We are a small rural hospital (80 beds), and recently had a patient in the ER with possible ectopic pregnancy. Dr. orders TS etc. Phlebotomy drew blood and banded. Patient stated name as "Smith," and computer labels are "Smith", therefore banded with that name. Before phlebot leaves room, admitting personnel enters, and patient says she has recently been married, name is "Jones." Phlebotomy comes back to lab with blood and wants me to tell her what to do. I tell her blood must be redrawn. She disagrees, because she knows blood is from that patient. ER changes name in computer system, so "Smith" is no longer being used.

I made phlebot redraw and reband patient.

My question is, where do I draw the line? Did I do the correct thing, or should I have let the phlebotomist reband and relabel the patient and blood tubes?

I thought the phlebotomist should have rebanded and relabeled in the room before leaving the patient.

What do you think?

I would do the exact same thing you did. We require new specimen. Once the tube is labeled and patient gets band we do not allow to make any correction(we use typenex band).

If the name is changed by registration people we need new specimen....most of the cases they do nor change the name without calling blood bank.

What is the purpose of labelling & banding the patient and tube? To ensure that the two match! Once the computer was changed, the phlebotomist could go to patient with new band and match old band with new band which ensures that tube and patient match--without having to perform an invasive procedure on the patient. What is the difference if she does it before leaving the room or a little later considering all items match. Also, as all know, a patient with an ectopic pregnancy can bleed out VERY quickly.

if there is an emergency we can always give uncrossmatch blood with emergency release.

This all depends on the patient population you are dealing with and how confident you are in your system(RN labeling tubes)....if you have an incident of WBIT you do not want to take any chances...I would not...

as long as the Smith band stayed on the patient, the tube is labeled Smith and the blood would be tagged with Smith, you can call the patient anything you want. It is similar to banding a "Doe" patient.

I would have used it (provided the original band was still there). We always call the RN and attempt to explain the situation... and generally the band is removed by some "helpful" person so the crossmatch is then repeated with the current band.... but we try...

Is the name change in trail in the Information System? As long as you have something documenting that the name chage occured, you could use the same sample and subsequently re-band the patient. This is acpetable and infact a reccomendation to do, since there will be plently of coccasions with differetn last names due to marriage/divorce..

We always get a merge log from the computer that shows the connection. When the patient name changes, we hand write the new name on the slip along with the old name (this frequently happens with trauma patients.) If the medical record number changes, we write that also. The bill account number stays the same and the BB bracelet number stays the same. In a situation like the one described, even the birth date stays the same (unlike the unknown trauma patient who always seems to find their name at the height of the emergency).

I agree that the best scenario would have been for the phlebotomist to change the bracelet and the tube before they left the patient. However, when do you ever get people to do the best thing in a confusing scenario?

Meditech has a release frozen history routine that we go through when patient names are changed like that. We get a message that Mrs. Smith was involved in a merge, do we want to view detail? We say yes and the screen shows what the name used to be when the orders were placed. If it all checks out, I use the tube. This happens all the time. Either someone has gotten married or divorced or registration goofs up. The history is then merged with the old one if BBK staff allow it. We just have to see the paper trail.

Once they change the name in the computer system, though, your unit tag will now be printed with a name that does not match the BBID band. So whent the nurse goes to hang the unit....So I agree that (unfortunately) you should reband and redraw.

If there is a name change, we will use the specimen as long as both bands are on the patient until the patient ID is verified, there is an audit trail of the name change being transmitted from the hospital registration system to our system, and other patient identifiers (med rec number and DOB) remain unchanged.

[quote=lgabbert;278 Phlebotomy drew blood and banded. Patient stated name as "Smith," and computer labels are "Smith", therefore banded with that name. Before phlebot leaves room, admitting personnel enters, and patient says she has recently been married, name is "Jones." ER changes name in computer system, so "Smith" is no longer being used.

I made phlebot redraw and reband patient.

My question is, where do I draw the line? Did I do the correct thing, or should I have let the phlebotomist reband and relabel the patient and blood tubes?

I thought the phlebotomist should have rebanded and relabeled in the room before leaving the patient.

What do you think?[/quote

If the knowledge was acquired before the phleb left the room with the specimen, you can be fairly sure that you have a correct specimen. But "fairly sure" is not okay in Blood Banking.

It sounds like you should have a policy or procedure document for handling name changes; I don't see any reason to handle Jane Smith --> Jane Jones any differently from a patient who goes from John Doe in the emergency room to whatever his real name is.

Edited June 28, 201015 yr by heathervaught
wrong last name

You were exactly correct in having the phleb redraw the patient. Especially with common names like you had. I work in a big hospital and I've seen to many weird things happen!

Where our facility draws the line is if the name and/or MRN or SS# is not correct is MUST be redrawn.

And always label at the bedside! Just my thoughts!

I agree with heathervaught, that your facility should really have something in place to be ready for something like this - so you're not caught wondering, which is never a fun thing to happen as a blood banker especially if you're working alone. However in my personal opinion, considering that your facility doesn't have a policy, you did the right thing. I would have done the same thing had it happened in my facility. Arguably I have a cynical perspective about things like this but I also worked in phlebotomy / specimen processing for a couple years as a young MLT in the army and I saw a whole lot of weird stuff happen.

The main cause of transfusion fatalities are clerical errors. When in doubt (and not to create future doubt) discard the sample and ask for a new one, especially in this case. Also you definitely need a policy in place. What label were you going to put on the blood units? If you understand that Jones and Smith is the same patient, the night "transfusionist" and Blood Banker may not. Never take a risk at the Blood Bank. Yes you will face disagreement but you did the right thing.

Liz