Dispense/issue rules

[RL0121]

(pardon my type os... I'm on my phone and at the gym on a bike)

One of our full time staff insisted that a non bb staff should be trained to dispense a unit in order for a BBer to go to break peacefully during break time and without no interruption and for extra coverage if it's busy. I know about our staffing issue particularly evening shift but it worries me a lot to have a non bb worker to issue a unit. I'm curious if there's any facility who allow this practice.

Edited January 16, 2012 by RL0121

[David Saikin]

You could do this if you train someone. We had non-technical staff in the BB do many "chores" - signing out blood; retyping units from the blood supplier. All were rigorously trained and did very well. Depends on your (and your Medical Director's) comfort level.

[Mary**]

Dispensing is the last chance to detect an error. Most places do not even allow a non-Med Tech or even a Med Tech student to dispense blood on their own. Be cautious.. What price do you place on a work break?????

[Justina]

Like David said it depends on your policy and the comfort level of the higher ups. I worked at a place that allowed non MLS/MTs issue blood and at a place that didn't allow it (although they did other tasks). I believe if someone is trained and competent (understanding what to look for when dispensing, etc...) they are capable.

[JOANBALONE]

I agree with David, train them well and it will work.

JB

[RL0121]

This is going to be very interesting. It's actually up to me to decide whether that process will be allowed. The higher ups asked me if im comfortable to have it going. Not everyone of course is on board but we'll see. Thanks for the input.

[LIMPER55]

competancy reviews should be used for inspectors and compliance?

[estiner]

I agree with Mary - it is the last chance to catch a serious error... I would not be comfortable with a non-tech doing this important task.

[mhc]

I think it depends on the qualifications of the "non-BB" staff. Are they techs, lab aides, clerks? In a previous life we trained BB lab aides to dispense blood products. If you have a good SOP and good training, I think they can be successfully used.

[John C. Staley]

During the training process of non-techs do not hesitate to over emphasize the possible consequences of issueing the wrong blood to the wrong patient. The more graphic the better. Once they grasp the critical importance of doing it right evey time you should have a comfort level you can live with.

[L106]

I agree with David and Justina. (Actually, a BB Lab Aide issues/delivers the majority of the donor units at our facility.) As others mentioned good training is essential, as well as encouraging them to ask questions if "something just doesn't seem right".

On another tangent: In your original post, RLO121, you mention that your staff tech thought there should be another individual trained "for extra coverage if it's busy." Do you have only one tech on the evening shift trained to work in Blood Bank? If so, is that absolutely necessary? I think it's a little scary.

What do you do if the BB Tech falls and gets hurt, has a family emergency and needs to go home, or is on vacation, etc.? I think it's a good idea to always have a second individual cross-trained to be able to do at least the basic testing/functions in BB (not just to cover for the main tech's break period, but more importantly, to help keep things afloat during busy trauma situations, etc.)

Donna

[SMILLER]

I agree that if you have a successful and thorough training session and review, and file the competencies (just like you would for anything else in the Lab), there is no good reason not to let non-tech associates issue blood.

[Brenda K Hutson]

I have been training (Med Tech Students; Residents; Fellows; New Technologists) almost since my first year as a Tech. (29 years) in 5 different Institutions. I always prefer to teach people in an order such that they are building on information learned previously; that it has a logical sequence. I too have worked places where staff wanted non Blood Bankers to Issue. However, for me, that is one of the Last things I train them in. That is because, in my mind, they should have a good understanding of the following in order to avoid errors in Issuing (which can be a risk to the patient; not to mention, FDA Reportable):

1. Order Processing (so when Issuing, you can see if something does not make sense based on what you know about Order Entry, Specimens, Special Requirements, etc).

2. Serology: So you know what you are looking at in the computer, and on the paperwork attached to the unit; what is acceptable and/or expected under certain circumstances. This should also include a basic understanding of antibodies (i.e. does it require antigen negative blood, or just crossmatch compatible).Note: Obviously, Lab Assistants have very limited knowledge in this area. They should at least have the knowledge to know "what they don't know; and be sure to ask questions."

3. Blood Product Receipt: you really should have a good understanding of the different types of products; what requirements go with what type of product (i.e. IRR only applies to RBCs and Platelets); expirations; Product Codes; and much, much more.

I know many will disagree with me, but that is my opinion. I have seen too many errors; even among people who were trained in the process!

Brenda Hutson

(pardon my type os... I'm on my phone and at the gym on a bike)

One of our full time staff insisted that a non bb staff should be trained to dispense a unit in order for a BBer to go to break peacefully during break time and without no interruption and for extra coverage if it's busy. I know about our staffing issue particularly evening shift but it worries me a lot to have a non bb worker to issue a unit. I'm curious if there's any facility who allow this practice.

[DOGLOVER]

What do you mean by non-BB personnel? We have a BB lab assisstant who we have very successfully trained to log in blood, dispense blood, wash red cells, and various other tasks that do not involve actual testing. This person was trained as a pharmacist in another country a long time ago(which training did not qualify in US, but shows her education level). I feel way more comforable with her, then I would with a med tech from another dpt who doesn't do BB very often. That being said, there is a valid point about only having one med tech in the BB on off shifts. This is common at night, including my facility, due to cost constraints. We did have a tech pass out once from an insulin reaction on the weekend. He had not shared the fact that he was diabetic and hadn't made sure to have emergency food handy. Also had one tech, recently end up admitted to the coronary floor after passing out. Fortunately he was not alone at the time. It is a risk that unfortunately many of us have to live with. We do have an on-call person on the weekend from 7A to 7P if things get to out of hand.

