Armbands on Patients

[Brenda K Hutson]

We currently have a "mixed bag" when it comes to armbands on patients for transfusion purposes. Inpatients have the white hospital armband. Outpatients (including pre-op patients) receive the red typenex armband (however, until a couple of weeks ago, they would let the patients carry them home and bring them back; an issue for me in my 3 years now and I just won that fight so patients are banded when the blood is drawn; but only the Outpatients who use the red armbands; I still have not won the fight of us using a system across the board for ALL patients being drawn for the Blood Bank). Then once they get to surgery, they are cut off and the anesthesiologists are adamant that they will cut them off and that they will not replace them during the surgery; not even in a different location like the ankle. Which of course brings up scenarios like last week where the armband from the previous patient was left in the room and was still there when the next patient was brought in.

Today we met with a Rep. about becoming a beta site for barcode armbands. That is all well and good; I think barcoding the band against the specimen against the blood is a great system; however, in my mind, it still loses it's power if the patients are again allowed to carry the armbands home and bring them back for surgery, and, if the OR continues to cut them off.

I would like your feedback about how you do this in your Hospitals and any efforts you may have had to go through to get OR to stop cutting them off.

Thanks!

Brenda Hutson, CLS(ASCP)SBB

[David Saikin]

We have just recently started using the BloodLoc system . . . it is a code attached to the armband by admitting. The armband is the only place that code can be found. It is copied on the specimen by the phlebotomist. It was a formidable procedure to STOP Nursing/Surgery from removing the armbands. Now that we have had to redraw a few patients, I am hopeful that the message is being understood. Classically, our pts rec'd an armband with every change of status: er to in pt; in pt to snf; snf to in pt. There was no reason to change bands to accomodate an encounter number - some nurses are really po'd at me but . . . that's why I make the big bucks. Fortunately, the CNO and Quality people are really positive about this system. It is considered a barrier system which means no 2nd venipunctures are necessary. If/when you have a sentinel event, maybe someone in administration will wise up. Good Luck.

[mjshepherd]

For outpatients the phlebotomist draws the specimen and labels it with out banding system, then clips the band to the patients chart. Then when they come on the day of surgery, the nurse confirms the patient identity and then attached the band on the patients wrist. Also, it sounds like you need to get your pathologist to talk to anesthesia, there should not be exceptions made to patient safety standards just because the doctor feels inconvienced. Patient/specimen identification is number one right now on Joint Commisions hit list, we a few major citiations because admin did not want to reign in the doc's.

[Brenda K Hutson]

My one step of progress recently was to take our system that was similar to yours; but to require that the patients being drawn as Pre-Admit be banded "right then;" not attach armband to chart and put on patient upon admission. To me, that breaks the system (though I know this is certainly how many people do it). We are moving towards the barcode armband system but I still have concerns about not banding the patients "at the time they are drawn." And I agree that we need to find a way to make our Anesthesiologists comply but that usually takes backing from one's Medical Director (as many Physicians will only talk to other Physicians...aaaahhhhh).

Anyway, thanks for the feedback!

Brenda Hutson

For outpatients the phlebotomist draws the specimen and labels it with out banding system, then clips the band to the patients chart. Then when they come on the day of surgery, the nurse confirms the patient identity and then attached the band on the patients wrist. Also, it sounds like you need to get your pathologist to talk to anesthesia, there should not be exceptions made to patient safety standards just because the doctor feels inconvienced. Patient/specimen identification is number one right now on Joint Commisions hit list, we a few major citiations because admin did not want to reign in the doc's.

[reidhospbb]

We have banded all patients with the red typenex for years when the specimen is drawn (even in onc physicians' offices). One incident with that office made them realize they no longer wanted the responsibility of drawing the specimen for transfusion testing. We also have no luck with anesthesiologists cutting off armbands and occasionally have to perform an emergency crossmatch because the tags are nowhere to be found. The nursing staff does the best the can to "control" the docs, but there is a limit to what can be done. One terrible outcome will change the culture, but I hope it never has to come to that.

