Rpeat Testing

[KKidd]

My question regards conversion of a Type and Scrren to a Crossmatch or orders of additional units. Does anyone repeat the antibody screen if the original tech is not crossmatching the blood?

Years ago we tried dropping the repeat testing but had a tech who thought that meant you never had to do another screen ( even with a new sample). We went back to the old ways and everyone who tests a sample must perform the T&S if appropriate. I think it's time for a change.

Thanks!!!!

:please::please::please:

[L106]

At the hospital where I spent my first few years (back when the earth was cooling), we had a policy that if a different tech touched the pt specimen (ie: to crossmatch additional units), that tech had to start from scratch (repeat the ABO, Rh, Antibody Screen & do the additional crossmatches.) (Not fun!)

At my current hospital, whoever does the additional crossmatches (using the pt specimen that has already had the ABO, Rh, Antibody Screen testing done) does only the additional crossmatches.

It should not be difficult for the BB staff to follow the rules that:

1. ABO, Rh, & Antibody Screen must be completed on every new pt sample.

2. This testing does not have to be repeated if you are using a previously-tested sample.

[KKidd]

I agree. The incident that I described occurred when the Dinosaurs roamed the earth. Thanks for the input!

:wave::wave:

[Deny Morlino]

We honor the antibody screen of another tech. We do repeat the ABO/rh as a "quick safety check" to help be sure the correct specimen was pulled from storage (I did not put this practice in place...I think it may be from the dinosaur era as well). Would like to get away from repeating the ABO/rh and just go for the crossmatch.

[David Saikin]

No need to repeat absc . . . unless it makes your Medical Director sleep better at night.

[Brenda K Hutson]

Wow, sounds like you have more than 1 problem on your hands!

1. I would certainly hope you could trust the work of your Techs. such that you would not need to keep repeating the Antibody Screen on the same specimen!

2. A Tech. who cannot understand the simple (Blood Banking 101) requirement of needing a new Antibody Screen only on a new specimen??

Maybe this sounds harsh (and I try not to do this on the website; but feel compelled to make an exception this time), but I would go back to 1 Antibody Screen per specimen, and start the process of eliminating staff who cannot remember that simple rule.

We do repeat the Forward type and Rh if we pull a specimen out of the refrigerator (which has already been typed and screened), to XM additional units.

Hmmmmm...

Brenda Hutson, CLS(ASCP)SBB

My question regards conversion of a Type and Scrren to a Crossmatch or orders of additional units. Does anyone repeat the antibody screen if the original tech is not crossmatching the blood?

Years ago we tried dropping the repeat testing but had a tech who thought that meant you never had to do another screen ( even with a new sample). We went back to the old ways and everyone who tests a sample must perform the T&S if appropriate. I think it's time for a change.

Thanks!!!!

:please::please::please:

[Byfaith]

We also do NOT repeat testing when additional units are ordered. Our computer has built in safeguards, but we have also found it helpful to store samples with a completed T/S in one box (ready to set up more units), and all other samples in a seperate box with Red Tape over the caps. Samples with antibodies also get blue tape over the cap so techs are immediately alerted to perform gel xm, antigen typings etc.

[L106]

we have also found it helpful to store samples with a completed T/S in one box (ready to set up more units), and all other samples in a seperate box with Red Tape over the caps. Samples with antibodies also get blue tape over the cap so techs are immediately alerted to perform gel xm, antigen typings etc.

That's a clever idea, Byfaith!

[AMcCord]

We repeat the ABO/Rh with the crossmatch, but not the antibody screen. (We are NOT computerized - long, sad story - so we feel the repeat type is an appropriate safety check.)

[Brenda K Hutson]

We are computerized but we still perform a repeat Forward Type when we pull a specimen out of the refrigerator to crossmatched units at a later time.

Brenda

We repeat the ABO/Rh with the crossmatch, but not the antibody screen. (We are NOT computerized - long, sad story - so we feel the repeat type is an appropriate safety check.)

[adiescast]

We also repeat the forward ABO/Rh on the tube when adding units to a tube that has been stored IF the patient is not eligible for electronic crossmatch. If they are eligible for electronic crossmatch, we don't even pull the tube.

[Brenda K Hutson]

Right after I stated that we repeated the forward type (and in thinking then that someone might follow that up by asking "why"), I thought about the fact that in the places where we performed electronic crossmatch, we certainly did not pull the tube out of the refrigerator and re-type it. I realize that the computer is doing a check (and that you have a 2nd blood draw; but we will soon be getting a 2nd draw but not yet going onto electronic crossmatch); but that would still be the case if you pulled in a unit (into the computer) to perform the crossmatch on your patient and document the results; the computer would still warn you if the types did not match. And of course, the whole purpose of the immediate spin crossmatch is to detect ABO incompatibility.

I think that historically, the thought has been more one of a confirmation (however lame, given that there are only so many blood types to choose from) that you pulled the correct specimen

from the refrigerator. And I suppose one could also argue that we have not validated our system for the electronic crossmatch (though it is built into it).

So as things have "progressed," (i.e. 2nd blood draws; electronic crossmatch; etc), perhaps it is time for us to re-think some of our processes.

Anyway, just thought I would throw all of that out before someone else did.

Brenda

We also repeat the forward ABO/Rh on the tube when adding units to a tube that has been stored IF the patient is not eligible for electronic crossmatch. If they are eligible for electronic crossmatch, we don't even pull the tube.

[bbonnema]

We do not repeat the ABO/Rh when doing additional units. We have set Soft Bank to require the armband number from the original specimen when crossmatching. This assures that we have chosen the specimen that was tested originally. It will also alert us when an IgG crossmatch is indicated.

