Type and Screen and Hold-Do labs use this order?

[AFiddler]

Type and Screen and Hold-Do labs use this order? In a multi-lab software build, a few sites really want this orderable so they can segregate pre-op specimens. It can be built as inactive so that labs who don't use it would not see it in the lab order catalog. Thoughts?

[shelleyk482]

We use it for our outpatient cancer center & our L&D. The cancer center draws a "Hold" sample at the same time they draw the CBC on their outpatient; then if they determine they need to transfuse, we don't have to restick the patient. Very few of our L&D patients need blood bank testing but by drawing the "hold", we assure that we don't have to try to draw during a traumatic birth. We no longer let OR use this order; we apply a blood bank ID band when we draw a "hold" sample and we had problems with OR assuming that if there was a blood bank ID band on the patient that the patient had RBC's available.

[David Saikin]

I dislike the "hold" order as it means different things to different MDs. We do not allow a "hold" order - either type and screen or crossmatch.

[ckcheng]

I do not see there is any advantage of the 'hold' order in term of patient care unless you don't wanna burden your workload. Type and screen should be done on all samples send to blood bank (of course those are potentially need blood during or after the procedures). Advantages are keeping blood group and antibody screen results as a record, and resolve problems if find during the testing.

CK Cheng, MSc, SBB(ASCP), CQA(ASQ)

Oct 15

[Likewine99]

We don't use a "hold" order. We have the option on our pretest samples to extend the expiration date in the computer, to 14 days from sample date. Then if blood is needed we do a quick, IS XM.

If one of your labs wants a hold order built you could honor their request. In the multi-site build though, the more you can standardize the easier it is to maintain, esp when upgrades come along.

[Dr. Pepper]

I agree with David: order and do the test or don't. We built a nonreportable test "BBJIC" (BB just in case) in our LIS. What it does do is generate a label for a BB tube and let you track it from the lab end. Our ED uses these all the time. If the patient ends up needing a type and screen or crossmatch we just add those tests to the JIC specimen number.

[kitty]

We have the "hold" order built into our system but rarely ever use it...For the most part our ER will go ahead an order a T&S and add units later if needed...

[LaraT23]

I have a "hold" order built, but only lab personnel can order it. It is used when ED draws Blood Bank for a "just in case" and we get no orders for the entire shift. Then we can order the "hold" which generates a specimen number, and we just result the clot expiration and BBK id number. This way there is a tracking in the computer that we have a specimen.

Otherwise, even if the doc orders "Type and Hold" he gets a type and screen. Then, they can add the crossmatches.

[jwilb]

Hold orders are not allowed. In my experience 2 out of 3 blood banks have the Hold option.

[reidhospbb]

If you order a type and screen why would you need a hold to go with it? To me there are two options: crossmatch the blood or don't. When the electronic crossmatch becomes more of the SOP, it becomes even more irrelevant. Once a patient has been transfused we only allow a specimen to be used for three days before requiring a new specimen. I have never understood what "hold" means.

[LEGuerraJr]

We do not have a "hold". We electronically crossmatch blood for patients with negative antibody screens so "holding" would be pointless. You either need blood, or you don't. If a patient becomes unstable, it takes about 5 minutes or less to tag red cells with an electronic crossmatch. Patients with clinically significant antibodies, however, have their own protocol.

[KarenJ]

We have a BBH, blood bank hold, which is the same as the just in case. It is also mainly for oncology and L&D. We do not routinely cross units unless there is a transfuse order. We have (tried) to get everyone on board with the knowledge that a type & screen is almost always sufficient. And if not, we can have units ready within 5-10 minutes.

Edited October 19, 2010 by KarenJ
typo

[Joanne P. Scannell]

We have a BBH, blood bank hold, which is the same as the just in case. It is also mainly for oncology and L&D. We do not routinely cross units unless there is a transfuse order. We have (tried) to get everyone on board with the knowledge that a type & screen is almost always sufficient. And if not, we can have units ready within 5-10 minutes.

Ditto.

Type and Screen = we Type and Screen and we wait for orders to actually transfuse. As long as we can promise a 5-10 min 'ready to issue', we wait. If the patient has antibodies that would prevent that, we do set up the units ahead of time for surgeries (not routines). Nb. To prevent last minute surprises (e.g. Screen is negative but I.S. XM is positive because of rouleaux or cold agglutinin and now we have to spend some time working that out), we run a tube test I.S. with pooled O cells (from the 3 screening cells) with every Type and Screen. This gives us the preview we need.

Blood Bank Hold = No testing, we just log it in (it's a 'test order' so it gets tracked as such, i.e. we can 'see' it in the LIS) and keep in in the refrigerator. n.b. We do check our records and if we have a record of problems, we notify the attending. This gives us a 'head start' if needed.

