Calling All BB Armband Users

[KKidd]

For those of you who are using one of the BB armband systems, I have a question. What is your protocol for completing the tube label and armband information?Our current protocol is to copy the patient's name and MR# form the hospital armband and then add other pertinent info. Last week a patient's name was spelled wrong by leaving the "s" off of the last name. The ED nurse told me if we wanted a new sample we could get it.

I'm trying to get a handle on what others do when they fill out the armband information. Thanks!!

:confuse:

Edited January 17, 2011 by KKidd
can't complete a thought!

[tbostock]

We use the Typenex band, and we had many clerical errors with nurse draws (names misspelled, middle initials missing, etc). We just switched to the Typenex Next Generation barcode band that allows you to use pre-printed labels. Our clerical error rate went down drastically, but I had (and still do) serious concerns about using pre-printed labels, but I was overruled.

I feel your pain with the "if you don't like the specimen then come and redraw it yourself" attitude. Ugh.

[Deny Morlino]

We still use a Hollister style system. The BB label set is labeled with a label generated by the HIS (lots of labels in that sentence). The phlebotomist in turn copies the patient name, medical record number, date, time, location, and initials of the phlebotomist onto the band insert and bands the patient. We did have the ED nurses performing this task in the ED, but discontinued it about 3 years ago due to a high error rate and necessary associated redraws.

On a side note, I discussed the use of a blood bank band system vs. the hospital ID bands looking for an opinion one way or the other with the HFAP inspector I spent 7 hours with Thursday and Friday. He was strongly in favor of the use of a dedicated system citing several examples of the "chain's" ability to be broken when utilizing the hospital bands. Was an interesting conversation.

[DPruden]

We use the handwritten Typenex bands currently and we do reject specimens for even slight misspelling errors. We use patient name, DOB, date and initials, we will accept MR#, but prefer DOB so that it can be verified verbally with the patient (if possible). I will not go to a pre-printed label until we have bedside barcoding. We have too many mislabels with the pre-printed labels in the main lab for me to feel comfortable using them for blood bank specimens. The floors all know that we will reject specimens, so they are pretty resigned to the fact of the redraw.

There is a very interesting article in Transfusion from 1997 about a study Johns Hopkins did around mislables. they found that specimens that failed to meet the criteria for specimen acceptance were 40 times more likely to have a blood grouping discrepancy. Every time I see a tube with only one letter missing, I always think of that!

[carolyn swickard]

We use the Typenex type of band which requires hand labeling. Yes, we do get a number of errors with spelling and Hospital ID number transcriptions and have a policy that any misspelling in the name (even 1 letter) or any transcription problem with the hospital ID number requiring a redraw. The phlebotomist of record can correct date, time and initials problems only. We used to have a policy of allowing corrections of 1 letter problem or 1 number problem errors, but stopped that in 2008 and went with the AABB recommendation of "no errors" on a Blood Bank specimen. Because we have been backed up by Nursing Administration and the hospital Education Dept (which trains new employees), we have managed to enforce our policy. I would suggest you get Lab administration (and the Medical Director in charge of the Blood Bank) involved in changing and enforcing Blood Bank labeling policies. Until Nursing Administration backs you up and enforces the policy, you will have no enforcement.

I agree that a dedicated system is the only way to close the circle between the draw, the tube , the unit and back to the patient. Any hospital that relys solely on "100%" perfection in the patient identification at draw and the 100% perfection of the pt identification at transfusion, with no link in between, is just asking for an error somewhere along the line. RNs can find ways to break the "chain" too, but at least you can prove they broke the "chain", because otherwise, there would be no error. No band, no number match.....no transfusion!

I am wondering how these expensive, fancy barcode generating, bedside labeling systems are going to replace the simple "chain" that a Blood Bank bank provides. I look forward to seeing how they tackle that problem. I am looking into the new Typenex band as a start, but my hospital can not yet afford one of the full-blown bedside systems.

Good luck with this - you might point out to Nursing Administration that it is usually the RNs that make the transfusion error that lose their jobs (and possibly their licenses) when transfusion errors hit the media. That seems to have been the pattern in past incidences. Do a web search for past transfusion errors and investigate how they have occurred and what the consequences were for pts and staff.

[David Saikin]

Having used Typenex in the past I have seen its downside. We have recently begun using the BloodLoc system. Admissions places a bloodloc code on the pt id band. The phlebs put the code on the blood bank specimen label. The only place the code exists is on the tube and the id bracelet. Can't open the bloodloc without the code. works well but if they only made the bags so you couldln't cut them open it would be GREAT!

