Cutting off blood bank ID bands

[sharlene]

Recently, we switched to a different blood bank ID band and found out that surgery was routinely cutting off the blood bank ID bands that we had and reapplying them after surgery. The bands that we switched to cannot be reattached without taping. My question is how do other transfusion services deal with this problem? (Loss in the chain of identification) As a blood banker, I was shocked when I found out that this was so routine. Any anwers that you may have will be much appreciated.

[Mary**]

:cool:We provide the OR with extra bands. They use the original insert and place it in a new band when the surgery is over.

[bxcall1]

Here is what we put in our nursing procedure manual for Blood Transfusion;

"At the time of specimen collection for cross match, the patient will have a Blood Bank ID

attached by lab or nursing staff. If it is necessary to remove this band for any reason, contact

the lab to obtain a new Blood Bank ID band. It is the responsibility of the individual removing

a Blood Bank ID to immediately replace it on the patient in a new location. Failure to

immediately replace a BB armband will result in a significant delay in blood products being

available for transfusion."

Unfortunately, the band isn't always replaced. In these cases a 'significant delay' occurs because we will re-draw the patient and do all of the work on the new specimen.

[Mabel Adams]

One issue in OR is that the patient's arm is usually under sterile drapes and can't be accessed for checking ID. A system needs to be created for that ID band to be checked when the patient is brought into OR before being draped and wherever that ID is transferred is used in lieu of the band throughout the case. The need to check the ID may be the reason behind the band being cut off. In a way, this is good, because it means they are checking it.

We all need to work with our ORs etc. to come up with solutions that actually work for them and us. Positive ID is the necessary outcome and we need to make it easy if we can. If we give them only impossible choices, they simply won't do them.

[AMcCord]

Surgery cuts off Blood Bank ID armbands at will. I don't like it, but we have reached an agreement. The bands are cut off only by anesthesia in OR. The band is put on the patient's chest (we don't have any chest cutters here) or forehead. Before the patient leaves the OR, anesthesia (same one who cut the band off) must put the band back on the patient. If the patient reaches PACU without the band, the crossmatch and all specimens are null and void, no exceptions. We have lots of anesthesia locums coming through but this still works pretty well for us.

[LaraT23]

We have a lab staff member go to the patient and tape the ends of the band back to gether. I am going to ditch bands as soon as I get barcode patient scanning next month.. HOORAY. The nurses will have to scan both the unit and two areas on the patient band in order to transfuse. Everything goes in to the computer system including the scanning of the id of the two nurses who verify the patient.

[MARINA]

One issue in OR is that the patient's arm is usually under sterile drapes and can't be accessed for checking ID. A system needs to be created for that ID band to be checked when the patient is brought into OR before being draped and wherever that ID is transferred is used in lieu of the band throughout the case. The need to check the ID may be the reason behind the band being cut off. In a way, this is good, because it means they are checking it.

We all need to work with our ORs etc. to come up with solutions that actually work for them and us. Positive ID is the necessary outcome and we need to make it easy if we can. If we give them only impossible choices, they simply won't do them.

This same thing happened to us recently. Nursing explained to us about the sterile conditions for the patient during the procedure, they showed us a clear armband sleeve that the original blood bank armband slides into. These have more secure latches. Nursing replaces the armband after the procedure and it usually works out well. We rarely have an instance where the patient has returned to their room wothout the armband on.

[quint]

Surgery cuts off Blood Bank ID armbands at will. I don't like it, but we have reached an agreement. The bands are cut off only by anesthesia in OR. The band is put on the patient's chest (we don't have any chest cutters here) or forehead. Before the patient leaves the OR, anesthesia (same one who cut the band off) must put the band back on the patient. If the patient reaches PACU without the band, the crossmatch and all specimens are null and void, no exceptions. We have lots of anesthesia locums coming through but this still works pretty well for us.

Sure you're not at our place? OR is routinely giving us a major headache.:mad:

[AMcCord]

You do "know" that the silly rules (Blood Bank's) don't apply to OR, don't you? And of course ER doesn't have time for those silly rules during a trauma......

Every year the stats for fatal ABO hemolytic transfusion reactions come out showing that the majority of cases come about because a unit was hung for the wrong patient and many years several (or most) of these cases happened in ER or OR. I always have a strong urge to blow up the information to huge poster size, highlight the pertinent stats and hang it in ER and OR staff areas! It's a constant battle and we have to keep fighting it for the sake of the patients.

There, I've vented now...I feel better.

[John C. Staley]

Ann,

For years I've said the most dangerous person in the hospital is a nurse with a pair of scissors and a willingness to use them. I don't know why but for some reason nursing school does not emphasize the need for patient identification, not sure what they emphasize but it's surly not patient ID.

