Do you require a second specimen from a different draw when you have no history for a pre-transfusion candidate?

[Maureen H. Brown]

How has anyone that has instituted patient blood management principles (including limiting phlebotomy losses) made it work with the drawing of 2 samples for blood type checking? Do you draw really small repeat samples? Just do a forward type or...?

For computer crossmatches AABB Standard 5.13.1 applies, which requires front and back typing.

[Liz]

I agree with you Malcolm (does that make me a grouch too )! And typing the same specimen twice (which has been done in other places I have worked; some requiring a 2nd Tech., and some, allowing the same Tech.) only catches (maybe; you have to allow for biased Testing) a mistype; not a misdraw. Having worked in 5 Hospitals (this being my 6th), I have seem a LOT of misdrawn/mislabeled specimens in my day. I think the 2nd blood draw (at a different time; by a different phlebotomist) is a great idea; regardless of the method of crossmatch.

Brenda Hutson, MT(ASCP)SBB

I agree! I am the third grouch!!!

[Liz]

To prevent sticking the patient twice: You can have 2 people identifying the patient and signing to that effect prior to the draw.

I must comment that tubes sent to the rest of the lab should be well labelled just like the BB tubes and that the second ABO test (if you have 2 draws) is just as serious as the first!! come on of course it is, and if you get a discrepancy you need to get a thrid one. This is serious business! Lives are at stake, and depend on our accuracy.

[Liz]

ok I'll go back to sleep now. I am very upset because i caught a discrepancy, so one of the tubes was wrong >>>>> forgive my anger, while I shall not forgive sloppiness.

[sblanchard]

We require a different draw on all non-O patients prior to transfusion type-specific blood. If the patient has no history and is an O we do a second type on the same specimen.

Akron General Medical Center

[Dr. Pepper]

I will be a 4th grouch. I sleep better at night since we've had the second typing rule in place. I collate the QA data in our lab and see all the specimen ID errors made - it's very scary, since we only see the tip of an unknown iceberg (the errors that we catch).

[Annadele]

Do many of your laboratories also require a confirmed ABORh type on a current encounter before administering FFP (or even PPH)?

I've been wondering about this because especially with the cost of healthcare in the US, it isn't outside of the realm of possibility for a patient to present him or herself as someone else that had been seen previously at our hospital and then receive incompatible plasma.

Annadele

I will be a 4th grouch. I sleep better at night since we've had the second typing rule in place. I collate the QA data in our lab and see all the specimen ID errors made - it's very scary, since we only see the tip of an unknown iceberg (the errors that we catch).

[Dr. Pepper]

Do many of your laboratories also require a confirmed ABORh type on a current encounter before administering FFP (or even PPH)?

I've been wondering about this because especially with the cost of healthcare in the US, it isn't outside of the realm of possibility for a patient to present him or herself as someone else that had been seen previously at our hospital and then receive incompatible plasma.

Annadele

We've seen this (and others have in previous threads), not infrequently with our prenatal clinic patients. It doesn't have to be deliberate fraud, either. The ER, central reg or other admitting dept can simply pull the wrong patient up out of the computer. Seen that too.

[Mabel Adams]

I am interested in the 2 specimen requirement, but we are the centralized transfusion service for a hospital 20 miles away. I don't want stat specimens to wait while they collect a second one and it would add expense and delay to send a courier back for the second specimen. Likewise for getting second specimens delivered on pre-ops. We do have a lot of repeat customers so we might be able to get by with just giving O blood until the next sample comes. Which adds more safety--using a barcoded wristband system (which we do mostly) or drawing a second sample?

[Auntie-D]

Iwe might be able to get by with just giving O blood until the next sample comes. Which adds more safety--using a barcoded wristband system (which we do mostly) or drawing a second sample?

I think that is more the principle. In all but lifetreatening situations a second draw is not going to delay in a clinicaly significant way. In an emergency situation it is best to issue group O - most mixups happen in an emergency situtation as we all know!

As for previous references to doing a second group on the haematology sample - the sample will have been drawn at the same time as the trans sample so this is not a suitable sample...

[AMcCord]

We have seen admission error as the cause for an apparent wrong type, so we do require a current type for FFP and platelets.

[Brenda K Hutson]

I don't think I would accept just a 2nd person witnessing 1 draw. I have seen a lot of biased testing in the Laboratory world; better to have a different person, at a different time, identify and draw the patient from scratch. Just my opinion.

Brenda Hutson

To prevent sticking the patient twice: You can have 2 people identifying the patient and signing to that effect prior to the draw.

I must comment that tubes sent to the rest of the lab should be well labelled just like the BB tubes and that the second ABO test (if you have 2 draws) is just as serious as the first!! come on of course it is, and if you get a discrepancy you need to get a thrid one. This is serious business! Lives are at stake, and depend on our accuracy.

[Liz]

As John would say: keep it simple and when they want to NOT follow the policy they will not follow the policy.

[Townsend]

Sorry for the late response....

For all non-group O patients, we require a second sample that is collected at a different time than the first PRIOR to the issue of type-specific red cells.

All samples submitted to the lab have the same labeling requirements. We are in the process of completing house-wide bedside barcoding requirements for sample collection, but we do not plan on changing our policy on second sample confirmation before giving non-O blood.

