Second Sample for Confirmation of ABO/Rh

[jasonviau]

The hospital I work at recently started requiring a second sample to confirm ABO/Rh on patients without a history. Great idea. However, the lab is a contracted service at the hospital. Prenatal profile testing is done at the lab company's reference lab in another state and the results are in a computer system we do not have easy access to. We are now experiencing problems with women coming in to deliver thier babies at our hospital, and we have to ask for a second sample. The doctors are mad because their patients were already tested by the same company who runs the hospital's lab and we should be able to use those results. I looked over the CAP checklist and AABB Standards for some guidance, and I only found a CAP item referring to being able to accept an Rh result from another CLIA-accredited lab for issuance of RhIG.

I hate to have the patients drawn again if we don't need to, but I want to make sure we're doing the right thing. Is there any regulation as to what can be used for a historic result? Can we use the ABO/Rh performed at another lab of our parent company as the second type? Ugh!

[Malcolm Needs ☆]

I am from the UK, and so do not know the rules and regulations of which you speak, but at least some of the problem lies with your parent company for you not being able to access their computer (especially in this day and age).

:eek:

[L106]

jasonviau -

We apply the "needs a 2nd ABO/RH" rule only to patients who have Crossmatches or a Type & Screen ordered.

[jasonviau]

Part of the admission protocol for Labor and Delivery is to send a type and screen sample. We have a hand full of patients each month that do require transfusion after delivery.

[eric1980]

I think the main issue is communication between your parent company and your lab.

[jasonviau]

I agree that there is a problem not being able to access the results in our parent company's computer. My question is, if the problem were fixed and we could access those results, are those acceptable to use for confirmation of ABO/Rh? They were technically performed by a different laboratory.

[Malcolm Needs ☆]

It depends what the rules say, but we would trust the results of another NHSBT Red Cell Immunohaematology Department (whether they would trust ours is, of course, another matter)!!!!!!!!!!!!!!!!!!!

[WFMB]

Is there not a copy of the prenatal workup on their chart up in LD? At my hospital when a prenatal is done at a reference lab we just have them fax a copy from the chart in LD. Then my comment is "ABO x2 LD chat history". I then file this copy away and if my T&S turns into a cross match we are covered.

[hunb]

WE DO NOT require a 2nd draw on Labor and Delivery patients and similar to your situation the intial pre-natal testing is done by a reference lab not affiliated with our hospital. However, in those instances where we have no blood type history in our LIS I ask technical staff to obtain history from the patient's chart, the reference lab report is bundled with their admission documents upon arrival. I see no issue unless the mother needs a C-section and a type and screen or crossmatch is necessary.

[bbbirder]

WFMB and hunb,

[

QUOTE=WFMB;20605]Is there not a copy of the prenatal workup on their chart up in LD? At my hospital when a prenatal is done at a reference lab we just have them fax a copy from the chart in LD. Then my comment is "ABO x2 LD chat history". I then file this copy away and if my T&S turns into a cross match we are covered.

[L106]

QUOTE=WFMB;20605]

Do you have a copy of the CLIA certificate from those other labs? and have they been approved by the Medical Staff? We had some sort of to-do with something similar a few years ago (the details have escaped me, just that we needed the CLIA certificate for outside labs if results were going to be included in the chart.)

Linda Frederick

[jcdayaz]

We perform 2 blood types on patients with no history. We don't have the patient re-drawn, but we do the first type--discard cell suspension and make a new one--and perform second type.

We do the same as a previous post on external lab results only for rhogam administration. We require a copy of the reference lab's result showing RH neg. We make a comment "Abo/RH obtained from MD office".

[eric1980]

We perform 2 blood types on patients with no history. We don't have the patient re-drawn, but we do the first type--discard cell suspension and make a new one--and perform second type.

You do recognise that you are actually doing an internal check and not eliminating the chance of the ward mislabelling the specimen tube? And that if the re-test is not performed, any ABORH error can be picked up easily at the crossmatch?

I believe that sending a second specimen (for patients without history) is more helpful than doing the same test on the same specimen...

[jcdayaz]

Absolutely I recognize we are doing an internal check. It is impossible to "police" all the nursing wards. You do realize that if the same person(nurse, whoever) collects both of your specimens that you are no better off? And the patient(hopefully the right one) has now been drawn twice!

