We use the 3-day time frame EXCLUSIVELY, meaning that we do not perform XM testing on ANY specimen older than 3 days including our pre-admission patients. We have a system in place to identify pre-admission orders, and then we have anything from a hold tube to a full crossmatch ordered, collected, and resulted again on the day of surgery.

I'm sure there are arguments against this practice, but for us, it eliminates the entire paper trail for determining transfusion/pregnancy within the past 3 months and it prevents billing issues...2 problems that seemed to be at the forefront of this discussion. This process also eliminates the need to store specimens that are greater than 10 days old or edit the specimen expiration date in the computer.

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We also only use samples for the three day time frame. The logistics of tracking longer and determining who had been transfused or pregnant were beyond what we were willing to do.

I know other places do it routinely and have assessed places that held samples anywhere from one to two weeks before transfusion. The main considerations are how you keep the positive patient ID and how you document the patient history.

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When we extend the crossmatch to the 7 day limit, we dispense only those units crossmatched. Our rules are that the sample must be less than 48 hours old to do a type and screen and antibody identification and that crossmatches may be done up until midnight of the third day after collection. On extrended crossmatches, Surgery knows to get us a fresh specimen if more than the orginal number of crossmatched units is needed.

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  • 4 weeks later...

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