[Eoin]

Ah Brenda,

You dare to question the God Like Creatures, the untouchable anaesthetists!!!!!!! A few good kicks in the butt until their nose bleeds would work wonders.

We got the CEO on side as well as Consultant Haematologist (Director of Transfusion Service here). The CEO threatened to withdraw their practice priveleges if they did not comply. Haven't heard a peep since.

Cheers

Eoin

[Brenda K Hutson]

Ah, and therein lies the only way we ever make process, doesn't it; support from "above." Sometimes you have it; sometimes you do not. I have also noticed that it depends on the view of the Lab Medical Directors by the rest of the Hospital Medical Staff. If they are influential; knowledgeable; respected; etc. they will be heard. One place I worked at, for some reason, the Lab Medical Director actually had the most power of any Physician in the Hospital! I don't know that history but it was certainly helpful in accomplishing lab goals.

Brenda Hutson

Ah Brenda,

You dare to question the God Like Creatures, the untouchable anaesthetists!!!!!!! A few good kicks in the butt until their nose bleeds would work wonders.

We got the CEO on side as well as Consultant Haematologist (Director of Transfusion Service here). The CEO threatened to withdraw their practice priveleges if they did not comply. Haven't heard a peep since.

Cheers

Eoin

[KKidd]

We use an armband system and the bracelet is applide to the pre-op patient at the time of sample collection. About 10 years ago we were running into problems with the OR cutting off the BB armband. Our solution was to furnish a clear armband and the OR staff would place the information portion inside and place it on the patient. I haven't had any post-op patients without an armband (as far as I know).

My father was having surgery in another hospital and was given his BB bracelet to take home with him. My mother clipped it to the calendar until the morning of surgery. I have patients that cannot keep track of their pre-op instructions much less an armband. This would not be my first choice.

Good Luck!!!

:juggle::juggle::juggle::juggle::peaceman:

[Mabel Adams]

In the OR we need to make sure we have solved the underlying problems (besides turf and ego). For instance, how do your OR people check that BB armband # when they hang blood and the patient's wristband is under sterile drapes where they can't get to it? Some places have a policy of IDing the patient when they bring them into the OR and transferring the band number from the wristband onto a card or the chart to refer to as ID during the surgery. Everything in that room is for that patient only and is matched to the card. Once they move out of the OR the process reverts back to the band. This leaves the band on the patient but can provide proper ID in the OR. So be sure to talk to them to see what the problems are that they think they are solving by cutting off the band and see if there is another way to solve that and your problem. This is one place where RFIDs will be valuable because the reader can "see" through the drapes.

As for barcoded wrist bands--if there is no electronic device for them to connect to they don't do you much good when drawing samples or hanging blood. Even with a bedside phlebotomy system, I find that phlebs and nurses create so many "work-arounds" that we can't really trust that the patient's barcoded wristband was really read at the time of the draw. Again, they are trying to solve what they see as their problems so it behooves us to find out what they are.

[Brenda K Hutson]

In our Hospital, the reason given by Anesthesiologists for why they WILL cut off armbands; period; is that they can get in the way of I.V.s, and, if the patient swells from fluids, the band would be too tight. Knowing that there ARE other Hospitals that manage to leave armbands on "and" perform surgery, I just feel like they are digging in their heels here.

With the barcoded armband, the barcode would also be placed on the specimens, in the Blood Bank Computer System, and print out on the Chart Copy document that goes up attached to the blood product. They have to scan the barcode on the armband against that unit/paperwork prior to transfusion (so it also eliminates the need to have 2 Nurses performing a read-back).

So currently, my only 2 issues with this method (at my Institution based on how we do things) is that they still will probably resist banding outpatients/pre-op patients at the time of draw; and, OR will still cut them off in the OR room. However, this is the system we are moving towards at this point.