[richardsonj]

Having used Typenex in the past I have seen its downside. We have recently begun using the BloodLoc system. Admissions places a bloodloc code on the pt id band. The phlebs put the code on the blood bank specimen label. The only place the code exists is on the tube and the id bracelet. Can't open the bloodloc without the code. works well but if they only made the bags so you couldln't cut them open it would be GREAT!

We use Bloodloc also. We require the nurses to send us back down the bag, lock and blood ID tag for each unit. That way we have proof that they didn't cut the bag open. I have only received one bag down that was RIPPED open. When I questioned the nurse, they said they forgot and ripped it open then remembered and then used the code to open the lock. The lock was opened when sent down and they did not try to hide it so I guess I have to believe it. ;/

[Eoin]

We produce an armband when a crossmatch is requested to go up with the compatibility report (which is also coded with Patient Record Number). We have in place the Neoteric BloodTrack Manager combined with BloodTrack Tx (you will find description on web). Currently as a legacy we also use the Typenex system (useful for emergency crossmatches) on all patients, but would like to get rid of them as they are now not required with full use of the BloodTrack system. The BloodTrack Tx system briefly - nurse uses a real time wireless PDA - scans her ID, scans the patient's crossmatch armband, and scans the unit (when prompted) and gets a good to go or an error if wrong patient or unit. (Mind you, unit should be right, as they use the barcode on the compatibility report to get blood out of issue fridge using BloodTrack Courier system- will not unlock the fridge unless there is a useable unit for the patient. - Won't let them take units that may have been returned if out of controlled refrigeration for more than a half hour also {a bonus}). They also enter patient vital obs, which they can print off at the time of recordings for the patient transfusion management document. This also goes real time to the BloodTrack Manager. If there is an error made - the BloodTrack Manager will sent a visible and audible alert to anyone logged on to the system (usually always in Bloodbank and Quality Manager's PC and Haemovigilance Officer's PC.)

The number of non-conformances has dropped dramatically since introduction of the system. As always, the software has some limitations - but as we all know none are perfect.

Cheers

Eoin

[MAGNUM]

We use the typenex band and card. By using the typenex card we can use a hospital label on the band and still have a barcoded bb band, plus the hospital label includes a barcode.

[Eagle Eye]

we use typenex band with hand written pt. name, medical record#, date and signature...we reject the specimen if name is misspelled, mR# is missing number, no signature, if they have write over to make correction...

[Likewine99]

We use an armband that has a specific BB number on the armband. The tube label is handwritten at the bedside and we require name, MR #, BB number, collector ID (the ID they use when they log into the electronic med record), date and time.

The items on the tube label were decided in conjunction with Nursing and we recently started rejecting specimens that were not 100% accurate.

We also get the "come draw it yourself" attitude but we stick to the policy and offer uncrossmatched blood if the pt is actively bleeding.

[profbaud]

Terri,

We use the Typenex armband system and we are looking at changing to a barcode readable band. You mention that Typenex has one? Can you elaborate on this.

[EDibble]

This may not be much help, but we only use the separate wrist band in two circumstances: at Outpatient facilities for folks getting an outpatient transfusion in our interventional unit, and for trauma patients whose treatment cannot wait for them to be registered into the computer system. Either a phlebotomist or a tech apply the band and label the tubes. in the case that a patient's name is known, (the outpatient transfusion, or a trauma patient with identification), perfect spelling and DOB matches are required. Sometimes a trauma patient is only "Jane" or "John Doe", so that and the band number are the identifiers. Since only lab trained personell use the bands, we rarely if ever have had any problems.

[Eagle Eye]

Terri,

We use the Typenex armband system and we are looking at changing to a barcode readable band. You mention that Typenex has one? Can you elaborate on this.

Typenex has one with blank space where you can add label generated from your pt. ID system...They had small one where you can write information manually but they were going to discontinue them///

[Mabel Adams]

I hope to change to Typenex' barcoded BB armband as soon as I have time to roll it out. It is a pretty slick system and they are very responsive to suggestions. It will afford us the advantage of being able to scan the band number into our computer so we reduce typos. As mentioned, the patient ID label can be used on specimen and band for greater legibility/accuracy. We already allow this although we get some mislabeled specimens due to "label slapping" errors (nurse draws). Our phlebs are using barcoded hosp bands to print spec labels at the bedside. Unfortunately there are lots of end runs around this rather tight ID system so we shall keep a separate BB band until I feel the bedside barcodes are universally used as intended.

[LaraT23]

We actually just went with a barcoded band with an area for a pre-printed label. I ask that two persons sign the label before it is applied to the patient's band with the date and time to verify that the preprinted label matches the hospital ID band. Our staff really likes them much better than the old hand written ones. Less risk of typos or unreadable handwriting.