We do not require second type prior to plasma administration. Only a historical type is required. We also do not perform electronic crossmatch.

Nationwide Children's Hospital (Columbus, OH)

[Mabel Adams]

Does anyone that has made a change to requiring a second sample have a change control document for it that they would be willing to share? Between training, dealing with pre-ops and emergencies, building computer tests, billing etc, this is a big project and I would love to not have to reinvent the wheel. Besides, there is probably something I haven't thought of.

[Dr. Pepper]

[ATTACH]599[/ATTACH]

Here's our procedure if it helps. We had to put an order rule in the LIS canceling the charge for the second typing if on the same day, 3rd party payers did not want to pay.

[tbostock]

Does anyone that has made a change to requiring a second sample have a change control document for it that they would be willing to share? Between training, dealing with pre-ops and emergencies, building computer tests, billing etc, this is a big project and I would love to not have to reinvent the wheel. Besides, there is probably something I haven't thought of.

I don't have a change control doc, but here are some things to remember:

Test: We did not use the blood type order code, we made a new one called CONF (for blood type confirmation) and we have no charge attached to it. That way it doesn't bill.

Training: Unless it is a PST sample or a cord blood, whenever a tech receives in a Blood Bank specimen and they see no previous blood type history, they order the confirmation test. That way it is on our pending log and everyone knows to keep an eye out for a CBC sample to use.

Computer: We have it set up in our LIS (SoftBank) to only allow type O red cells to be issued until there are two separately drawn matching blood types. This is what we do for emergencies.

Pre-ops: We draw patients at PST and again the morning they arrive for surgery. Takes care of our 2 blood types.

FFP: we don't require the second draw for just FFP or platelets; the computer is set up to allow type specific if there is a current type.

Kind of a pain to have to do this, but it has already saved us twice when specimens were mislabeled and that's how we caught the error, when the CONF type didn't match the original tube. So well worth the effort as far as we're concerned.

If only people were consistent in patient identification and labeling their tubes, we wouldn't have to go through all this.

[jill]

[ATTACH]599[/ATTACH]

Here's our procedure if it helps. We had to put an order rule in the LIS canceling the charge for the second typing if on the same day, 3rd party payers did not want to pay.

Very interesting.

[SRTECH]

To prevent sticking the patient twice: You can have 2 people identifying the patient and signing to that effect prior to the draw.

I must comment that tubes sent to the rest of the lab should be well labelled just like the BB tubes and that the second ABO test (if you have 2 draws) is just as serious as the first!! come on of course it is, and if you get a discrepancy you need to get a thrid one. This is serious business! Lives are at stake, and depend on our accuracy.

We presently have a policy where two people need to be present for a draw. You'd be amazed at how ingenious nurses can be...recently we received two specimens supposedly from the same patient with double verification(two initials); each specimen had a different name!!!! When I called the nurse..she told me nursing's take on double verification....."Each nurse goes to do their draws and brings it back to the nursing station to be double verified by a second nurse...

[Mabel Adams]

Nothing works right if the people involved don't understand the reasons for it and "buy into" the need for doing it that way. The best system can be undermined if the people aren't motivated to do it right. Amazing work-arounds they come up with!

[Auntie-D]

There was a case where someone drew bloods from all the patients on a ward and placed them in kidney dishes, which were then placed on top of the patients' notes - for labelling later by one of their minions! Another person walked past and accidentally nudged the table sending the kidney dishes flying. That person then proceded to match up the kidney dishes with the nearest notes... Luckily they were caught and all the patients were rebled!

This is a situation where the patient had to be bled twice by different people, but they deemed filling in the forms and tubes to be too time consuming. All beside checks were made, twice, just the samples weren't labelled. Once they had left the bedside who knows who the samples belonged to!

This person moved to a bronchoscopy clinic and proceded to do exactly the same thing, and the same 'bump' occurred. The repeating of all the bronchoscopies and biopsies ended the person up under review, thank goodness...

[CM2]

We presently have a policy where two people need to be present for a draw. ..

Yeah they tried that here too, but I think its a good example of the people making a policy not being aware of how the drawing process works. It might be fine for say, a single patient redraw in OR, but not for general rounding. I never thought it was practical to expect the nurses to follow CCT's from room to room or making CCT's work in teams or however else it was envisioned to work.

[L106]

We presently have a policy where two people need to be present for a draw. You'd be amazed at how ingenious nurses can be...recently we received two specimens supposedly from the same patient with double verification(two initials); each specimen had a different name!!!! When I called the nurse..she told me nursing's take on double verification....."Each nurse goes to do their draws and brings it back to the nursing station to be double verified by a second nurse...

Doesn't it make you want to scream???!!

[cinbb]

Thanks for sharing. Like the previous poster I shy away from re-inventing the wheel. So many tasks,,, too little time. This will give me a jump start on my outline.

[ANORRIS]

And if you do - would you mind sharing your facility name?

We have this requirement at Presbyterian Hospital in Albuquerqu, NM.

Thanks!

Yes...we do at Georgetown Memorial Hospital System in Georgetown, SC, unless the sample is drawn with a mechanical identification system.