[LAS]

QUOTE=WFMB;20605]

Do you have a copy of the CLIA certificate from those other labs? and have they been approved by the Medical Staff? We had some sort of to-do with something similar a few years ago (the details have escaped me, just that we needed the CLIA certificate for outside labs if results were going to be included in the chart.)

Linda Frederick

That's very interesting. Thanks for the information, Linda. (Do you have any idea exactly who would be responsible for obtaining and keeping a file of these CLIA certificates? Perhaps the hospital's Compliance Officer??)

[YorkshireExile]

Absolutely I recognize we are doing an internal check. It is impossible to "police" all the nursing wards. You do realize that if the same person(nurse, whoever) collects both of your specimens that you are no better off? And the patient(hopefully the right one) has now been drawn twice!

My previous hospital we discovered nurses were taking two samples at the same time. one would be sent to the Blood bank and when the request came later for another sample then the second one was sent down with a new time on! That way they didn`t stick the patient twice. A system is only as good as its weakest link, in this case that is the people taking the sample.

My hospital now does not do a second group check. As we are a maternity hospital the vast majority of our patients have a prenatal group history. To try and get the right sample drawn from the right patient we insist all T&S and crossmatch specimens have hand-written details on the specimen tube (as recommended by BCSH guidelines) that must be written by the patients bedside immediately after taking the sample.

Is a 2nd sample mandatory by any accrediting body?

[John C. Staley]

Apparently complicating a process does not make it any better or safer. Imagine that!!!

Keep your processes as simple as possible and diligently training eveyone not only to the "what" but also the "why" of it.

Human nature will discover a work around that makes their life easier, keeping it simple helps to avoid this.

[Malcolm Needs ☆]

Again, I agree (twice in 5 minutes - I must be ill)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:D:D

[bbbirder]

That's very interesting. Thanks for the information, Linda. (Do you have any idea exactly who would be responsible for obtaining and keeping a file of these CLIA certificates? Perhaps the hospital's Compliance Officer??)

We also must have copies of CLIA certificates just as Linda has described. We are responsible for obtaining those copies ourselves. We have a staff member who coordinates send out testing and she keeps up with it.

[eric1980]

Apparently complicating a process does not make it any better or safer. Imagine that!!!

Keep your processes as simple as possible and diligently training eveyone not only to the "what" but also the "why" of it.

Human nature will discover a work around that makes their life easier, keeping it simple helps to avoid this.

Someone told me before, that if we need more and more protocols in order to make things right, it shows that we are not educated in the first place. And to add on to what he said, more protocols will end up with those uneducated relunctant to comply and do more wrong things instead.

[Malcolm Needs ☆]

Someone told me before, that if we need more and more protocols in order to make things right, it shows that we are not educated in the first place. And to add on to what he said, more protocols will end up with those uneducated relunctant to comply and do more wrong things instead.

It goes to prove the old saying, "If it ain't broke, don't fix it."

[RR1]

The hospital I work at recently started requiring a second sample to confirm ABO/Rh on patients without a history. Great idea. However, the lab is a contracted service at the hospital. Prenatal profile testing is done at the lab company's reference lab in another state and the results are in a computer system we do not have easy access to. We are now experiencing problems with women coming in to deliver thier babies at our hospital, and we have to ask for a second sample. The doctors are mad because their patients were already tested by the same company who runs the hospital's lab and we should be able to use those results. I looked over the CAP checklist and AABB Standards for some guidance, and I only found a CAP item referring to being able to accept an Rh result from another CLIA-accredited lab for issuance of RhIG.

I hate to have the patients drawn again if we don't need to, but I want to make sure we're doing the right thing. Is there any regulation as to what can be used for a historic result? Can we use the ABO/Rh performed at another lab of our parent company as the second type? Ugh!

Surely if the contracted company runs this lab then they are responsible for ensuring that results are easily viewable by the satellite lab. Also the companies procedures should state how the satellite lab needs to handle these situations.What happens if the patient has an antibody, does this mean you may not be aware of this?

In the situation you describe I can understand why you are asking for another sample, but if all results were viewable and blood was required for these patients would you not need a sample on site anyway, or would you perform electronic issue?....if this is the case, what about the patients with antibodies?