Who collects your blood bank samples?

[Michaele]

Hello, I'm sure this has been addressed somewhere before. I'm just not finding it...

1. Who collects your blood bank samples?

2. Do you use an armbanding system?

3. If nursing draws your samples, how do you handle patients who have no history?

4. Have you had instances of wrong patient drawn?

We are a smaller transfusion service and the lab has always drawn the samples for blood bank, but one nursing department has decided that they want to change that--they want to begin drawing and sending type and screen specimens down to the blood bank to save time. We have enough instances of wrong samples collected /not labelled properly on other tests that we are a little leery of making this change. Any help or words of advice would be appreciated.

[Deny Morlino]

1. ONLY our lab staff!! We had the ED try it for a very short time and non-compliance with the "rigid" labeling requirements put a stop to this practice.

2. Yes and there are too many positive aspects to discontinue for now.

3. The only time nursing would draw the sample is if a specimen collection was through some sort of port and lab staff must be right beside the nurse during the collection to assure proper identification of the patient per lab's protocol (NO EXCEPTIONS).

4. By our staff, not in my almost 20 years. Phlebotomy performs the vast majority of the blood collections. The importance of patient identification on a normal specimen collection has been stressed to the nth degree. Identification assurrance for blood bank is beyond that and the phlebotomy staff tow this line. I have had question over the years about "banding the patient we just drew without a redraw". The answer is always a definitive "NO". Rarely is the question asked anymore.

[David Saikin]

1. Hospital staff - Lab, Nursing, Paramedics can draw BB specimens. We beat correct labeling into them. We only accept specimens from the ambulance if we have a history on the patient. We do not accept specimens for transfusion/T&S from nursing homes or physician offices.

2. We use BloodLocs.

3. We use BloodLocs.

4. Only if ordered on the wrong person.

[Michaele]

So, do you give type specific or O if you have no history on the patient?

[Bill]

Michaele, if you document the number of incorrect patients drawn, you can show how many potiental incorrect transfusions would be given in a year. Ask Risk Management if this is what your organization wants for transfusion therapy patients.

[David Saikin]

So, do you give type specific or O if you have no history on the patient?

i give type specific if there is time to do a quick tube type - otherwise O+ unless a female of child-bearing age (50 at my place).

[MAGNUM]

1. Our blood bank samples are collected by our phlebotomists, and nurses that have been trained specifically by me and our phlebotomist staff on how to correctly collect samples.

2. We do use a banding system. We now use the typenex barcoded flexiblood system.

3. Since nursing draws a lot of our blood bank specimens, when we get the specimens into the blood bank and check histories if they have no history, then we send a phleb back to see the patient to collect another sample (begrudgingly of course).

4. I can only think of one instance where we had an incorrect draw by the floor, and that was determined upon check of the patient history and a different blood type. Reteach and retest of the nurse before she was "allowed" to collect ANY other lab samples and then on a probationary period of 60 days, 30 of which they could not collect any specimens by themselves.

On a separate note, any labeling errors for the blood bank (other than writing a date or time of collection in rare instances), and the specimen is treated as unlabeled and must be recollected. I hate doing that to the patients, but we can NEVER be tooooooooooo safe in the blood bank.

[Generic]

1. At our hospital, the nurses draw the vast majority of the blood bank samples. Only very occasionally do we get one drawn by the phlebotomists. Blood bank tests can't be ordered by the floor, so no draw order gets sent to phlebotomy. All our samples have to have the 2 identifiers, date, and initials of the person drawing or the sample gets written up and thrown away and a new correctly labeled sample requested. Either the rest of the lab didn't have the same requirements as blood bank or they weren't as strictly enforced (I've always been fuzzy on the exact situation), but our new lab director has been very strict about the blood bank labeling policy applying lab-wide (and adding time of draw too). That has greatly reduced the number of mislabeled samples we get...