I work at a Hospital that has had very little employee turnover for many, many years (which says something about the Hospital); but unfortunately, that means trying to convinve people who are very stuck in their ways that there ARE other ways; and that sometimes those other ways are better ways.

Brenda Hutson, CLS(ASCP)SBB

In the OR we need to make sure we have solved the underlying problems (besides turf and ego). For instance, how do your OR people check that BB armband # when they hang blood and the patient's wristband is under sterile drapes where they can't get to it? Some places have a policy of IDing the patient when they bring them into the OR and transferring the band number from the wristband onto a card or the chart to refer to as ID during the surgery. Everything in that room is for that patient only and is matched to the card. Once they move out of the OR the process reverts back to the band. This leaves the band on the patient but can provide proper ID in the OR. So be sure to talk to them to see what the problems are that they think they are solving by cutting off the band and see if there is another way to solve that and your problem. This is one place where RFIDs will be valuable because the reader can "see" through the drapes.

As for barcoded wrist bands--if there is no electronic device for them to connect to they don't do you much good when drawing samples or hanging blood. Even with a bedside phlebotomy system, I find that phlebs and nurses create so many "work-arounds" that we can't really trust that the patient's barcoded wristband was really read at the time of the draw. Again, they are trying to solve what they see as their problems so it behooves us to find out what they are.

[Mary**]

In our Hospital, the reason given by Anesthesiologists for why they WILL cut off armbands; period; is that they can get in the way of I.V.s, and, if the patient swells from fluids, the band would be too tight. Knowing that there ARE other Hospitals that manage to leave armbands on "and" perform surgery, I just feel like they are digging in their heels here.

With the barcoded armband, the barcode would also be placed on the specimens, in the Blood Bank Computer System, and print out on the Chart Copy document that goes up attached to the blood product. They have to scan the barcode on the armband against that unit/paperwork prior to transfusion (so it also eliminates the need to have 2 Nurses performing a read-back).

So currently, my only 2 issues with this method (at my Institution based on how we do things) is that they still will probably resist banding outpatients/pre-op patients at the time of draw; and, OR will still cut them off in the OR room. However, this is the system we are moving towards at this point.

I work at a Hospital that has had very little employee turnover for many, many years (which says something about the Hospital); but unfortunately, that means trying to convinve people who are very stuck in their ways that there ARE other ways; and that sometimes those other ways are better ways.

Brenda Hutson, CLS(ASCP)SBB

We have solved the OR issue by giving tem some extra armbands and having them place the old insert with the patient info on it into the new armband before they leave the room. It is working pretty well. Good luck.

[Mabel Adams]

So you must have a computer system that nurses are using to chart the transfusion which will react if the scanned barcode on the unit does not match the one on the patient. Which HIS are you using? I hope they don't find as many creative work-arounds for that as many seem to do for everything else.

[Brenda K Hutson]

That is already our back-up plan. However, I do not like the idea of the armband being cut off, laid down somewhere, then "hopefully" inserted into a clear band and placed back on the patient before they leave. And last week proves my point in that the armband from the previous case was still in the OR room when the next patient was brought in! It is just never a good idea to break the "closed system" of banding a patient at the time of draw and leaving the band on. Once cut off, regardless of by whom; where; for how much time, you have increased the risk of error. I would have at least preferred that if the Anesthesiologists were not willing to "try" to leave the bands on, that they would have agreed to immediately putting them somewhere else on the patient; somewhere that would not be in their way. It is done at other Institutions so I know it can certainly be done. I know of one place where the Physicians, when writing the pre-op orders, state exactly where they want the band placed on the patient such that it will not be in their way during surgery (i.e. right wrist only; or ankle; etc).

Brenda Hutson, CLS(ASCP)SBB

We have solved the OR issue by giving tem some extra armbands and having them place the old insert with the patient info on it into the new armband before they leave the room. It is working pretty well. Good luck.

