staffing issues and workload, etc.

[pbaker]

I have a few questions I hope you all can help me with. We have cut staff in the blood bank (really, the entire lab) and are having some issues continuing to maintain the services we have provided in the past.

1. How does blood get to the OR? Does the blood bank run it over, does OR have a transporter, do you use a pneumatic tube system, etc. etc.??

2. Who does you patient specimen collection, nurses or a phlebotomy team?

3. If you have a phlebotomy team, what is your policy for line draws? We currently must have a phlebotomist witness the nurse draw the specimen. This is a nursing request because they are afraid they will get dinged for a mislabeled specimen.

4. Who draws your nursery specimens? Not the cord blood but things like PKU, bilirubins, etc.

5. When a patient pretests for surgery, what testing, if any, do you perform on the day of surgery? I am especially interested on patients with antibodies and if you completely work them up again.

I apologize for the number of questions in this request. We are having some big staffing issues and need ammunition to take to lab and nursing management to try to get some resolution.

Thanks so much in advance for all your help!!!!!

[David Saikin]

1. OR p/u blood - we will run it in an emergency

2. Nurses in the ED/phlebs or tech on pt care floor

3. No team - we use bloodloc codes for all pts with hosp id. Nurses can draw.

4. Nurses in OB will draw most rt labs.

5. As long as it has been >3 months since last exposure, we do not w/u with new spec unless necessary. We set up 2 ag neg units on pts with ab or ab history.

Hope that helps

[PaulSunV]

1. The nursing unit including OR comes to the blood bank when more than one or two units are needed otherwise we use a pneumatic tube system, which is how a majority of the units are delivered.

2. We have a phlebotomy team, however there are several nursing units that collect their own patient samples, such as ICU, NICU and L&D?

3. The phlebotomist witness the nurse draw the specimen.

4. NICU draws their own samples, the phlebotomist draws bilirubins and labortory tests, with the exception of PKUs and other State required testing which is performed by the nursing staff.

5. No testing is performed the date of surgery unless missed on pretesting, If the patient has a history of an antibody and it appears that antibody is still present at the time of the T&S then an addition 3-4 cells are run to verify nothing new has been created and of course 2 ag neg units are made available for surgery.

[L106]

1. A Blood Bank Lab Aide or BB Tech can deliver donor units, but most of the time we use Pharmacy Techs to deliver donor units for us. (Unfortunately, our pneumatic tube system is too forceful and small to be used to deliver units.

2. We have a phlebotomy team who collect most blood specimens, but nurses in the ECC and floors can collect blood samples. RN's collect specimens from line draws.

3. No Lab witness is necessary if nursing staff collect and label a specimen. We see a fair number of labeling omissions/errors with nurse-collected specimen. However, if you require a witness by assure proper patient identification for lab specimens, do they also have to have a witness giving medications? (That's pretty important, too!

4. Lab drawn newborn blood specimens.

5. We typically get the crossmatch specimen from surgery patients the day or two before surgery (and completely work them up at that time.) We do not retest them the day of surgery.

Donna

[SRTECH]

1. We use the pneumatic tube for all products dispensed; however if the tube stations are not working or for Massive Transfusions, the OR sends a retriever to collect the blood/products.

2. Nurses do inpatient draws and phlebotomists do outpatient draws. If nurses are unable to do the draws, phlebotomists will do them.

3. All draws, whether by a phlebotomist or nurse are witnessed. Each specimen has two initials.

4. Nurses draw nursery specimens.

5. We perform Type and screen. If patient is immunized, we do ABID and xmatch 2 units on downtime form and request that a new specimen be collected on surgery day. We do TS on new specimen and xmatch the same two units with new specimen.

[MAGNUM]

I will answer these by number also:

1. The OR staff NURSES come to the blood bank to pick up their blood. Only nurses (or physicians) can pick up blood.

2. Specimen collection in the OR is performed by the nurses and hand delivered to the laboratory.

3. We do not have a phlebotomy team, but the only collections from lines are done by nurses, respiratory, or physicians.

4. Nursery specimens and NICU specimens are collected by the nurses in their respective units. Second NBS's collected post discharge are done in the lab.

5. I request that the patients come in the day prior to their procedure and for the most part the patients comply. We have them come in the day before in case there are antibodies, and they can be identified and blood available. All the pre op specimens are collected by nursing, unless there is a problem and then they cry for the lab to help.

[tricore]

"1. The OR staff NURSES come to the blood bank to pick up their blood. Only nurses (or physicians) can pick up blood."

How do you justify taking nurses/doctors away from the patient/nursing unit/OR to pick up blood?

[pbaker]

Until recently the BBK had to deliver blood to OR. That took staff away from the BBK where we should be preparing blood products for other patients that are equally as important.

It is a tricky give and take within the hospital.

[MAGNUM]

"1. The OR staff NURSES come to the blood bank to pick up their blood. Only nurses (or physicians) can pick up blood."

How do you justify taking nurses/doctors away from the patient/nursing unit/OR to pick up blood?

