Blood pick up

[bmarotto]

The electronic age is supposed to make things easier? Currently, if a messenger comes to pick up blood, they have a "pick-up" slip that has patient and product requested information. Now, they want to implement a system where messenger will get a page to "Go To BB for job #1234". Then BB has to log into the dispatch system to see what job #1234 is. In addition to blood, we give out up to 800 bottles of albumin a month so I see this as potentially bogging things down, especially on evenings when I only have 1 or 2 techs working. Is anyone using such a system? If so, do you print out a copy of the job request to match the request to the product being issued? Or do you do the review from the screen display then go into the BB system to issue the product?

[JOANBALONE]

Perhaps the messenger can log in to the system? It sounds like it is their system.

[Malcolm Needs ☆]

Perhaps the messenger can log in to the system? It sounds like it is their system.

I agree (except that I m prepared to bet a tidy sum that it was probably foisted upon them too by some "suit" in the background who "thought it was a good idea" and would "improve patient safety", wsithout a thought for those who would have to operate the system).

:mad::mad::mad::mad::mad:

[bmarotto]

The system covers admissions, housekeeping, and transport functions. I told the person in charge having a BB tech pull up the job was not an option....unless they want to give me a clerical person for each shift. The reply was "Well, we will figure something else out or leave blood bank they way it is now".

[Malcolm Needs ☆]

The system covers admissions, housekeeping, and transport functions. I told the person in charge having a BB tech pull up the job was not an option....unless they want to give me a clerical person for each shift. The reply was "Well, we will figure something else out or leave blood bank they way it is now".

Hmm.

Sounds like they did neither.

Now, where have I heard that before?????????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:angered:

[RR1]

If only the rest of the hospital understood and adhered to good old 'Change Control'

[Cliff]

We make them present the slip to us, that way it's a lot harder to give the wrong product out. We prefer not to put the responsibility on the blood bank for who is getting what and when.

[kate murphy]

We do the same as Cliff, evn though the messengers have an electronic system and pagers, they still must present with a paper with patient name and MRN for us to issue anything. We then keep the slip as a "receipt" so if there ever is a question about why we issued for Mr X, we can show that the request was for Mr X.

[Bill]

We do same as Kate Murphy and have had to show receipt becasue nursing said we issued for wrong patient.

[bmarotto]

Well, that is what I am insisting on for the same reason. I like the security of having a paper record to go back to.

[froggymork]

We are still on a mostly paper system so we have the nurses/cnas bring a duplicate form with the labels of who they are transfusing. We then match it with our information and then write the unit on that duplicate form. Also, we have a triplicate form for the original work documentation that must be present for every unit. Very cumbersome. But at least we have the doublecheck of their vs. ours. I guess. This is the first facility I have worked without a computer system for BB but without the budget we do what we can......

[Malcolm Needs ☆]

To those of you that have had to show receipts when the nursing staff have disputed that the correct patient's blood has been issued, or that the correct component has been issued, and you are shown to have been correct, what happens to the nursing staff who have requested the wrong patient's blood, or component?

Are they disciplined, re-trained, or is it all just swept under the carpet?

:confused::confused:

[jcdayaz]

To those of you that have had to show receipts when the nursing staff have disputed that the correct patient's blood has been issued, or that the correct component has been issued, and you are shown to have been correct, what happens to the nursing staff who have requested the wrong patient's blood, or component?

Are they disciplined, re-trained, or is it all just swept under the carpet?

:confused::confused:

It seems like in the hospital setting, nurses are never "officially" wrong. I have only heard of one instance when the offending nurse was terminated due to such a transgression from the protocol. Everything else seems to be "swept under the carpet".

[sgoertzen]

We are now implementing a new pick-up slip that the transfusing nurse has to fill out and sign stating he/she is sending for "this" specific product for "this" specific patient after reviewing the doctor's orders for transfusion. (The unit coordinators will no longer be allowed to do this for the nurse.) This is due to a recent incident where the unit coordinator in ICU placed an order for PLTs, we set it up, issued it and the nurse administered it without ever checking the MD orders that were actually written to give FFP. Rather than hold the nurses accountable, our Patient Safety Chair wanted to make it the BBK tech's responsibility to actually "see" the written MD orders from the chart and compare it to the orders placed in the computer before preparing any products (his idea was that someone on the floors would fax the written MD orders to us), but PLEASE... this wouldn't work for at least 1/3 of our orders! What about surgery where there are no written orders to transfuse, or the outpatient clinics where they use a generic standing order for 6 months for both RBCs and PLTs dependent on drops in Hgb and PLT counts? Or orders written in the chart that look like a scribble? Or Pre-Op orders where they order 3 different products all at the same time for the same patient? When they come to pick something up, how would WE know which product they "should" be coming for? My medical director and operations director (and me) are all saying no. The person transfusing the blood has to be the one who double-checks the orders to transfuse to make sure he/she is sending for the right product on the right patient (as per their policy/procedure). We are planning to move to CPOE within a year, where if the orders are placed for the wrong product, the doctors won't have anyone to blame but themselves.

