Is this legal?

[banker2010]

Our blood bank is working with Peds ICU and neonatolgists to have newborns be put on ECMO as soon as they are born. It hasn't happened yet, but these doctors said they want blood (2 washed rbcs and 1 plasma) in the OR at the time of delivery. In order to accommodate this our manager's solutions is for us to crossmatch the blood to the mother and write on the tags "for infant use only". I take serious issue with this and got in trouble trying to dispute it. It just doesn't seem right or legal to me. My stance is to wait (no longer than a bleeding out emergency patient) and get the baby it's own registration number and then give the units as emergency release. At least the units will be tagged for the correct patient. Because to me, once the baby is born it's a new patient and any units it receives should be tagged for it with it's own registration number. It's not intrauterine once it's born. I just question the legality of writing on the tags, "for infant use only". If anything goes wrong it's going to get ugly fast. Any takes on this situation? JACHO, CAP and any other certifying bodies answers are welcome. Thank you.

[Malcolm Needs ☆]

Our blood bank is working with Peds ICU and neonatolgists to have newborns be put on ECMO as soon as they are born. It hasn't happened yet, but these doctors said they want blood (2 washed rbcs and 1 plasma) in the OR at the time of delivery. In order to accommodate this our manager's solutions is for us to crossmatch the blood to the mother and write on the tags "for infant use only". I take serious issue with this and got in trouble trying to dispute it. It just doesn't seem right or legal to me. My stance is to wait (no longer than a bleeding out emergency patient) and get the baby it's own registration number and then give the units as emergency release. At least the units will be tagged for the correct patient. Because to me, once the baby is born it's a new patient and any units it receives should be tagged for it with it's own registration number. It's not intrauterine once it's born. I just question the legality of writing on the tags, "for infant use only". If anything goes wrong it's going to get ugly fast. Any takes on this situation? JACHO, CAP and any other certifying bodies answers are welcome. Thank you.

I don't know the situation in the USA vis-a-vis legality, but cross-matching against the mum's blood is certainly what we do in the UK (although, of course, the blood is always group O). Don't forget, if the baby has any IgG antibodies, these are almost certainly derived from the maternal circulation, and it is doubtful if you would get sufficient sample from the newborn to perform a full work-up.

:):)

[banker2010]

My issue is with the "for infant use only" on the tag. The crossmatch is irrelevant if it's given as emergency release. But thanks anyway.

[YorkshireExile]

I don't know the situation in the USA vis-a-vis legality, but cross-matching against the mum's blood is certainly what we do in the UK (although, of course, the blood is always group O). Don't forget, if the baby has any IgG antibodies, these are almost certainly derived from the maternal circulation, and it is doubtful if you would get sufficient sample from the newborn to perform a full work-up.

:):)

Malcolm, just a small point - why do you say almost certainly derived from the maternal circulation. Where else would the antibody come from?

[Malcolm Needs ☆]

Malcolm, just a small point - why do you say almost certainly derived from the maternal circulation. Where else would the antibody come from?

There are extremely rare cases of "precocious" baby's who have not only made their own IgM ABO antibodies (e.g. a group O baby with anti-A from a group A mother), but also made their own IgG antibodies.

They are extremely rare, but that is why I used the term "almost certainly"; it never pays to be dogmatic about humans!!!!!!!!!!!!!!!!!!

:redface::redface:

[nmpoupard]

We had this situation occur at our institution. In our case, Mom was having a planned C-section and the infant was pre-registered and had a name and medical record number. We were able to tag the units with the baby's information and release O negative red blood cells and AB plasma and platelets using our emergency release protocol.

If it is an emergency or your institution will not pre-register, do you have a protocol for a Jane or John Doe with temporary medical record numbers that could be used to tag units and then issue with the emergency release?

[banker2010]

THAT should be the solution!!! Unfortunately our institution does not allow for pre registration. I wish it did for situations like this. This is what should happen. I still don't like the idea of writing on the tag with the mother's name on it. I just want somebody at an accrediting agency to reply to tell me I'm right, so I can show it to my manager. She just got her PhD in hospital administration and what she says goes! Sheesh! LOL!!Thanks for responding.

[nmpoupard]

You must have a policy for emergency release when the patient's identity is unknown. Can this be adapted to the situation with the ECMO newborns?

All regulatory agencies require bedside comparison of the components being transfused with the recipent identity: name and medical record number of the recipient compared to the information on the unit tag. This practice clearly violates the standards of AABB, TJC and CAP.

[heathervaught]

Does your hospital have a standard convention for identifying newborns (i.e. Mom is Jane Smith, baby is Infant Smith)? As mentioned before, crossmatching using maternal serum is not the problem, rather issuing the blood in the computer system to the mother. Does your laboratory have procedures for how to issue blood when the computer is down? I would say issue the blood to the correct patient using your computer downtime procedure, then re-build it to the newborn's patient ID once registered. I too would object to a procedure that required knowingly assigning blood to the wrong patient.

[L106]

I understand your situation and your concerns, banker2010. At our facility, we do pre-register unidentified trauma patients, and what nmpoupard suggests would work for us. However, I like heathervaught's gameplan even better. (ie: perhaps have the testing with mom's sample done, have all the paperwork ready to go, except handwrite the baby's name and ID # the minute they register the baby, and it's ready to go. Then complete the records in the computer later.)

[clmergen]

We have had blood at the bedside for delivery. We used the mom's last name, baby mom's first name. We issued it with a blood bank id bracelet and strict instructions that the bracelet be put on the baby prior to the transfusion. That way we met the 2 identifiers with ease.

[banker2010]

Thank you all for your expertise. I think the "for infant use only" violates the accreditating agencies policies too. We will be cited bigtime if it's ever found out. Thanks again.

[sgoertzen]

I would treat it like an "Unidentified" trauma patient - using downtime bands (like a Typenex), downtime forms, and uncrossmatched O neg blood. Once the newborn is born and registered in the computer, you can go back and enter all the information into the system, including a name change and ID band change (i.e. from the typenex number & band to whatever name they enter into the computer system and regular band they generate for the infant). At our hospital, they let us "Pre-Reg" 20 or so of these "Unidentified" typenex bands into the computer, so that when a crisis patient shows up with no ID or no time for registration, they only have to activate that armband account in the computer and attach the band to the patient, then everything can be ordered, entered, and issued in the computer, and then later... when the dust settles... everything can be reconciled to the patient's real name and information.

[grace]

Find out which agencies accredit your facility, JCAHO, CAP, AABB, etc. They all have customer service folks who will answer questions from a customer. They will need your customer ID.

In the interest of maintaining a good relationship with your manager, offer to make inquiries for her. I'm sure she enjoys clean surveys and would welcome your effort to be proactive, as long as you keep your approach professional.

[L106]

Grace -

That is great advice - both your recommendation to contact the accrediting agencies and your wise suggestion regarding interaction with the manager. Thanks!