There is nothing written that says that that particular nurse or physician has to pick up the blood. In fact the nursing supervisor is available 24/7. The OR nurse manager is also available to pickup. I just dont allow medics, unit clerks, nurse aids or any other non licensed personnel to pick up blood, and it works fine. In a true emergent situation one of the techs from the lab/blood bank will play runner also.

So to answer your question I am not really pulling that nurse or physician away from their patient.

[macarton]

1. OR has runners who pick up the blood in coolers. We don't require RN's to pick up, nor for floors. 2 RN's/docs have to verify blood before given.

2. We have a phlebotomy team that does all draws. Lab draws any outpatients.

3. RN's do line draws.

4. Nursery draws

5. We have a survey form & if patient has a history of antibodies comes w/i days of surgery & gets collected & we do 2 units antigen negative. If a new patient w antibodies, we find units & either have patient come back in w/i 3 days or day of surgery depending on distance they live from hospital & crossmatch them.

[Likewine99]

1. OR picks it up, we do not tube it to any nsg division in the hospital

2. All nsg deployed phlebotomy, except in our OP lab

4. Nsy staff draws everything.

5. No additional testing on the day of surgery, as long as they meet the pretesting requirements of no blood tx, no pregnancies or surgeries in the last 3 months.

Good luck, I've been where you are and it's not pretty but you will figure out something I'm sure!

[Brenda K Hutson]

Having worked in 6 different places, let me answer some of these questions from what I see as "best practices" in my own experience:

1. Hospital Courier or Pnematic Tube. A Hospital Courier would not impact the Lab staffing (would be part of another department; so robbing Peter to pay Paul). The Pneumatic Tube would still require staff to Issue the unit(s) in the computer, bag them up and send in pneumatic tube. Not so sure either of those save time. One thing that may save time though depends on whether or not you use coolers (i.e. for OR)? If so, you could have the coolers (and whatever cold inserts they use; would recommend a standard type rather than bags of ice which are more subjective) stay up in the OR. Then you could send the units in the pneumatic tube (with temp. monitors in them; and yes, it works) and the OR can place them in the coolers (you would probably want to call them as soon as you tube it in that scenario). But packing coolers can be time-consuming; so that might be a place to cut back.

2. Specimens drawn by both phlebotomy and Nursing.

3. Same here; if the Nurse does a line draw, phlebotomy has to witness it.

4. Not positive; but think phlebotomy.

5. Depends on your protocols for this one. Where I am at now, we don't have to do any further work. We are moving towards a 2nd blood draw. At another place, when we did this, an OR transporter often brought that 2nd specimen at the same time they came to pick up blood products (so time saved if they never have to pick them up; which you can get an idea of from your C:T ratio). If you use electronic crossmatch, you could choose to perform this when blood is actually needed (on Nursing Units or OR). Could perhaps choose to crossmatch ahead for OR cases that tend to use blood products; and definitely for outpatient transfusions. Perhaps limit pre-crossmatching for OR, to those patients with antibodies.

Brenda Hutson

I have a few questions I hope you all can help me with. We have cut staff in the blood bank (really, the entire lab) and are having some issues continuing to maintain the services we have provided in the past.

1. How does blood get to the OR? Does the blood bank run it over, does OR have a transporter, do you use a pneumatic tube system, etc. etc.??

2. Who does you patient specimen collection, nurses or a phlebotomy team?

3. If you have a phlebotomy team, what is your policy for line draws? We currently must have a phlebotomist witness the nurse draw the specimen. This is a nursing request because they are afraid they will get dinged for a mislabeled specimen.

4. Who draws your nursery specimens? Not the cord blood but things like PKU, bilirubins, etc.

5. When a patient pretests for surgery, what testing, if any, do you perform on the day of surgery? I am especially interested on patients with antibodies and if you completely work them up again.

I apologize for the number of questions in this request. We are having some big staffing issues and need ammunition to take to lab and nursing management to try to get some resolution.

Thanks so much in advance for all your help!!!!!

[jschlosser]

We are in a situation where there is one or two techs during the day to cover the whole lab. We often need to answer the phone or draw outpatients during a crossmatch or type and screen. We aren't comfortable with this and have let our director know but nothing changes. I realize she's under pressure to do more with less but. to me. patient safety comes first. Any thoughts or comments?

[Brenda K Hutson]

Hi,

Just a comment on #3; no Lab witness if Nursing collects and labels specimen; and the fact that you see a fair # of labeling ommissiona/errors with Nurse collect specimens. Your comparison about Nursing giving meds w/o a witness; so why for a Lab blood draw, is well taken.

That being said, I think the majority of misdrawn/mislabeled specimens in our Facility are also Nurse drawn. They do then often hand them to the phlebotomist who "witnessed" the draw, to label them. But if it were me, I personally would not want to label blood someone else drew; especially given their seemingly lower standards in this area. So while your rationale is sensible, all you can control is specimens coming to your dept. And I try to have tight requirements for specimens for the BB (more so than the rest of the Lab) and would thus prefer "at the very least" that a phlebotomist witness Nurse drawn specimens.

