72 hrs

[hati]

Hi,

I work at a small hospital. Being in a small lab, we have to deal with outpatients on weekends. It is hard enough to deal with ER pts and we have to deal with Outpatients. I have no phlebotomist on Sunday. My question is, how do we get away from this 72 hrs period blood bank samples for Preop.Usually , they come for certain tests but they have to come back for the type and screen before the surgery. There is so much emphasis on customer service. There should be a way that our Type and Screen results will still be good for certain days. Thanks .

[khalidm3]

72 hours limit is for the patients who have/had transfusion (blood or blood products) or the females who are/were ever pregnant. Consult AABB Technical Manual and AABB standards and develop a policy.

[David Saikin]

As long as the pt has not been pregnant or transfused in the past 3 months you may extend your preop specimen to as long as you feel comfortable . . . I have seen places that freeze the plasma and use it for up to 30 days.

[khalidm3]

As long as the pt has not been pregnant or transfused in the past 3 months you may extend your preop specimen to as long as you feel comfortable . . . I have seen places that freeze the plasma and use it for up to 30 days.

--ditto--

Sorry! "ever" in my last post is incorrect-- with in last 3 months is correct.

Edited January 18, 2011 by khalidm3

[fenwayman]

We will collect samples and hold up to 21 days prior to OR date as long as there have been no transfusions/pregnancies in the last 3 months.

[Gkloc]

We will extend the crossmatches for up to 28 days prior to surgery and we have a preadmission form that has to be filled out that has the the patients information and the phlebotomist asks the patient if they have been transfused or been pregnant in the last 3 months. If they aren't filled out we expire the specimen at 72 hours

[EDibble]

We do the same as Gkloc, but for a 14 day period. I believe the 14 days corresponds to a time frame that many orthopedic surgeons use for some of their testing. It allows many patients to just come in the one time. We have a form with the two questions regarding transfusion and/or pregnancy. The patient and the interviewer sign, and it goes on their chart.

[PalmerSil]

We have been looking for this very thing for a while now. A couple of questions:

If you use Blood Bands, what is the procedure for banding the patient?

Do you use the plasma from the extended draw for crossmatches if needed or do you redraw the day of surgery?

I'm so excited! My first post!:cool:

[Malcolm Needs ☆]

Congratulations!!!!!!!!

You'll soon catch up with me PalmerSil!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[Deny Morlino]

We have been looking for this very thing for a while now. A couple of questions:

If you use Blood Bands, what is the procedure for banding the patient?

Do you use the plasma from the extended draw for crossmatches if needed or do you redraw the day of surgery?

I'm so excited! My first post!:cool:

Our policy is to redraw patients the day of surgery. As for banding the patient can you define your question just a bit more (i.e. are you looking for what is included as far as information on the band or what exactly)?

[Joanne P. Scannell]

72 hours limit is for the patients who have/had transfusion (blood or blood products) or the females who are/were ever pregnant. Consult AABB Technical Manual and AABB standards and develop a policy.

Please note: The AABB rule was changed from 72 hours to 3 days (Date of draw being Day 0) several years ago.

[PalmerSil]

I guess if you redraw the patient the day of surgery, that answers my question. The patient would be banded with the redraw. If the plasma was frozen to use for crossmatch when the patient came in, then the question is when to band the patient?

Thanks for the great information!

[Brenda K Hutson]

You absolutely can get away from that 72 hours, provided: The patient has not been pregnant and/or transfused in the past 3 months. Different Institutions will extend for different periods of time; perhaps depending on their other protocols. For example, one place I worked used the Electronic Crossmatch. So they would do the Type and Screen when the specimen arrived, but then "set up" the blood closer to OR. They actually extended the "specimen expiration" to 30 days! At my current Institution, we use 10 days. We have a Form that the patients must sign; acknowledging that they have not been pregnant and/or transfused in past 3 months (though that is not fail-safe either in that we do get the occassional signed Form on a patient we know has been receiving blood products). However, in both of these examples, that is just the maximum amount of time we extend the specimen. In reality, we extend it to "3 days past the intended use date." The most likely time they would be transfused is on the day of surgery; so in keeping within the 3 day regulatory requirement, we only extend the specimen to 3 days past that date. Otherwise, you would have the logistical nightmare of actually having to track exactly when the patient received their first unit (i.e. could have been day after surgery).

Places that do have a Policy for extending specimens, are primarily doing it for patient convenience. The patient may live out of the area and need that added flexibility; etc. But it also helps us decrease the number of STAT Same-Day Surgery Orders (though not as much as I would like to see).

So besides documentation of their pregnancy and transfusion status, you should set a Policy on when the specimen testing must actually be performed, keeping in mind Manufacturer's Instructions for given reagents.

