Cutting off blood bank ID bands

[adiescast]

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

Where do you get the secondary band?

Thanks!

[SRMC BB]

We use clear bands with inserts for our surgical patients. They can be removed and reapplied. OR & ER understand that if they do not have an armband on the patient then the patient has to be restuck and a new band applied. Otherwise, the dr will have to sign an emergency release to get the blood and have a band placed on the patient at that time of collection. Our doc's don't like to sign emergency releases so they understand not to remove. I inservice the nurses in their yearly competency that if they must remove a BB armband to call us so we (BB) can fix a new band and apply to patient's limb. They don't like being told we have to work-up the patient again because of a lost BB armband, so they usually let us know.

[Penny Thiel]

Ya know, actually, we have precious little problems with our OR staff, it's the LDU nurses that just DRIVE us!! That's what got me goin on this thread to begin with!

[LISA140]

our or occasionally needs to remove the armband, our policy is the one that cut it off needs to put it back on the patient promptly. if this does not get done we start over again with a new sample. more often we get calls from floor nurses that say the band is getting tight etc and we send them a new outer sleeve and then put the insert in that and reattach. we had for a while nurses cutting armbands off and attaching them to the beds. this practice has stopped with education

[Mabel Adams]

The Hollister banding system, now sold by Precision Dynamics, has a clear pink band that works as a sleeve.

[cinbb]

I like Lara T23's solution. We recently had a teleconference about the barcode method for patient ID/transfusion Sunquest/Mysis. I can't wait till we get that system on board at our facility! We have the same issues with the armband system. Surgery is really very good. Our issues are with the floors! CA's are constantly cutting off armbands. Finally I told one Resource Coordinator just have the CA's "CALL BEFORE THEY CUT"!!

[bbbirder]

While I am all for bedside scanning, and we want to implement it at our hospital... I know how inventive nurses are (scanning water pitchers, etc.) that some serious monitoring needs to be possible before I jump on that bandwagon.

Linda Frederick

[MARINA]

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

Here is the link. The supply a box of 250 for approximately $100. They have pictures of the armband. You can also google search "Soft-lock Colorguard" and it brings up multiple suppliers. Sorry took so long!

http://www.cardinal.com/us/en/distributedproducts/ASP/01-0651W.asp?cat=surgerycenter

[jch]

We no longer use Blood Bank armbands. We use the 3 identifiers on the patient's ID band: name, DOB and medical record number. The Blood Bank armbands only add one unnecessary layer of confusion and delays patient care if they are cut off.

[BBankerTime]

Hello from Typenex!

We did intensive customer research throughout 2008 and have heard the same sentiments across the board that BBID bands get cut off in the OR. To that effect, we introduced the R3 Attachment System designed to allow for relocation, resizing or replacing the BBID on a patient in a controlled setting. As AMcCord mentioned in an earlier post, if a patient reaches their PACU without a BBID band, their blood work is null and void and we have several facilities using that exact practice.

The R3 Attachment System works with the Typenex Next Generation Barcode Blood Band (both label and handwriting versions) and we can put you in contact with facilities who have implemented the bands in their processes. Please visit http://www.typenex.com/products_r3.html to see a video demonstration of the band in use, as well as see other product information to determine if this is a solution for you.

I am very happy to answer any facility-specific questions and put you in touch with current customers, so feel free to send me an email at jholmes@typenex.com at your convenience. We hope this system can help build your cultures of safety, especially in the OR where cutting BBIDs is so common.

Thank you and have a great evening!

Jessica

[John C. Staley]

We no longer use Blood Bank armbands. We use the 3 identifiers on the patient's ID band: name, DOB and medical record number. The Blood Bank armbands only add one unnecessary layer of confusion and delays patient care if they are cut off.

I wondered how long it would be before someone echoed what I have always said. Complicating a process does not make it better and in my opinion secondary, blood bank specific arm bands do nothing more than compicate the process.

[BB001]

I agree with John and jhession that complicating the process by having multiple armbands does not make the process safer. Point-of-Care patient identification is not an issue that is unique to the blood bank. The need for Positive Patient Identification extends to all areas of patient care such as medication administration for pharmacy, specimen collection for core laboratory even to patient identification for milk feedings in the NICU. A single hospital wide barcoded armband with multiple patient identifiers combined with a point-of-care solution using the barcoded information to identify the patient, label specimen and match the patient to the medication, blood, milk or other products being administered is the safest solution.

[clmergen]

That is why we ceased using second armbands years ago. If the armband is cut off, the patient is rebanded using in place hospital policies and Transfusion Services does not have to start over from scratch. It eliminated more errors than it has caused.

[mawomack]

Not only are there problems in ER & OR, but our outpatient areas that transfuse on a regular basis send the patient home with the armband. When the patient comes back they are presenting the armband (not attached, usually in the patient's hand/pocket/purse/etc.). Obviously for RBC transfusions we are getting a new sample, but this is not the case with FFP & PLTS, where if the armband number stays the same we don't require a new specimen. Should I be concerned?