Brenda Hutson

1. A Blood Bank Lab Aide or BB Tech can deliver donor units, but most of the time we use Pharmacy Techs to deliver donor units for us. (Unfortunately, our pneumatic tube system is too forceful and small to be used to deliver units.

2. We have a phlebotomy team who collect most blood specimens, but nurses in the ECC and floors can collect blood samples. RN's collect specimens from line draws.

3. No Lab witness is necessary if nursing staff collect and label a specimen. We see a fair number of labeling omissions/errors with nurse-collected specimen. However, if you require a witness by assure proper patient identification for lab specimens, do they also have to have a witness giving medications? (That's pretty important, too!

4. Lab drawn newborn blood specimens.

5. We typically get the crossmatch specimen from surgery patients the day or two before surgery (and completely work them up at that time.) We do not retest them the day of surgery.

Donna

[Brenda K Hutson]

Just a note regarding "who" is allowed to pick up blood products. I have worked places where all blood was sent via pneumatic tube; I have also worked places where only Nursing was allowed to pick up blood; and where I am at now, a Transporter (non-professional) or Nurse can pick up blood (but they must all have been trained on the process).

We have the person picking up the blood, perform a read-back from the document attached to the bag (Transfusion Form that will go on patient's chart), while the Tech. compares that to the computer, the unit itself, the pick-up card and the Tag attached to the unit. While it is safe to say the Transporters almost certainly have NO idea what types are compatible, etc., what we get from this is that the Tech. is "hearing" what is read back and hopefully they would notice if something they heard, did not match something they see (not saying that happens 100 % anywhere; but it is the protocol). We have then never had problems with Transport not taking it to the correct location.

On the other hand, I can say that at one place I worked where only Nursing could pick up the blood, this did not seem to me to ensure more safety. Just one example of that which I recall was a patient who needed Irradiated blood products. The Tech. had missed that and handed out a non-irradiated product. Upon follow-up with the Nurse (given that upon chart review, I did see that the MD clearly requested Irradiated Products), the Nurse stated that they saw the unit was CMV- and thought that was the same as Irradiated!

And for places that Issue through the pneumatic tube (which I have done other places; and which I plan to implement here), you will not have anyone performing a read-back. So it will be important to come up with very strict guidelines for this process to help ensure things are caught (though if guideleines are not followed, well ????).

Lesson learned......

Brenda Hutson

There is nothing written that says that that particular nurse or physician has to pick up the blood. In fact the nursing supervisor is available 24/7. The OR nurse manager is also available to pickup. I just dont allow medics, unit clerks, nurse aids or any other non licensed personnel to pick up blood, and it works fine. In a true emergent situation one of the techs from the lab/blood bank will play runner also.

So to answer your question I am not really pulling that nurse or physician away from their patient.

[carolyn swickard]

Just a quick point - you have to make sure that your pneumatic tube system is cabable of transporting blood before you can consider adding it to your options. Ours is way too old, too rough and the tubes are too small for any kind of padding.

[Brenda K Hutson]

Right; but any system should be validated before use anyway (even if a brand new pneumatic tube system).

Brenda Hutson

Just a quick point - you have to make sure that your pneumatic tube system is cabable of transporting blood before you can consider adding it to your options. Ours is way too old, too rough and the tubes are too small for any kind of padding.

[Mary**]

I have some chats Iused for tube validation. Send me your email address if you would like them.

[SMILLER]

I have a few questions I hope you all can help me with. We have cut staff in the blood bank (really, the entire lab) and are having some issues continuing to maintain the services we have provided in the past.

1. How does blood get to the OR? Does the blood bank run it over, does OR have a transporter, do you use a pneumatic tube system, etc. etc.??

 

Usually a OR staff person picks it up.  (Or only a few steps from the lab)

2. Who does you patient specimen collection, nurses or a phlebotomy team?

 

Both.  In general, Lab does outpatients and the regular floors.  Decentralized is OR, ER and the units.  Lab draws all BB except for OR.  Lab also responds to codes and traumas.

3. If you have a phlebotomy team, what is your policy for line draws? We currently must have a phlebotomist witness the nurse draw the specimen. This is a nursing request because they are afraid they will get dinged for a mislabeled specimen.

 

Simular situation here.

4. Who draws your nursery specimens? Not the cord blood but things like PKU, bilirubins, etc.

 

No OB or peds here.

5. When a patient pretests for surgery, what testing, if any, do you perform on the day of surgery? I am especially interested on patients with antibodies and if you completely work them up again.

 

Often Labs, including BB, are done day of surgery.  And, yes, this is a problem sometimes because of Ab workups while the patient is going to OR.

 

Scott

 

[Justina]

1. Transporter can pick up blood (multi-tech, RN, runner), we read the units to the courier. Though we are considering validating the pneumatic tube system for the OR only.

2. Specimen collection is done by a combination of phlebotomy, RNs and multi-techs.

3. No witness is needed, if they collect using the Positive Patient Identification label reader. If not, there has to be a witness, and both the witness and collecter sign a form that gets sent down with the samples.

4. N/A

5. Pretesting for surgery, is performed the day the sample is collected. No new sample is required the day of surgery. Antibody is identified the day the sample is collected and units crossmatched.