[Eoin]

HI Folks,

Even from the answers, it is evident the term "HOLD" means different things in different hospitals. We use it extensively on pre-op patients at a clinic, usually a couple of days before they are due in for a procedure. The charge on the order though is for a group and for an antibody screen. The hold part just means we will hold their plasma and crossmatch is only performed if blood is needed (2D barcoded armband issued at time of crossmatch). The plasma is held at -35deg.C. The procedure is only used if certain conditions are met (not pregnant, no antibodies, not transfused in previous 3 months, no history of reactions to blood or blood products).

It allows us to manage the workflow better, and not have a rush late in the day for patient admissions for next morning surgery & similarly in early morning. Phlebotomist's workflow similarly is more controlled.

If antibody/ies are detected, we automatically crosmatch 2 units (more if it is a high incidence antigen) - when patient is admitted no matter what the surgery is for. New consultants/ registrars and house doctors are educated at induction as to what group, screen and hold means at our hospital.

Cheers

Eoin

[cwonder]

In our facility Type Screen & Hold indicates that we will do a Type and Screen and verify that we have 2 units in house that should be compatible. This describes a situation where they are not necessarily planning on giving blood but may need to.

We are a small facility about 35-40 miles from our blood supplier and our blood bank is not computerized.

[rcollins]

We also have a "hold" order that we use for our Oncology and L&D folks. My question is...if you have a similar "hold" scenario: How are you notified to make the specimen "active"? I have had some problems of L&D patients having an actual Type and Screen ordered because the mom is being taken to the OR for a C-section but the BB never knows about it. We are pretty small but I don't want to be checking the pending logs every second of the day! Besides a phone call from the floor, what do you all do to keep on top of it?

[Deny Morlino]

type and screens for L&D are only ordered once the decision has been made to take the patient for a C-section here. It simplifies things related to your issue, but can make things a bit dicey if L&D is in a hurry.

[KKidd]

For us, most of the time some one will collect an extra BB specimen that we centrifuge and place in the specimen rack. The only time we get a "HOLD" order is for pre-op patients. Actually it is slightly antiquated - we still call it HOLD a CLOT.

:crazy::crazy::pcproblem

[Abraham]

We allow blood bank hold to be ordered by Emergency Care Unit and L&D. Very few of these specimens get converted to TS or TC. By ordering and collecting a hold specimen we have a specimen avaialble that meets all labelling requirements of the transfusion service.

[MsDuffy]

We have a "hold" order, but there is no testing performed on the sample. The sample is merely received, evaluated for specimen acceptability: labeling and hemolysis, and then held for 3 days. It is utilized primarily by outpatient cancer therapy, Emergency Department and Labor & Delivery.

[SUNSHINE1]

We do not use "HOLD"specimens, either they want it or they don't. It simply causes too much confusion. and the end result is the lab gets screamed at when something is not done correctly So we do not allow "hold specimens, and this works very well. We get orders for Type/Rh/Abscr, and if they deceide they meed a X-Match, we pull the specimen and run it, (within 3 days, after that a new specimen is obtained.) It really does not take that long to run, so why go crazy trying to figure out what is wanted, when every doctor has different ideas of when they want a X-Match. If they want it they must order it, a WIN WIN way to handle it:)

[dgibaud]

We have 3 levels of service: T&S, XM and what we call a PRECaution tube. This is a no-charge BB test, which requires sample ID, phlebotomists initials, etc. It is held in the BB, mostly for our cath lab patients. The beauty of this order is that we keep costs and workload down, but know exactly where the tube is if blood is required. The PREC order can be upgraded to either T&S or XM if necessary. We LOVE the PREC order and wish more docs would use it, rather than performing unnecessary XM's. Tube good for 3 days then discarded. It's a good idea.

Don G

BB supervisor

MidMichigan Med Ctr

[Malcolm Needs ☆]

We have 3 levels of service: T&S, XM and what we call a PRECaution tube. This is a no-charge BB test, which requires sample ID, phlebotomists initials, etc. It is held in the BB, mostly for our cath lab patients. The beauty of this order is that we keep costs and workload down, but know exactly where the tube is if blood is required. The PREC order can be upgraded to either T&S or XM if necessary. We LOVE the PREC order and wish more docs would use it, rather than performing unnecessary XM's. Tube good for 3 days then discarded. It's a good idea.

Don G

BB supervisor

MidMichigan Med Ctr

It is, until one of these patients has a major bleed, and their plasma contains an antibody directed against a clinically significant middle (not high) incidence antigen that you cannot readily identify. Surely, it is much better to know about such antibodies BEFORE, rather than when blood is required.

:confused::confused:

[dgibaud]

We give our physicians enough credit to know to order PREC on only very low likelyhood to be bleeding. I would guess that less than 5% of PREC ever get upgraded to T&S or XM. It's better than having an unexpected major bleed WITHOUT having a tube already in the blood bank, and it's better than having an "extra" mixed in with the hundreds of tubes from the other lab departments. Anyway, it's a system that has worked well for us in most cases.

Don

[Malcolm Needs ☆]

Fair enough Don.