[jcdayaz]

We are now implementing a new pick-up slip that the transfusing nurse has to fill out and sign stating he/she is sending for "this" specific product for "this" specific patient after reviewing the doctor's orders for transfusion. (The unit coordinators will no longer be allowed to do this for the nurse.) This is due to a recent incident where the unit coordinator in ICU placed an order for PLTs, we set it up, issued it and the nurse administered it without ever checking the MD orders that were actually written to give FFP. Rather than hold the nurses accountable, our Patient Safety Chair wanted to make it the BBK tech's responsibility to actually "see" the written MD orders from the chart and compare it to the orders placed in the computer before preparing any products (his idea was that someone on the floors would fax the written MD orders to us), but PLEASE... this wouldn't work for at least 1/3 of our orders! What about surgery where there are no written orders to transfuse, or the outpatient clinics where they use a generic standing order for 6 months for both RBCs and PLTs dependent on drops in Hgb and PLT counts? Or orders written in the chart that look like a scribble? Or Pre-Op orders where they order 3 different products all at the same time for the same patient? When they come to pick something up, how would WE know which product they "should" be coming for?

What we do at our facility is require a faxed copy of the Dr's written order for transfusion of any product. We will NOT even begin thawing FFP until we see a faxed order with the word "transfuse" (or some other verb..ie..Give, Infuse, etc) X-number of FFP (surgery is exempt--we prepare whatever they call and ask for). Our Blood Bank has its own dedicated fax machine just for this purpose. We also require whoever is picking up the product(s) to bring another copy of the written physician's order with the patient's armband number affixed--or hand written if they have run out of stickers-- if they are trying to pick up RBC's. Obviously, an emergency release situation is also exempt from all these rules. As far as our out-patient service goes, we require our out-patient phlebotomy staff to send us the physician's order. Yes, each and every time even with a recurring order.

Ha Ha on your "Orders that look like scribble" comment!!!! Don't most DR's orders look like scribble????:D:D:D I have spent WAY too much time trying to interpret DR's orders. Do you think they take a special DR's handwriting course???

[Mary**]

:crazy:We have implemented a system very similiar to Sgoertzen due to a very similiar incident in which the nurse verbally requested a plateletpheresis and transfused it, then the order for FFP printed in the Blood Bank 30 minutes later. There was no order to give the platelets. (They are both "yellow", you know!! Our hospital did a Root Cause Analysis on this situation, and YES, their conclsion was that the Blood Bank should continue to use their pick up slip and they now have to present a copy of the physician's order to the Blood Bank. As usual, it fell back on us. It will never end.

[L106]

These stories just burn me up!!!! I, too, believe it is the transfusing nurse's responsibility to confirm the doctor's order before transfusing. (Silly me thinks she should also understand why the blood product is being given.)

[Likewine99]

The nurse who picks up the products is responsible for getting the right product into the right patient. In sgoertzen's case it's a classic example of not putting the blame squarely where it belongs, on the transfusionist.

It doesn't matter if you have a million pieces of paper or forms to be signed, at every step of the process, where there is human intervention it is a place for an error.

CPOE does eliminate stuff like this, but watch out for the doc who tries to call in an order to circumvent the electronic process. Now you just have another piece of paper that has to be scanned into the chart.

You can't expect the BB who is not at the pt bedside to police poor nursing practices.

[jcdayaz]

you can't expect the bb who is not at the pt bedside to police poor nursing practices.

such a true statement!!!!!!

[L106]

I agree with Likewine. The more people that get involved, the more steps in the procedure, etc., increases the risk of something falling through the cracks (or errors.)

Your comment regarding Physician Order Entry is also true. After a few months, we found out that some docs were going to a phone on the other end of the nursing station and calling in Lab orders to the floor secretary or nurse (to avoid entering the orders into the computer himself!!) (If it's so difficult to learn how to enter orders into the computer, how come the nursing unit clerks/secretaries get paid so little???)

[Jack J]

I am now writing a policy to implement a pick up slip. I like the idea Cliff stated above to have the department present the slip. With that in mind, we will have the floor order the test code for the component to pick up. This will generate a label with Pt name, MR#, location, and component. They will then have to go to pt. bedside and place a typenex sticker on this label and then present to Blood Bank.

[jcdayaz]

:crazy:We have implemented a system very similiar to Sgoertzen due to a very similiar incident in which the nurse verbally requested a plateletpheresis and transfused it, then the order for FFP printed in the Blood Bank 30 minutes later. There was no order to give the platelets. (They are both "yellow", you know!!

PLEASEtell me the nurse did not say "They are both yellow, you know"!!

[tbostock]

PLEASEtell me the nurse did not say "They are both yellow, you know"!!

I once had a doctor that talked a Jehovah's Witness patient into accepting a unit of apheresis platelets "because it's not red like blood"...oh jeez....