[bbbirder]

Our SOP is written to allow deviations on an individual basis. We use this for our some of our Outpatient transfusions. These people are well known to the nursing staff and phlebotomists (and even a good number of the techs have met them). (We have a patient who gets blood every 2 weeks as an outpatient, he has rec'd over 250 RBCs and some PLTs. After he is drawn, his band stays in the outpatient room between transfusion visits.) I am comfortable with this and so are the nurses in the area.

This is a decision that I can approve for individual patients.

Linda Frederick

[Mary**]

What would happen if a new nurse was transfusion???

[LAS]

Our OR removes armbands at will as well. We were told that they cut off ALL armbands because they needed access to the patients' wrists. At one time we were told that if we would place them "loosely on the left" wrist, they would try to avoid removing them. (We do not ever reattach bands here.) The "loosely on the left" rule went by the wayside a long, long time ago since around here anyone wearing scrubs can draw blood - with or without our knowledge, with or without training. ("If you can start an IV...")

Everyone understands now that if OR removes the BB ID band and the patient needs a transfusion post-op, everything must be redone on a new specimen. Big headache, yes indeed.

[L106]

Yes, we have our share of Surgery personnel cutting off wristbands. (Can anyone explain to me just what they are doing to the patients' arms that they need the entire arm totally bandless???)

Edited June 2, 2009 by L106
Hit the wrong button!

[L106]

bbirder - I understand what you are saying about getting to know frequently-transfused patients, etc. However, we had a situation in the past involving a frequently-transfused patient who the Out-Patient nurses knew well. Unfortunately, whoever ordered a unit of plasma in the computer ordered it using the name of a relative of the patient, whose name was almost identical to the patient. Blood Bank had a record for that relative (who coincidentally had recently been transfused.) BB thawed an appropriate unit of plasma for the relative, which was not an appropriate ABO Group for the "real" patient. To make a long story "not-so-long", the patient experienced no serious harm (fortunately!)

But isn't it incredible how one person can make a mistake (Yes, none of us is beyond an error!), but then the mistake can get past the next 3 or 4 people without getting caught?!!

[Stoogiesfreak]

One we discover that an armband has been cut off or removed we start the entire type and crossmatch over again. We feel that removing an armband breaks the identification procedures and we prefer not to take any chances. Also, we collect blood bank testing with the MobiLab system which scans two patient identifiers directly from their admission armband at the site of the collection. It has proven to save many hours of duplicate testing.

[rravkin@aol.com]

We do not use BB issued arm band ID's. We simply use the patients admission braclette for product transfusion ID purposes. I have woked at facilities which utilize the BB bracelet ID and had the same problems. There doesn't seem to be an easy fix. The patient's admission braclette is never cut off. Does anyone practice incorperating in some way the patient's admission bracelet with the BB ID bracelet??

[vilma_mt]

BloodBank armbands have been a 'pain'. Nurses/Docs cut them off....they become unreadable at times. I have worked at big hospital where BB armbands were not used, it's a hospital policy for patient to always wear hospital armbands and no blood draws or any procedure done on patients without one and encourages employees to report....they don't mess around with patient identification and they let everybody know they mean it! Blood Bank's special requirement was for every new specimen 'attestation statement' is submitted with the phlebotomist's FULL SIGNATURE'. It's surprising how people are very careful in what they do whenever they have to sign something. Unfortunately I haven't had any luck with the new places I've worked in to implement this kind of policy....everybody is uncomfortable drawing and transfusing patients without BB armband

[AMcCord]

I know of a facility that uses a small sticker with a Blood Bank ID# on it that is placed on the patient's hospital ID band. The sticker also says that it is not to be removed.

We copied their idea and used it successfully until the 'powers that be' decided to change the armband format here. The barcode on the band become bigger and there was no room left for our stickers. We found about the change when a phleb came back from preop saying they couldn't figure out where to put the BB ID#. (You ever notice that folks in one area never imagine that something they change can affect other areas?? Usually in a bad way!) Anyway, we started putting the same sticker on another blank hospital band and have continued using the separate ID#.

I know that the hospital we copied from is still using the same small sticker on the hospital ID band - I saw one 2 weeks ago. It's been working for them for > than 10 years.

[Stoogiesfreak]

One thing we are working on is patient ID based on barcoding their admission armband. It will be used for all medications including the blood bank products that are given. In our preliminary testing it has worked very well. This will also integrate in the hospitala computer system to document all patient checks during transfusion and alert the nurse to any transfusion reaction criteria, etc. It appears to be capable of helping our entire process. We are very close to implementation. Once implemented, blood bank armbands will be history! One armband will serve all and they will be barcoded so no one will have to write. I will keep you posted!

[adiescast]

We do not use BB issued arm band ID's. We simply use the patients admission braclette for product transfusion ID purposes. I have woked at facilities which utilize the BB bracelet ID and had the same problems. There doesn't seem to be an easy fix. The patient's admission braclette is never cut off. Does anyone practice incorperating in some way the patient's admission bracelet with the BB ID bracelet??

Actually, they do cut off the admission bracelet. It is particularly likely to happen in OR, but other areas cut them off as well. We have suggested to put one of the BB ID stickers on the hospital bracelet and put the BB armband on a different limb in the hopes that one of them would stay on. They don't always remember to put the sticker on the hospital armband and they are very resistent to putting the BB armband on a different limb, so it doesn't work very often.