Advice about Emergency Release

[AMcCord]

Years ago when I lectured medical students, they got 2 hours of blood banking. I doubt if that number has improved. The rest is passing on incumbent habits during residency. In my experience, many medical students specialize in pathology because they like anatomical pathology; clinical pathology including blood banking is just a necessary evil. When I tell residents that part of their job is to talk to clinicians, I frequently get some horrified looks. My pet peeve is that they don't seem to learn the difference between a direct and indirect Coombs (antiglobulin) test.

The really scary part is that the 'habits' and 'knowledge' that are passed on in residency by their mentors may be poorly understood by the mentor or just plain wrong, yet it's perpetuated. I would have a pocketful of cash if I had $1 for every time a physician has told me (when he's written a squirrely order) "Well, that's what I was told when I was a resident." ...Well, you were told wrong!:mad::mad:

[lateonenite]

Our protocol is the same as everyone else, and in the end it's up to us as to what we will give out according to what we have currently on the patient (ie, if we have a current sample grouped then always group specific rather than our O's).

According to protocol we are supposed to get haematologists approval to switch a patient from Neg to Pos, but what really happens is that we'll notify them that it's happening (because we eithr don't have the stock or it's an older patient). Approval we only need for females less than child-bearing age or transfusion dependant patients in a trauma/bleeding situation.

Of course, we have had a doctor say to one of our seniors:

D: Well can't we have the O Negs?

S: No, as I explained, the patient has antibodies, (a little-c in this case), we need to give you O Pos

D: Well, everyone knows O Neg is the safest to give in trauma, don't you know that?

He still grits his teeth at that today, and it was some years ago now....baby doctors are so speshul.

Edited January 12, 2010 by lateonenite
Forgot the haematologist bit.

[MAGNUM]

It looks as though my protocols are following what others are doing. The ED doc gets O Neg PC and AB FFP. As my daughters kindergarten teacher used to say, "You get what you get, and you dont throw a fit!!"

[Dr. Pepper]

We do pretty much all the above mentioned. I thought we had it covered in P&P and "common knowledge" until a 3rd shift generalist tech actually came close to issuing the O Pos FFP! (Never, never assume......) So, I include "universal donor" RBC and plasma questions in our annual competency evals, have a conspicuous sign on the FFP freezer "Group ABO is the universal plasma donor", and post the component/compatibility chart in the ER. Logic tables can be set up for your LIS as well to block the issue of the incompatible FFP.

[Joanne P. Scannell]

Our protocol is the same as everyone else, and in the end it's up to us as to what we will give out according to what we have currently on the patient (ie, if we have a current sample grouped then always group specific rather than our O's).

According to protocol we are supposed to get haematologists approval to switch a patient from Neg to Pos, but what really happens is that we'll notify them that it's happening (because we eithr don't have the stock or it's an older patient). Approval we only need for females less than child-bearing age or transfusion dependant patients in a trauma/bleeding situation.

Of course, we have had a doctor say to one of our seniors:

D: Well can't we have the O Negs?

S: No, as I explained, the patient has antibodies, (a little-c in this case), we need to give you O Pos

D: Well, everyone knows O Neg is the safest to give in trauma, don't you know that?

He still grits his teeth at that today, and it was some years ago now....baby doctors are so speshul.

Got one along that line of thinking!

We were told by a resident to just give him WASHED cells if we couldn't find compatible units (the patient had a few antibodies). Ahh, if it were only that simple!

[TimOz]

Nice thread and a reminder. The "Group O universal donor is a statistical construct for Caucasian populations" and it comes unstuck if there are Bombays around.

I have told this story before but as a reminder, a large Asian Hospital knew they have a significant Bombay issue so they did not issue group O blood (ONeg is very hard to get in m ost of Asia) and issues grouped matched blood. As they antibody screened every routine patient they chose NOT to include a group O cell in the serum (reverse) group to save money but decided ONLY to include it in emergency group testing. They did not use this process often.

Outcome: MVA. Group tested. Staff member forgot to add the O cell in the serum group. Matched O blood issued. Death. Patient was a Bombay.

I think the incicence in that population is probably 1:200,000 but Murphy's law states.......

[adiescast]

It is easy to forget that not all populations are the same. That assumption can lead to critical (sometimes fatal) mistakes. Thanks for the reminder, TimOz!

[bbbirder]

Doctor's knowledge of blood compatibility is so poor. .. We had a B neg patient who needed a couple of units. We were either out of B negs or had some short dated O negs, whatever, so gave out an O neg. The patient happened to have a febrile reaction to the unit. The doctor called us, wanting to know why we gave the patient the wrong blood type?

Geezzz...

[Stoogiesfreak]

Would anyone like to share criteria you use for documenting emergency release vital signs? We are currently relying on the patients chart for that information when needed.

Thanks,

John

[Deny Morlino]

The same form we use for transfusion record applies in all cases here. It is a two part form (chart copy and blood bank copy) utilized by nursing to document the vitals at specific intervals. Thus we capture the results for the charting purposes and blood bank without the creation of extra work (in theory). Does that answer your question (I hope)?

[Stoogiesfreak]

Deny,

Thanks - that is exactly what I am looking for. We are only using a single sheet and have a difficult time getting back vitals for documenting in our LIS. A form like you mention would be great.

thanks!

John