[Brenda K Hutson]

I know that in reality, plenty of places work with only 1 Blood Bank Tech. on off-shifts (or even 1 Generalist who "kind of" knows Blood Banking). That really scares me! At my last place (about 400 beds), I was always the one insisting on having 2 trained Blood Bank Techs. on every shift. My biggest concern was a bad bleeder. I guess that stems from working at a place where the 2 Midnight Shift Techs. had a patient bleed to death. They were both competent Techs. and worked their hardest; but it wasn't enough. Would it have been different with 2 strong Blood Bank Techs.? Don't know (and in actuality, the Nursing Unit was a large part of the problem with erroneous orders and delays). But I think it goes without saying that someone who works in the Blood Bank often and feels comfortable in there, stands a much better chance at keeping up with a bad bleeder. Blood Banking is just a "different beast."

Brenda Hutson

What do you mean by non-BB personnel? We have a BB lab assisstant who we have very successfully trained to log in blood, dispense blood, wash red cells, and various other tasks that do not involve actual testing. This person was trained as a pharmacist in another country a long time ago(which training did not qualify in US, but shows her education level). I feel way more comforable with her, then I would with a med tech from another dpt who doesn't do BB very often. That being said, there is a valid point about only having one med tech in the BB on off shifts. This is common at night, including my facility, due to cost constraints. We did have a tech pass out once from an insulin reaction on the weekend. He had not shared the fact that he was diabetic and hadn't made sure to have emergency food handy. Also had one tech, recently end up admitted to the coronary floor after passing out. Fortunately he was not alone at the time. It is a risk that unfortunately many of us have to live with. We do have an on-call person on the weekend from 7A to 7P if things get to out of hand.

[Cxm]

The issue of blood by non BB tech is fine in my book. If you train them and document it then I see no issue with it. Let consider the use of Hemosafe (blood bank vending machines). They are entering the market in an increasing number. Nursing staff will need to be trained in the visual inspection for the dispense of blood from these machine.

[Mabel Adams]

We have lab assistants that issue most of our blood. Training and understanding the consequences are essential. They do not have the capacity to override warnings in the computer at issue. They have to get a tech.

[tbostock]

I agree with really good training, etc. My concern is that if they do it very infrequently, how much will they retain?

[DPruden]

I agree with the training. We try to scare the beejeebees out of them when they are trained and we also do not allow them access to override any exceptions that come up at issue. I had to design the training differently than I would train an MT, but we have not had any problems.

[Mabel Adams]

At my prior workplace we had a checklist for the steps in issuing blood that we had people use when they were training in hopes that repeating the same correct steps the 10 or 20 times we required before they were allowed to go without the checklist would strongly imprint the proper steps in their minds. Some people preferred to continue using the checklist because they didn't do the process that often and wanted the reminders. Could this help?

[mollyredone]

At our hospital, people other than RNs are allowed to "check out" blood products. That would seem to be the same as letting lab assistants do it on the lab side. Proper training is the key!!

[RL0121]

I agree with David and Justina. (Actually, a BB Lab Aide issues/delivers the majority of the donor units at our facility.) As others mentioned good training is essential, as well as encouraging them to ask questions if "something just doesn't seem right".

On another tangent: In your original post, RLO121, you mention that your staff tech thought there should be another individual trained "for extra coverage if it's busy." Do you have only one tech on the evening shift trained to work in Blood Bank? If so, is that absolutely necessary? I think it's a little scary.

What do you do if the BB Tech falls and gets hurt, has a family emergency and needs to go home, or is on vacation, etc.? I think it's a good idea to always have a second individual cross-trained to be able to do at least the basic testing/functions in BB (not just to cover for the main tech's break period, but more importantly, to help keep things afloat during busy trauma situations, etc.)

Donna

Hi Dona,

Oftentimes we have 2 Blood Bankers on the evening shift. One works primarily in BB then one back up who works in the main lab. On rare occassion, if the back up tech calls out, the primary BBer is left with a non BB tech. A request to train non BB personnel to dispense/issue unit came from one of the evening shift tech. She suggested that all per diem techs should be trained to issue regardless of their shift. I opted not to do approve the request for many reasons: 1.) resistance from our casual CLS's 2.) keeping up with competency will be difficult. 3.) the previous supervisor didnt approve it... and we both probably feels the same way . it's just too scary!

[jerriemc]

I think this would be very hard to regulate and determine who was competent. I am guessing you are talking about using staff such as phlebotomists to issue blood. I have had some phlebotomists I would feel totally comfortable issuing blood and others I would not. How could you justify letting one issue blood and not another one.

[DOGLOVER]

I think this would be very hard to regulate and determine who was competent. I am guessing you are talking about using staff such as phlebotomists to issue blood. I have had some phlebotomists I would feel totally comfortable issuing blood and others I would not. How could you justify letting one issue blood and not another one.

We have a dedicated lab assisstant in the Blood Bank on day shift who we have documented training and competancy for dispensing blood. Question Who do you allow to pick up blood? RN's, associate care providers, volunteers, OR techs. How do you document training?

[jerriemc]

We do not have any lab assistants only techs and phlebotomists. We only allow RNs and LPNs to pick up blood. The nurses go thru training during orientation and then yearly during nursing skills lab. All aspects of blood transfusions from picking up a unit of blood, to starting the transfusion, reaction signs and symptoms, using the blood warmer, documentation etc are covered and they are given a written test over it for documentation purposes.