Emergency Transfusions

[Mary**]

Doe anyone issue O Negatives to the emergency room without patient identification? If so, do you handle the identification, emergency release form, etc. after the fact?

[Deny Morlino]

If the situation occurs of a patient presenting without an ID and unable to self identify we band them using our blood bank band system as a Jane or John Doe and use this as our identification until the appropriate ID can be determined. So no we don't issue O neg blood without some sort of ID. ER prefers this as well to help put the responsibility into our court when issuing blood products.

[KKidd]

Very occasionally, the ED will ask for a cooler with two O negative RBCs. We will ask if there is any information on the patient. We include an emergency release form in the cooler and the info is completed as it is available. I can't remember the last time this happened. We generally follow a procedure similas to Denny's. As you know, every situation different. My release form can be adapted for most situations and the doctors understands their responsibility to sign.

:handshake:handshake:handshake:handshake

[LABLAD42]

I worked for a Emergency Trauma Center and giving O negatives are always viewed as a last resort,

When a John Doe or Jane Done enters the ED, it is given a T number, or a trauma number in case they are many

following unidentied patient. It is a unique identifier besides the BBID # , temporary medical record number.

Also barcodes are the new recommended standard that is being adopted.

The patient should have a blood sample immediatedly drawn before any Type is given so that blood supply is not wasted.

And a virgin,reference sample is availlable, and further transfusions can then be swithed to the correct group.

Some hospitals are giving O Pos for Non-childbearing age patients to help the shortage of Oneg.

When time is important, pre-planning can mean the difference between correct action and saving a life .

[JOANBALONE]

Some trauma centers prepare emergency release blood ahead of time to minimize delay in transfusion. A generic name such as "Emergency Release" (and no mr#) is printed on the TARs, unit tags and Emergency Release form. Patient ID specifics are obtained later.

[tbostock]

No, we would never release blood to the ED without patient ID. You have to be able to show the audit trail for each unit to inspectors. For patients who can't be identified, it's best to have a system that creates a unique identifier immediately that can be assigned to those patients. John/Jane Doe doesn't work really well if you have multiple victims come in at once. We used to use Typenex bands, and we would give them the ID band number as their name ("ABC1234,Trauma"). They would be given a new MR# in the computer, so that would function as our second identifier. When the patient could be positively identified, their name and DOB would be updated, and the new MR# would be merged to any old MR#s in the system.

[LaraT23]

We require that the patient be registered as at least John or Jane Doe and the date; so for example it would be John Doe100510. Then we use the emergency release routine in meditech, which has two different ways to issue, one that orders a specimen to be drawn and another the adds to a specimen that is drawn. We keep the pigtails off of the units and crossmatch after we issue. The docs have a spot to sign on the issue card that was created via a canned text in the computer. This sheet is then returned to the blood bank after the units are transfused. If the patient is tranferred to another facility, the nurses make a copy of our form and send the copy with the transferring service and we keep the original.

Hope that answers everything!

[Kellpos]

Two unit of O Neg, tagged with a dummy pt name (Emergency 101 or Trauma 1), segments previously taken off, and stored in refrigerator. The blood is handed off immediately (in cooler) and issued under dummy name, along with request for uncrossmatched blood. When pt demograpics arrive, the units are returned in computer, then allocated to "real" pt, and tags are sent along. Proceed with testing on pt's sample, when it comes.

No waiting, no pressure.

Too bad it's not being done in my present institution!

[Mary**]

Thanks!

[Eoin]

Last hosp I worked in with trauma, as unknown patients were admitted, they were given next in line phonetic codes as used in flying, e.g. Bravo Female - elderly (as an example). This was armbanded as such, and thus emerg O Negs were traceable to the patient (always crosmmatched even if post infusion ASAP). I think we were up to Delta 2 by the time I left. We liked this as it got round - Unknown Female 1, Unknown Female 2 3,4 etc in case of multiple trauma, which we felt were more easily confused and increased the error risk. So we would have delta2 Female ~ age 20s - 30s (an indication of age was often given), Echo2 Male teen, Foxtrot2 Male baby etc. I am sure you all get the idea. Next name was always indicated on a large white board at ER station. When used next to be used would be written up. Often, these were issued immediately on arrival because paramedics called in expected trauma victims.

Never had a problem tracing (labels were issued with Emerg blood & sent back - or occasionally retreived from the morgue). Heightened awareness of risks involved made ER staff quite compliant.