[Brenda K Hutson]

Our computer system requires that we scan a specimen barcode label for any/all testing. And I was almost thinking I agreed with your logic and that I would DC this confirmation type. But here is part of why I do not agree given the way our Institution performs testing at this time.

While my future goal (soon) is to go to a 2nd blood draw and electronic crossmatch, what is currently in-use (which to me, is almost worthless given the risk of biased blood banking), is that a specimen from a new patient must have 2 blood types confirmed. However, those 2 types are performed by the same Tech.! Would at least be better to require 2 different Techs but

knowing my goal of changes, I did not make that change.

That being said then, while scanning the specimen barcode would ensure they pulled the correct specimen, it would not ensure that the initial Tech. had typed the specimen correctly. And yes, the Immediate Spin XM is to detect ABO incompatibility, but if a patient's mis-type is such that other blood types could be compatible with it (i.e. mis-typed as O; so XM O RBCs; but patient really A); while you would be transfusing compatible blood, the mis-type would possibly not be caught until the next specimen.

Brenda

We do not repeat the ABO/Rh when doing additional units. We have set Soft Bank to require the armband number from the original specimen when crossmatching. This assures that we have chosen the specimen that was tested originally. It will also alert us when an IgG crossmatch is indicated.

[butlermom]

I too am beginning to think through the process of electronic crossmatch. Like others, our system requires us to scan a specimen barcode for any testing, and currently, I require a forward re-type for samples pulled from the fridge for add-on crossmatches. Brenda, I am curious, how do you plan to implement the 2nd specimen draw? I fear there will be rampant revolt from nurses and patients, not to mention the burden on our already understaffed phlebotomy personnel.

Same subject, different topic: Has anyone done any sort of cost analysis on the savings from electronic crossmatching? I am actually being encouraged by hospital administration to implement electronic crossmatching as a cost savings measure. Our computer system has already been validated for it so we just have to figure out our process.

Kathryn Butler

MT(ASCP)SBB

[profbaud]

As long as each tech that handles the specimen performs a complete clerical check between the specimen and the computer record, it's not necessary to repeat any testing. This procedure should be written in your SOP. Crossmatching at IS will catch any ABO discrepancies if there was an error made in the typing. We use 2 blood types on file, 2 current or 1 current and 1 historical in order to crossmatch type compatible units. Also your computer system should be set up to catch patients with antibodies if someone tries to crossmatch a unit that is not antigen negative.

[SMILLER]

Regarding repeating a ABO/Rh on a stored specimen before doing a later XM: I have never heard of such a thing before now. (I suppose I can see some reason in it if it is part of an electronic crossmatch policy, but we do not do those here, so I cannot really say).

Like most labs (I think), our specimens are barcoded by the BB computer system and additionally have armband codes on them that match the computer record as well as the patient's armband. Not sure how this could get mixed up.

When a tech pulls a specimen out of the fridge to add a XM, the assumption is that the T&S tech did their job correctly--both in lableing and testing.

[Deny Morlino]

We are not an electronic blood bank (yet!) so there is not a computer to match records only the tech's brain (and we know how porous those are ). We perform the repeat ABO/Rh once the sample is pulled as a "safety" measure. I agree with the earlier post that this is not of huge value given the limited number of blood types

[Malcolm Needs ☆]

The only thing I can add to this thread is my profound objection to the implied insults to dinosaurs - after all, I often feel old enough to be classed as one (and my colleagues have often made the same statement about me)!!!!!!!!!!!!!!!!!

:shakefist:shakefist:shakefist:shakefist:shakefist

[Brenda K Hutson]

I think it is safe to say that everyone initial encounters push-back when changes are made that will affect their workload. What you have to perhaps help back you though is the fact that the regulatory agencies are moving in the direction of increased patient safety (2nd blood draws; barcoded armbands; etc). The CAP checklist even specifically makes reference to a 2nd blood draw (as an example of what types of processes can be used to ensure a specimen from the correct patient was drawn and tested). And certainly your Hospital Risk Management Dept. might be able to support you. In actuality, the Phlebotomy Manager is all for it (of course it is his staff that will be doing all of the running around; nevertheless.......). So I have Lab support (Phlebotomy Manager, Lab Director, Lab Manager, Medical Director) that will hopefully assist in this effort.

I have not done a cost analysis for electronic crossmatch, however, I can tell you by having used it for many years at 2 different Institutions that it saves a LOT of time! It is wonderful!

Good Luck on both!

Brenda

I too am beginning to think through the process of electronic crossmatch. Like others, our system requires us to scan a specimen barcode for any testing, and currently, I require a forward re-type for samples pulled from the fridge for add-on crossmatches. Brenda, I am curious, how do you plan to implement the 2nd specimen draw? I fear there will be rampant revolt from nurses and patients, not to mention the burden on our already understaffed phlebotomy personnel.

Same subject, different topic: Has anyone done any sort of cost analysis on the savings from electronic crossmatching? I am actually being encouraged by hospital administration to implement electronic crossmatching as a cost savings measure. Our computer system has already been validated for it so we just have to figure out our process.

Kathryn Butler

MT(ASCP)SBB

[adiescast]

The only thing I can add to this thread is my profound objection to the implied insults to dinosaurs - after all, I often feel old enough to be classed as one (and my colleagues have often made the same statement about me)!!!!!!!!!!!!!!!!!

:shakefist:shakefist:shakefist:shakefist:shakefist

I am sure that was a "present company excepted" insult.