Uncrossmatched Blood

[Llehman@ecmc.edu]

To All Blood Bankers in level I Trauma Centers: The Trauma Committee (Surgeons/Nurses/Physicians Assistants) want the Blood Bank to issue Uncrossmatched (UnXM) Packed Cells (PC) with NO Tags/labels in emergencies. I cited AABB Standard # 5.20.1 which states: "A blood container shall have an attached label or tie tag indicating....". They think this is a waste of time & want us to issue PC with paperwork to follow. If we get a phone call to alert us of the need for UnXM blood, it takes us 2 - 5 minutes from the time we receive the Request for PC to the time of the actual transfusion.

Question: WOULD YOUR BLOOD BANK ISSUE UnXM PC's WITHOUT A BLOOD BANK TIE TAG? Thanks for your help

[JOANBALONE]

No, I would not issue with out paperwork. Can you prepare your transfusion tags/paperwork before hand to eliminate any delay?

[Llehman@ecmc.edu]

Yes, as soon as we receive the phone call requesting UnXM blood, we get do all the paperwork (attach the 13-number ISBT-128 blood label to the Tag & write down the patient Name/Other Identifier on the tag), & have everything ready to issue as soon as someone comes with the Request Slip.

Thank you for your very prompt response!

[L106]

We also would not issue any units of blood without any paperwork. Even if the Emergency Dept does not know the identify of the patient, we assign the patients unique Medical Records # with the names "Emergent, A", "Emergent B", etc. (Without any paperwork, how can you safely tract which patient received which donor unit it you have a Trauma with multiple patient?)

[adiescast]

We do not issue without tags and emergency release paperwork.

[LIMPER55]

we store o negs with uncrossmatch tags attached just for this

[Michaele]

We do not issue without tags and paperwork as well.

[Dar]

We have ours pre-labeled with as much info as possible. The name actually gets placed on an internal log of what is included in our 8 pk. The blood goes out the door without a name sometimes; however, it is always pre-labeled as uncrossmatched.

[monroe]

we issue with attached tag. we debated the issue, but decided against having no attached tag. This is needed for tracking. to make sure the patient designated on the emergency release is the patient designated on the uncrossmatched unit (in some manner, such as name, unique #,etc) . We have had multiple traumas and I hate to say it but our ER might give the uncrossmatch unit to another patient if no patient designated on the unit. there are other scenarios i could come up with. the tagging of the unit I feel is a patient safety issue. I am sure there are other ERs very efficient in handling traumas and record keeping, etc. , but ours is not quite there.

[Mary Ann]

REALLY? Ask the Trauma committee,"how much training do they have in transfusion medicine",most will say very brief.What does the FDA and Joint Commision dictate,Yes identify your patient-assigned trauma name etc.The paperwork comes later? yea right,sounds like you will continue to label or tag units,don't worry-business as usual.

[Llehman@ecmc.edu]

Thank you, ALL Responders. You have confirmed and agreed with my strong convictions on issuing Uncrossmatched Blood WITH BLOOD BANK TAGS. I will print out all your responses as is and distribute to all concerned.

[JOANBALONE]

Just curious as to why the patient care area requested blood without tags? Do they think this is causing a delay in issue or they just don't want to be bothered with paper? Never heard of it.

[KarenJ]

We keep 2 O negs with tags and an uncrossed form ready at all times.

[Sharion Marshall]

We do not issue blood without any paperwork or the emergency release form for the doctor to sign. If the ER does not have any kind of identifier for the patient, they have to assign a temporary medical record number and register the patient as "Doe,Jane" or "Doe,John" until they can id the patient.

[Llehman@ecmc.edu]

What happened was this: The request for 4 units Uncrossmatched blood was phoned in. The BB Tech got all 4 units ready, but when the staff from the ER came to pick up the units, the computer failed to print out the BB tags. OneTech then started to manually write the info into the BB tag, while the other Tech was attempting to print out the tag. The person picking up the units went back to the ER in disgust while this was going on, and while that person was gone, the printer did print-out the info. We later found out the error was in the software (we had just gone live with Meditech version 5.64 from 5.5 on February 8th).This was what caused the delay. The patient died (not because he didn't get blood on time, but because he arrived in our ER 3 hours after he was shot in the chest). As is common, at the Root Cause Analysis (RCA), the Blood Bank was blamed for his death. A Physician's Assistant (who's well known to be rude, obnoxious & demanding) then demanded that we give them the UnXM blood immediately, with the paperwork coming later. That's when I said I will ask what other Trauma Centers are doing. I've gotten 10 responses, & NOT ONE responder said they would issue blood without tie tags.

[JOANBALONE]

Wow, pretty intense. You may want to consider what many others do - have units pretagged and ready to go to prevent this from happening again.

[Llehman@ecmc.edu]

The Root Cause Analysis Committee met a few minutes ago, and they liked the idea of pre-tagging & ready to go units, so I'm looking into this. Thank for all your help.

[ejsommers]

We send a Lab Assistant to all traumas with a cooler of 4 type O RBC's and 2 AB plasmas - to start with. That lab assistant stays with that trauma - all the way thru surgery if required - until released by the attending doc. We have the RBC units labeled as "uncrossmatched." We do not have any patient labels tagged directly to the unit. There is an emergency release form pre-labeled with the unit numbers and then labeled with the patient ID - either the name or ECC UNK + a rolling number if not ID'd. The Lab Assistant coordinates the distribution and documentation of the products and calls down for more products to be sent up if needed. The emergency release paperwork is signed by the doc and brought back to the lab where the usage of the products for that patient is updated in the LIS.