Brenda Hutson, CLS(ASCP)SBB

Hi,

I work at a small hospital. Being in a small lab, we have to deal with outpatients on weekends. It is hard enough to deal with ER pts and we have to deal with Outpatients. I have no phlebotomist on Sunday. My question is, how do we get away from this 72 hrs period blood bank samples for Preop.Usually , they come for certain tests but they have to come back for the type and screen before the surgery. There is so much emphasis on customer service. There should be a way that our Type and Screen results will still be good for certain days. Thanks .

[blessed]

Per AABB the Type and Screen is good for five days as long as the patient has not been transfused.

[Brenda K Hutson]

I don't see that referenced in the AABB Standards??

However, it is still true that in a patient not pregnant and/or transfused in the past 3 months, your Institution can come up with it's own Policy for extending specimens. I have gone anywhere from 7 days to 30 days; given the Institution.

Brenda Hutson, CLS(ASCP)SBB

Per AABB the Type and Screen is good for five days as long as the patient has not been transfused.

[KKidd]

We collect on Friday and the sample still meets the 3 day limit on patients who have been prenant or transfused within the last 3 months. THe day of draw (Friday) is day "0" so that Monday is day 3. We ask all BB pre-ops if they have been pregnant, transfused or had surgery in the last 3 months. The surgery is to cover someone who may have gotten blood during a procedure. They are evaluated on a case by case basis. For example, if a patient had cataract surgery, we will accept a sample earlier that 3 days/.

:whisper::wave:

[epfeiffer]

Where I work we will draw people up to 14 days before surgery. When we draw them we have them fill out a questionaire regarding their transfusion history and pregnancy history. We also place a blood bank arm band at the time of draw and insist that the arm band stay on their arm until after surgery is over. I like to scare the patient by informing them that blood is a very specific drug that will kill you if administered to the wrong patient, that usually helps inspire them to leave the arm band on.

[lalamb]

Our situation is similar to Brenda's.

Patient is drawn, banded and answers a questionnaire: been preg , rec'd bld products , rec'd tissue/transplant/graft w/in the last 3 months, been told you ever had an Ab or a reaction to a blood product?

Patient and phlebotomist both sigh the document (which goes in the "Save Forever" file). (We will be scanning in all documents shortly so this will go into the pt's electronic file)

If patient answers NO to all questions, the specimen is good for testing, for 7 days. Units can be added on Day 7 - each crossed unit is good for 3 days - hence we get the 10 day rule.

Pt drawn on a MON the 1st- surgery on following MON the 7th - blood needed so 2 units crossed on day 7 -blood good till Thurs the 10th at midnight.

Patient must not have removed their BB band. Otherwise they need to be rebanded and retested. OF course, if there was a problem, we'd have a heads up on it.

Edited February 19, 2011 by lalamb
edit

[Brenda K Hutson]

I like that! I have only recently (after 3 years of trying) been successful in stating that Pre-Op patients and patients for Outpatient Transfusions, must have the red armband placed on them "at the time of draw;" and, must wear it until they return (unlike previously here where they were allowed to carry them home with them). Hmm...so maybe some scare tacticts would be helpful (in that what seems to have occurred because of this, is more patients having their blood drawn "on the day of surgery" because they don't want to wear the red armband)! Aaaahhh Try to fix one problem, and end up with a different problem.

Brenda Hutson, CLS(ASCP)SBB

Where I work we will draw people up to 14 days before surgery. When we draw them we have them fill out a questionaire regarding their transfusion history and pregnancy history. We also place a blood bank arm band at the time of draw and insist that the arm band stay on their arm until after surgery is over. I like to scare the patient by informing them that blood is a very specific drug that will kill you if administered to the wrong patient, that usually helps inspire them to leave the arm band on.

[AMcCord]

We use an ID card with the BB ID# on it for the patient ID when they are drawn for pre-admission testing up to 7 days prior to surgery. They sign a form with the questions (with a witness signature) answered - transfused within 90 days, pregnant within 90 days - and are given the ID card after the specimen is drawn. The form comes back to Blood Bank. They are told they MUST bring the card back or we start from scratch, at GREAT expense, can't guarantee blood will be available to you, etc. etc. Makes for good compliance.

When they come in for surgery, we redraw the specimen if what we drew PAT is > 72 hours old. The redraw is used only if we need to add a crossmatch to the original order. The patient ID card is replaced with a BB armband which has the same ID # on it as the ID card. The card has a place for a patient signature on it. The card is signed in the presence of the lab person armbanding the patient (and drawing the new sample, if needed). That signature is then compared to the signature on the history form. IF it matches, then we are good to go. The ID card is attached to the history form to document the entire process. If the signature did not match, then we'd re-ID, reband with a new ID number and redraw the specimen to start from scratch. We would also have to explore the idea that we had some kind of 'funny business' going on - insurance fraud? or some other funky thing. Fortunately we have never had a signature that didn't match.

Edited March 1, 2011 by AMcCord
can't spell today!