ER and OR will always claim an exception to any rule and with OR it is behind closed doors and the sterile barrier we find difficult to pass we generally never REALLY know what goes on there. ER will hide behind the statement; "We don't have time to do it right" to which I have always replied; "Then you don't have time to do it twice!"

I realize these are rash generalizations but they come from first hand experience over many years.

Keep up the good fight but recognize that it will be never ending.

:lonely:

[quint]

I guess it is one of those walk in my shoes things for each department. it really comes down to upper management enforcement of policies.

[sharlene]

We have a lab staff member go to the patient and tape the ends of the band back to gether. I am going to ditch bands as soon as I get barcode patient scanning next month.. HOORAY. The nurses will have to scan both the unit and two areas on the patient band in order to transfuse. Everything goes in to the computer system including the scanning of the id of the two nurses who verify the patient.

I was really for barcoding bands and units, also, until I found out that the bb bands and hospital bands are routinely cut off during surgeries. Barcoding will not work if bands are not left on!!!

[bbbirder]

We also give surgery extra armbands for rebanding, as well as the form that goes with it. (I like the idea of a sleeve.)

At our hospital, one area that gets gold stars for patient ID (other than the lab), is OR. They take their 'time-outs' very seriously. We don't have a problem with OR. If a BB wristband name has one letter different (say the patient name was updated after collection), they catch it and call us.

Linda Frederick

[John C. Staley]

Linda, you are indeed fortunate to have the confidence you have in the OR. If only it were more universal. If you can figure out the secret I think would could retire wealthy.

:abduction

[adiescast]

This same thing happened to us recently. Nursing explained to us about the sterile conditions for the patient during the procedure, they showed us a clear armband sleeve that the original blood bank armband slides into. These have more secure latches. Nursing replaces the armband after the procedure and it usually works out well. We rarely have an instance where the patient has returned to their room wothout the armband on.

Can you tell us more about the clear armband sleeve (who makes it and how do you get it?

[Penny Thiel]

We go through the same thing and a few of our hospital departments are continually seeking ways to compromise our Blood Bank policy to meet their needs. For real: nurses, and doctors too, are the very last people who should be thinking they can dictate or change Laboratory let alone Blood Bank policy and procedure. I agree with Mr. Staley. We need to HOLD THAT LINE.

[rcurrie]

We are a bunch of old fogies who have failed to keep up with social practices. Some of you younger techs out there should have presented the most obvious solution: Blood Bank tatoos. Every transfusion service should have a certified tatoo technician, whose job it would be to tatoo the blood bank ID onto the potential blood recipient. Why has no one thought of this before now ! ! ? ?

BC

[Penny Thiel]

Bravo!!

Market it and sell it! : )

[John C. Staley]

Actually Bob I was thinking more along the lines of a microchip between the shoulder blades like they did for my dogs. All you need then is a scanner attached to a small printed. All electronic. You can't do that with a tatoo.

[Penny Thiel]

Dude! : )

[Mary**]

:rolleyes:That could be expanded to include a "complete" medical record for the patient. I have thought that for a long time. My cats have had them for 10+ years and they are cheap.

[L106]

One of my coworkers brought up the idea of tattooing patients' arms, but when they tried something similar in Germany in the 1940's it did not have very favorable results.

Nice to hear from you, Bob.

[Ellie Ross]

Unfortunately this is a routine event at our facility also and our bands cannot be reapplied either, I have fought this issue a long time and heard all the excuses.

What we do is supply surgery with a secondary band in which the number of the BB Armband can be inserted inside the second band and this band is put on the patient after the surgery and before they leave the surgery suite.

Even using a barcoding system will not circumvent this problem, what's to stop them cutting off the bacoded armband. If a patient is returned to their room without the armband we require a new Type/Screen and armband assigned.

Ellie

[mrstymt]

wow, i'm so glad i stumbled upon this thread, because i seriously don't know what goes on in the OR as well.

so i would assume that any patient ID band (admission band, BB band, etc) gets cut off before entering the OR for "sterile" purposes. so if you don't work with BB bands, does that also present a problem with just name and MR#?

and yes, shame on us younger BB techs who can't come up with microchips and tattoos as patient identifiers. but then again, we don't have the money to do that right now maybe soon, if this whole electronic MRs happen.

i will be sure to present this to my BB administration i don't think they do enough observations throughout the hospital (nor they can due to shortage of staff)

[John C. Staley]

There are just some things you are better off not knowing. Concentrate of the ones you might be able to do something about and recognize those that will, likely, never change.

:juggle: