Patient ID bands, yet again...

[adiescast]

We are in the process of requiring a unique blood bank armband for all patients. We went to this because nursing decided that name and date of birth were unique enough for patient ID and we disagree (having seen too many patients with the same or similar name and date of birth). We also do not have a good patient ID culture among the nursing staff. Additionally, we do not extend the crossmatch for pre-op patients for reasons that are too complex for this post.

The question that has come up is how other institutions in our situation (BB band required for each new sample, no crossmatch extensions) handle the next sample for a patient who was drawn, as an example, Friday for a Monday surgery and may require blood after midnight (when the sample has expired). We looked at having a repeat sample drawn Monday morning, but came up against the problem of either having two bands active on a patient (chance for errors), or having to hurry to get blood ready for the surgery using the new band number (chance for not having blood when needed). We are now talking about having the repeat sample drawn post-op, but the same problems could exist there as well.

Has anyone else approached this problem and found a workable solution?:juggle:

[David Saikin]

If the patient has not been transfused or pregnant within the 3 months prior to surgery, why are you limiting the specimen life to 3 days? This is entirely within your perogative, but you might consider extending the time frame for a valid preop specimen (we use 7 days, but I have seen places which will keep them for up to 30 days). I have worked in places using armbands . . . I did not really care for them. We are about to go live with the BloodLoc system. The BB number is good for the life of the admission UNLESS the pt's armband is removed, in which case another BloodLoc number will have to be used (admitting places the BL# on the pt id bracelet at admission).

[AMcCord]

We also use a Blood Bank ID # good for the entire admission - cut off the armband and we start over.

[bbbirder]

We extend, up to 2 weeks, for our pre-op patients who sign a form that they have not been transfused or pregnant wihtin 3 months.

The only time we have encountered a patient who may have two bands on his/her arm is a patient using a lot of blood and we need a new specimen. Good communication with the nurse usually takes care of this. The nurse can cut off the first band after the last unit from that draw is given. Since most of this type patient is in ICU, the nurse is probably the one collecting the specimen and putting the BBID band on the patient anyway.

Linda Frederick

[Cathy]

We use the Hollister band. As long as the band is still on the patient and remains legible we leave it on. When a new sample is needed, we have the phlebotomist hand write the "R" number on the new sample.

We extend our eligible pre-ops for up to ten days. These patients wear their bands home. If they show up without it we redraw.

[jhaig]

We use the Hollister band. As long as the band is still on the patient and remains legible we leave it on. When a new sample is needed, we have the phlebotomist hand write the "R" number on the new sample.

We extend our eligible pre-ops for up to ten days. These patients wear their bands home. If they show up without it we redraw.

That's exactly what we do here. One 'R' number per admission and if one of those scissor-wielding nurses decides to remove it, we start over with a new band and a new 'R' number.

[Eoin]

If confirmed not pregnant or transfused within previous three months, we will extend to 30days with pt plasma after screening held at - 30oC, providing bands are still barcode readable. We use 2D barcodes with Name, DOB & MRN as the three primary identifiers. Bloodbands have are mostly red except for print area. You may need to consider your case mix though. We have a large orthopaedic poulation, so lower risk of pregnancy etc.

Regards,

Eoin

[LAS]

For various reasons, we do not extend our expiration on any pre-transfusion specimens. We are a mid-size community hospital and have encountered little need for an extended expiration. When a specimen expires, we require a new specimen and a new armband every time. We have found that it is much easier for the nursing staff if we maintain a consistent policy with as few exceptions as possible. We run a report each morning listing the blood bank specimens that expired the previous midnight and lab staff removes the expired bands. Often the patients have been discharged by then or their need for transfusion has passed, so we have run into very few problems with this practice. This policy would be inadequate however, for a larger hospital with higher volumes.

Additionally, we struggle now with our pre-admissions dept getting patients in a day or two early for pre-op testing, so each morning is a mad rush for blood bank. When patients do come in and have labs drawn, it is not uncommon for them to go home and remove their blood bank armband, so extending the expiration of those samples would be a non-issue for us.

[lehooke]

We have the patient sign an attestation on the Blood Bank request stating whether or not they have been pregnant or transfused in the past 3 months. If not, the specimen is good for 7 days and we hold the crossmatched units up to 3 days after surgery. We use a "Secureline" blood bank armband with a unique BB ID#. The band is good for the length of admission as long as it remains legible. Phlebotomists may handwrite the BB ID# on subsequent blood samples after the pre numbered labels are used up. If the band is removed for any reason, the patient must be redrawn and a new armband is attached. We have very few problems with this system. For out patients and preops, we use a waterproof armband that has a sealed pouch, where we place the large white label from the BB armband. This was done because too many people were coming in with smudged armbands on the day of surgery. The new armbands have worked quite well to reduce this occurrence.

We use Cerner Classic and if the patient has signed the form stating they have not been pregnant or received blood products in 3 months, we make a notation in PTC that the patient has signed the form , with a date and time stamp. This system works well for us when we get a call from the nurses checking the status of a blood sample.

[PaulSunV]

A workable solution, not necessarily the best, that we had at one of the hospitals I worked for in the past is a unique Blood Bank numbered band, with patient’s name hand written on the card at time of the phlebotomy is placed on each patient that requires a transfusion specimen to be drawn. That unique numbered band is to remain attached to the patient during the entire hospital stay. Each sample is only good for 72 hours and if any additional blood, RBCs, is required then a new sample is collected for a new TS. If the unique numbered band is removed, anywhere other than surgery, then a new TS will be required for any new blood products requested. The unique number is on an embossed card that is placed in a label maker. In surgery they can cut off the band and reattach it with a new band but the same numbered card. That number made from the card is required on all transfusion tubes. It is not ok to have anyone hand write that number on subsequent samples.

So if we have a patient that is going to surgery on Monday and is present to have the pre-operative lab work performed on Friday with the intention of returning on Monday then no Blood Bank #ed band is placed on the patient and the most that would be performed is an antibody screen. On Monday prior to surgery the patient is banded and redrawn for the TS and crossmatch as needed. The unique number on the band can only be used once and the computer prevents it from being changed to a new number attached to the patient without someone authorized in the Transfusion department making the adjustment.

[bxcall1]

I just re-did the Type & screen and XM on a a patient this morning. He was in yesterday for his pre-op's, including XM. He showed up this morning with no Blood Bank band! = NEW SPECIMEN/NEW XM.

We don't extend beyond 72 hrs to better control our inventory and to avoid having to document whether the patient has been pregnant or transfused. This way we treat everyone the same.

[bxcall1]

We can use the same BB number for eternity, as long as the patient has the band. For individual testing we go by the date/time that is handwritten on each specimen ( a specimen is good for 48 hrs.). Subsequent specimens will have the same BB number with a new date & time ( also a new specimen number in Meditech).

[bbbirder]

Eoin,

Where are you getting your bands with 2D bar codes?

Do you print these out of your computer system or purchase them?

Linda Frederick

If confirmed not pregnant or transfused within previous three months, we will extend to 30days with pt plasma after screening held at - 30oC, providing bands are still barcode readable. We use 2D barcodes with Name, DOB & MRN as the three primary identifiers. Bloodbands have are mostly red except for print area. You may need to consider your case mix though. We have a large orthopaedic poulation, so lower risk of pregnancy etc.

Regards,

Eoin