Emergency release of uncrossmatched products

[BBKT]

This may seem like a silly question but we are having a major disagreement with a trauma doc.

Does anyone issue emergency release blood without having a patient name and MRN? If so, how do you track which blood goes where? We are a Class I trauma center where multiple traumas at one time is common. We have a system that works well with single traumas. Blood bank is included in the trauma page, we call ER get patient info and we deliver emergency release blood before the patient has even arrived. However, when there are multiple traumas at one time, the ER communication seems to break down - Pages aren't sent, phone calls aren't made etc etc. We tried an ER refrigerator but that was a nightmare. They could not comply with all of the regulations and it was removed after about 2 months and several attempts at retraining.

[Deny Morlino]

Not sure how much this will help but here is part of our policy:

ER: If the patient's name is not known and no ID number has been assigned, draw and band the patient according to procedures, using the Blood Bank number as the ID number. Fictitious names may be used, but all vouchers and labels should have proper name and ID written on them as soon as positive identification has been established. Race, sex, or other information should be used with the fictitious names.

If we are working with multiple phlebots and multiple victims it is up to the phlebotomy team to use a sequential identification system (i.e. John Doe 1, John Doe 2, Jane Doe 1, etc.). The information is kept consistant on any paperwork, label sets, specimens, etc. This is the method we have used for as many as 14 patients arriving within about 15 minutes from a hay wagon rolling over with the senior class aboard (don't ask...it is a rural area thing ). All patients were subsequently identified and information was added to all the paperwork, etc. to maintain the identification trail. This is one of those rare situations where a paper system may be more managable than electronic. May be a place to start. Good luck.

[adiescast]

Our trauma bay has trauma ID kits prepared ahead of time with a fictitious name (Patient, TR<year><sequential number>), medical record number, and bill account number. All patients get a blood bank armband. We use the trauma numbers and the BB armband number to identify the patient(s) for crossmatch and transfusion. The system works very well. The only glitch comes when they actually identify the patient (usually in the middle of surgery) and the computer information gets changed, but the OR doesn't know (or they know and we don't). We usually make sure that the fictitious information we started with and the actual patient ID are written on everything in those cases.

[John C. Staley]

Do you have a disaster plan that describes a patient identification system during a disaster? In my previous world multiple traumas = disaster and so that system went into play even if an official disaster was not called. The disaster ID system was simply an extension of the trauma ID system. Remember to Keep It Simple otherwise it is doomed to failure. Complicating something never made it better.

:juggle::juggle::juggle:

[Deny Morlino]

Remember to Keep It Simple otherwise it is doomed to failure. Complicating something never made it better.

:juggle::juggle::juggle:

Words to live by!!

[tbostock]

Deny, liked your hay wagon story. Our (urban) version was 8 drunk illegal aliens in the back of a pickup truck that rolled over. That was the day that we realized that John Doe 1-8 would not work. At my previous hospital, a level II trauma center, we used the BBID number as their name (ABC123,trauma). It worked very well, and kept each patient unique. They were not allowed to update the name to the real one until the patient was out of the ER and OR, and family members were present to confirm the patient's identity. They used to put in the info found on the driver's license, but that doesn't work for those little rascals that carry fake IDs to get into bars....or even worse, they use an older friend's ID. Not pleasant when you call the wrong parents to tell them that their child is critical. Ugh.

[rravkin@aol.com]

BBKT,

Our ER has pre-assembled blood collection tubes wrapped in a unique ID wristband with peelable number segments; similar to Typenex band. When we drop off uncrossmatched PC's to the ER we obtain one of these unique ID numbers for our records. This is then how we ID the trauma patients. The only mix up that I have witnessed came from our registration dept and was caught in the blood bank; Lucky for us!! The two trauma patients were ABO incompatible.

[Byfaith]

We do the same. While not a trauma center, we do get frequent unidentified patients as we are in a "touristy" area with many travelers and foreign workers.

[Lcsmrz]

Only two weeks after being assured in writing that our ER's "John Doe" system was alive and well at our facility, major wailing and gnashing of teeth occurred when our lab refused to draw blood without a trauma ID number. Apparently, no one in ER was aware that our stated, well-communicated and enforced policy is that no blood will be drawn and no blood products will be issued without a wristband (hospital or trauma) affixed to the patient.

I had a great written policy in front of me, but unless it's implemented and practiced, it's just a piece of paper. I sincerely hope that the manager has corrected the problem, since I may be the next "John Doe" that rolls into or center in need of some uncrossmatched Onegs ...

[Malcolm Needs ☆]

I sincerely hope that the manager has corrected the problem, since I may be the next "John Doe" that rolls into or center in need of some uncrossmatched Onegs ...

I hope not - your posts are too valuable for that!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:D:D:D:D

[John C. Staley]

Larry, that's a problem which is very wide spread. Once a "piece of paper" exists and they can show it to any one who may inquire they feel the process is done and no followup occurs until something like you described happens.

For some reason it is taken for a fact that if the paper exits so does the process. Not only does it need to be trained but if it is something that does not happen daily then it needs to be drilled on a regular basis otherwise it will not be functional when needed.

Of course this is much easier to say than accomplish!!

:bonk:

[L106]

Only two weeks after being assured in writing that our ER's "John Doe" system was alive and well at our facility, major wailing and gnashing of teeth occurred when our lab refused to draw blood without a trauma ID number. Apparently, no one in ER was aware that our stated, well-communicated and enforced policy is that no blood will be drawn and no blood products will be issued without a wristband (hospital or trauma) affixed to the patient.

I had a great written policy in front of me, but unless it's implemented and practiced, it's just a piece of paper. I sincerely hope that the manager has corrected the problem, since I may be the next "John Doe" that rolls into or center in need of some uncrossmatched Onegs ...

Doesn't it make you want to scream??!!!

[AMcCord]

No ID, no blood is our rule. Our ID is the trauma # with Male or Female. Any docs who get sniffy about it, get a quick education from the ER Trauma coordinator. Once they understand the reason for it, they usually behave themselves when it comes to ID. Most of our anesthesia staff is very good about ID, so that's a help when things are stressful.

[ejsommers]

We create an "ER+rolling number" patient name for the trauma patient with a MR# and Male/Female. All tubes are labeled with that name/# until the ID of the patient can be determined later. Once the patient is ID'd the name gets changed on the registration. The MR# is used to tie the ER# name to the real name. If it's a patient with previous hx the MR#'s are merged.

ED....MT(ASCP)