Cheers

Eoin

[emadlabs]

Doe anyone issue O Negatives to the emergency room without patient identification? If so, do you handle the identification, emergency release form, etc. after the fact?

we in National Bank of jordan give the Specialist doctor 4 choices 1- for 24 hour supply in daily Operations (not urgent) 2- for 45 minutes supply for urgent case ( with x-match test ) 3-give same blood group without x-math test for very urgent case and 4 choice for life save we give O + for male patient or female over 45 years ( will not be pregnant in the future ) or give O Negative only for female under 45 years

and we give the blood which Specialist doctor choice from this 4 choices under his Responsibility behind his signature

to keep o negative in blood bank and give it for right case and right patient

Edited October 12, 2010 by emadlabs

[lateonenite]

Two unit of O Neg, tagged with a dummy pt name (Emergency 101 or Trauma 1), segments previously taken off, and stored in refrigerator. The blood is handed off immediately (in cooler) and issued under dummy name, along with request for uncrossmatched blood. When pt demograpics arrive, the units are returned in computer, then allocated to "real" pt, and tags are sent along. Proceed with testing on pt's sample, when it comes.

No waiting, no pressure.

Too bad it's not being done in my present institution!

We do this regularly, although we give out four units. One advantage of the PathNet is Emergency Dispense. Half the labs in our area have blood fridges in the ED and keep two units down there. Does it work? Hmmmm.

We enter whatever information we're given (so often, "resus 1") - I've also been putting in the time the blood was requested so there's tracking that way - we get a lot of returns where they didn't need the whole four, so has to be returned within the hour. (Before anyone asks, it's 30 minutes by guidelines, but because we send it in an esky/cooler with an ice pack, we extend).

Edited October 12, 2010 by lateonenite
Grammar problem!

[AMcCord]

Our trauma patients get admitted with trauma numbers for ID/name and are assigned a MR#. When they are formally ID'd, the record is updated for their name. The MR# is the link between the unknown patient and the formally ID'd patient.

We used to send a cooler with O neg to the ER, if requested, without a patient identifier. We quit doing this quite some time ago because the folks in the ED seemed to feel that it was fine to grab a unit of blood out for whichever patient they might need it for, so units in one cooler could end up transfused to multipe patients potentially. Not dangerous to the patients, as long as it was O neg, but not appropriate. Made the paperwork very confusing in a couple of cases. Now everything goes out by trauma ID# and MR# unless the patient's condition is absolutely dire. We have always managed to get blood out the door quickly enough to avoid that.

[lalamb]

WE also have PathNet, and the Emergency Dispense is nice. Just freetext in a name. When ER askes for emergency O neg, we ask ER for a name. Sometimes the patient is known. ER also has a list of made up names, but in our location, they could be real!

We also photocopy the unit and attach segments to it w/the unit stickers, time permitting - makes it easier to do computer work and follow up XM later.

Question about getting a Dr's signature for issuing uncrossed blood:

We have an ancient form the Dr signs. Usually write in the name or use a hospital label, and have the Dr sign it, when things calm down. Have never had a problem with not getting a signature.

Our new LIS, PathNet, has a place for the Dr to sign, on the actual BB Emergency Tag. HAve not used it though, as I assumed the Dr would prefer to sign 1 document , instead of multiple documents (each tag). The benefit of the Dr signing each emergency tag would be that the signature is in the patients chart, but it would not reside in the lab.

Where should the Dr's signature for release reside? In the Blood Bank, in the patients chart or both?

[Deny Morlino]

Where should the Dr's signature for release reside? In the Blood Bank, in the patients chart or both?

We have the original sent to the medical record and a photocopy for blood bank record. Agreed the physician wants to sign once, not multiple times during the crisis.

[newBB]

our blood bank give ED 4 units of PRBC O+ they use them wihtout informing us . only when they come to get replacemnet units every week we will know they use the units already. the bad thing one time we could not get the correct blood group beause patient was transfused before they took the speicemen to blood bank. not all doctor will get the unxmacth units they usually call blood bank for unxmatch units so they signe the form.

[tbostock]

our blood bank give ED 4 units of PRBC O+ they use them wihtout informing us . only when they come to get replacemnet units every week we will know they use the units already. the bad thing one time we could not get the correct blood group beause patient was transfused before they took the speicemen to blood bank. not all doctor will get the unxmacth units they usually call blood bank for unxmatch units so they signe the form.

This maybe should be re-evaluated. Is the ED so far away that you can't get type O units to them quickly in an emergency? If they were not cooperating with your needs and the regulations, maybe it is time to keep all blood in the Blood Bank, if that is possible.