What Would You Do?

[Likewine99]

I would issue the blood, I agree with mobea, nothing good ever happens after midnight. We have a policy addressing this and a form that we get Med Director approval, this is a deviation from SOP.

[Eoin]

We use Neoteric BloodTrack. Blood is crossmatched and sent to remote Issue Fridge. It is held for 48 hours (from time of Issue to the "Issue fridge" (time 0). We will take back units at that time unless instructed to hold for the third 24hr period. After the 72 hr mark, we have set BloodTrack to refuse issue, and the door won't unlock, so the nurse / porter cannot get the unit out, and they are instructed to contact Blood Transfusion Scientist, who will instruct to collect new sample and recrossmatch would be performed. (Emergencies excepted, but like Malcolm on advice of the Haematology Consultant or Haematology Registrar only).

Also, like Malcolm we actively discourage transfusion at night time (less staff, low light etc.) but recognise this has its own problems (lack of transfusions, so skill levels drop in night staff), and obviously clinical state often indicates that Tx is necessary at that time, but we do audit these.

Cheers

Eoin

[mwilde]

I'm guessing that many of Great Britain's processes are driven by SHOT. If so, I believe we're seeing the future of transfusion practices in the US as our own Biovigilance program progresses.

I for one have always wanted Blood Bank refrigerators that refuse blood to caregivers when problems exist, i.e. expired crossmatches/ issue times!

Margaret W.

[RR1]

We use Neoteric BloodTrack. Blood is crossmatched and sent to remote Issue Fridge. It is held for 48 hours (from time of Issue to the "Issue fridge" (time 0). We will take back units at that time unless instructed to hold for the third 24hr period. After the 72 hr mark

Cheers

Eoin

Is this really 48hrs or 2 calendar days from time of issue ?

[Malcolm Needs ☆]

I'm guessing that many of Great Britain's processes are driven by SHOT. If so, I believe we're seeing the future of transfusion practices in the US as our own Biovigilance program progresses.

I for one have always wanted Blood Bank refrigerators that refuse blood to caregivers when problems exist, i.e. expired crossmatches/ issue times!

Margaret W.

I think that you are thinking along the right lines, but i think it is a combination of SHOT, SABRE (another haemovigilence scheme), CPA and MHRA (the last two being regulatory bodies), and throw in a bit of GMP (good manufacturing practice).

I also think that you are thinking along the right lies in that this is the future for the USA.

While most of it is welcome, in that it does improve the way we do things, a certain percentage of it is a pain in the ****, with little to show for improvement.

:mad::mad::mad:

[RR1]

I'm guessing that many of Great Britain's processes are driven by SHOT. If so, I believe we're seeing the future of transfusion practices in the US as our own Biovigilance program progresses.

Margaret W.

Hi Margaret, our BCSH guidelines are based on some aspects of SHOT. The SHOT team produce excellent annual reports ( a few of which are attached in the resource library) with recommendations for labs and clinicians to follow, though some of these very sensible points have still not been implemented even after many years.

Also it would be useful nationally and even internationally to look at some of these SHOT recommendations (found at the end of the reports), and audit your practices against these. (easy to just cut and paste the matrix onto an audit template).

Does anyone know how the US Biovigilance program is doing?

Thanks

[mwilde]

While most of it is welcome, in that it does improve the way we do things, a certain percentage of it is a pain in the ****, with little to show for improvement.

:mad::mad::mad:

From what I'm reading about equipment validation and issuing blood products, some of it will be rather a pain. A lot of it is things already on our collective wishlists, so perhaps the purse strings of our administrators will be loosened also......?

Margaret W.

[mwilde]

In answer to Rashmi's question, AABB does a good job of updating the progress of Biovigilance. I don't know whether anyone on BBTalk is part of the early users and might give us more insight.

[Mary Ann]

Hi everyone,

The SOP at my facility considers collection date as day 1 and clot expires day 3 at 23:59,if needed may extend to 11am(magictime) the following day. Then there's the 7 day clot for NPOTs to expire 2 days after surgery or on 6th day-extend to 7days if needed,depending on transfusion status.HCLL has an override option for 3rd day extension at time of issue. I have seen antibodies appear in 16 hours of transfusion from a patient whose band was cutoff,educational mishap.I look at the sample amount and if transfused with prbc's and don't do favors,follow your protocol.There is always emergency release-or 35 minute wait. Thanks,

[jcdayaz]

I would not ever be willing to "override" your computer warning even at 0001 on the 4rth day. As Malcolm stated, the litigation potential is immense! You would have to be able to prove that you had followed your SOP's to the letter...and it doesn't sound like you would be too successful at that in this circumstance.

That being said, I would not let a patient die because it was 1 minute after their crossmatch expired and they needed blood. I would insist that the attending physician sign for Emergency Release, uncrossmatched blood if the patient was in danger and couldn't wait for a new sample to be collected and processed.

For our "3 day rule", date of collection is counted as day 0. ie. specimen collected on the 12th at 9am(or whenever) expires on the 15th @ 2359.

We do have a different policy for pre-op preadmission testing (of course, why would it be simple??). Those crossmatches can be held for 7 days after collection date if all the answers on the patients' preop question form ("green sheet"..how scientific is that?) are answered no. The questions cover pregnancy, previous transfusion within the last 3 months, etc. Even in these cases, say the preop patient has their type/crossmatch done 2 days prior to their surgery and then they receive blood during their surgery..then the crossmatch would expire on day 5 as opposed to day 7. We will never transfuse >3 days if a patient has received blood without getting a new specimen.

Sorry, I just reread this post...it is a jumbled garble of mess!!

[Mary Ann]

Thank you for the info and I understood your post.I will now go back to my emo corner.

[Nancy L.]

Sorry, I just reread this post...it is a jumbled garble of mess!!

It didn't sound like a jumbled garble of mess to me. Perhaps because we have the very same policy!

[jcdayaz]

I think all hospital blood banks would "issue" on the day of surgery. Many "issue" in a cooler validated to maintain the temperature for 4-6 hours so that the blood can remain in the same room as the patient.

I agree Marilyn. I don't understand the concept of "issuing" blood when it is still in the blood bank's posession.?

We use coolers for OR, ER (emergency), dialysis, and sometimes ICU. We STRONGLY discourage the use of coolers for the regular floors. Of course, we use our judgement. Typically, we have seen that requests for a cooler from a regular floor are made out of convenience...not true patient need.

[trisram]

I would issue the unit. Once the nurse is out of the room, the computer will somehow accidently crash to the concrete floor, smashing into tiny little pieces