[Brenda K Hutson]

So I hope I can get some feedback on this subject again in that it now appears that our Hospital is going to be a beta site for the lattice system. As I understand it, there is a barcode (which represents the financial number) that would be part of the patient label placed on the specimen, on the armband, and on the unit of blood. The Nurse would barcode the armbnad and the unit# and the lattice system would tell her if it was a match or not. I still see a number of issues:

1. When we started enforcing that the typenex bands be placed on patients "at the time the blood was drawn," (only used for Outpatient Transfusions and Pre-Op), we started getting a lot more same-day-stat-OR orders because patients did not want to wear a red armband outside of the Hospital. In my mind, I would still want this new lattice band to be placed on the patient at the time of draw. I do not see that there is any added protection around that issue, just by virtue of this system.

2. While the armband, specimen and transfusion record attached to blood products, will of course have our usual patient identifiers, it really bothers me that the common denominator that the barcode represents (and thus, what lattice is looking for) is that the financial numbers match. I don't care if financial numbers are not re-used; I would never use that as an identifer. So my concern then being that ALL people (phlebotomy, Lab staff, Nursing) will look for is that barcodes match, and not look closely to make sure the other identifiers match.

For those of you that use that use the BloodLoc system, can you explain that a little more to me?

Also, for those of you that do not require that a patient be banded at the time of draw (either you do not use a typenex system, or, you do as mjshepherd above and attach the band to the chart until admission), how are these patients identified upon admission and/or for transfusion?

Brenda Hutson, CLS(ASCP)SBB

[Eoin]

Wrote a big long reply Brenda, but it disappeared when I previewed it :mad:.

Just look at the attached form & you will get the gist of it. If you want more details, just let me know

Cheers Eoin

BB101F.doc

[AMcCord]

We use a patient ID card similar to Eoin's for the patient to take home and return the day of surgery. When the patient presents for PAT testing, the patient/phleb/Admissions nurse (working together) complete a separate form that details full patient info (B.D., SS#, MR# - if available, date of surg, surgeon, type of surgery, etc). The big form includes documentation of previous history for transfusion and pregnancy. The phleb IDs the patient per our protocol of "what's your name, spell your last name, what's your B.D., etc.", makes sure the form is complete, fills out the ID card, assigns a Blood Bank ID #, asks the patient to sign the big form, witnesses the signature with signature and date, then draws the specimen. The tubes are labeled with the patient's name, B.D., Blood Bank ID#, SS# or MR# plus the usual stuff (phleb initials, date, time). A duplicate Blood Bank ID # is attached to the big form and the patient card and the remaining duplicates (5 total) are clipped to the big form. The card goes home with the patient. The big ID form and the remaining ID#s come back to Blood Bank with the specimen.

When the patient comes in for surgery, he/she presents the card to his/her nurse, who contacts Blood Bank. If a fresh specimen is required, a phleb goes to PreOp and IDs the patient with the now present hospital ID band, the PAT card, the original PAT big form and asks name, B.D. etc. The patient is now asked to sign the ID card. The signature is compared to the signature on the original big PAT form. The Blood Bank ID band is applied - it has one of the duplicate ID#s on it that matches the PAT card/PAT form. A specimen is collected and labeled and we're good to go. If we don't need a fresh specimen, a Blood Bank tech goes to PreOp and IDs the patient, as above, asks the patient to sign the ID card, compares signatures and applies the ID band.

Works great as long as the PreOp nurse remembers to contact us. We emphasize to the patient what needs to happen on the day of admission, so they are good about prodding the nurse if he/she doesn't seem to know what to do with the card. I follow up with the PreOP supervisor any time we have a problem with the process.

[bhunterlabguy]

I have read the threads and have seen many of those situations. Perhaps it is time to go for the money. If your accrediting (or regulatory) agency knew about these non-compliance issues, serious deficiencies and/or out-of-cycle visits might get the attention of those "above".