2. We don't use armbands...

3. We require a confirmatory sample on all patients with no prior history. We only perform a forward type on these samples and the patient isn't charged for the test. If they can't get a 2nd sample, we require that an emergency release be signed before we issue any blood products. Nursing grumbles about this from time to time, but oh well...we almost always get the sample and very rarely have to issue under an emergency release.

4. Although we do rarely get the wrong patient information on a sample, this has always been caught with the second sample. It of course gets written up and sent to nursing to deal with, I don't know how hard they come down on them in those situations though...

[Likewine99]

1. Who collects your blood bank samples? All are collected by nsg, no phlebotomists in lab except OP lab.

2. Do you use an armbanding system? Yes, network wide, homegrown armband modeled after Hollister/Typenex

3. If nursing draws your samples, how do you handle patients who have no history? Two specs from two separate draws. Steal specs from Hematology about 90% of the time.

4. Have you had instances of wrong patient drawn? Yes, I hate to say.

[Liz]

Wow, I am impressed Deny. I am more like Dave. It would be nice if the Phlebolomy team rounded more often though.

[Michaele]

Thank you all for replying, this is very helpful. Wish me luck on my fight.

[SMILLER]

We are a 270 bed hospital with active intensive care units. Lab collects all BB specimens except for same-day surgery unit patients, where they are collected by RNs. We use BB armbands to connect patients to specimens to units. Patients also have regular hospital armbands, but like many places, thier use is problematic, so we do not soley depend on them for BB patient identification.

In general, we do not rely a history to "validate" a specimen that is otherwise questionable as far as being drawn from the correct patient. If there is some question, the patient is redrawn.

We occasionally get a Lab-drawn mislabled specimen, or a specimen with two different labels on it, but this type of problem is much more common with "decentralized" specimens. About 12 years ago there was an administrative push to maintain "patient-focused care". Somehow this translated into fewer people doing more things. One result was that we now have many of these decentralized-phlebotomy units (ER and intensive care mostly) that draw their own Lab specimens. But we do not let them draw BB specimens, other the exception for the pre-op unit and OR.

Not surprisingly, decentralized specimen problem rates (wrong tubes, clotted, hemolyzed, etc.) are much much higher than Lab phlebot drawn. Here mislabeled specimens rates (wrong patient ID) occur about twenty times more often than with Lab draws.

Check the internet for journal articles about misdraws. There have been several that point out the problems with decentralized phlebotomy.

[Liz]

I like your observation SMiller, we see the same. How is the transfusion administration at the ER and ICU, are you satisfied? Are they following policies as closely as other units?

[SMILLER]

Liz

We have problems with adequate documentation on the unit tag forms (all transfusion info is recorded here, a copy is charted) when our copy is returned to us, and we have Lab clerks check those for us if there is missing information, and if it appears they missed a febrile reaction or something, we do testing/path review for those patients as appropriate.

In the past we have run QA programs to observe and make sure that blood administration is by the book. We have redesigned the blood tags to make them easier to use and have gotten positive feedback about that. We will always be reviewing those tags to make sure nothing is missed re: FDA or JCAHO inspectior review at a later date!

[Liz]

Is all the information on the Tag? do you send an accompanying form and if so how does it stay WITH the unit?

Thanks

[SMILLER]

Liz

I think like I said in that other thread we are both looking at right now, the tag IS the form. A sticker on the tag with all of the crossmatch ID stuff goes from the tag to the back of the unit so when the form/tag is removed, the unit is still kosher.

Scott

[Michaele]

We also do a QA on the completed blood tags. Each transfusion tag is reviewed for completion and to make sure no reactions were missed. Once we find an error, we notify the nursing unit, and the nurse making the error has to complete corrective action/education. I'd say we have about a 95% completion rate.

So Liz, you see the same problem rates from nursing draws that Scott sees?

[Liz]

The draws are also: Phlebotomy, Nursing and MDs. They are trained 2 people must id the patient. The draws are good, I think what I get is the wrong Charge card being attached (yes for the BB we still use those), thats the clerks' mistakes. Once it was perfect as it should be and the tube was empty!! ICU is a problem at administration, as they dont want to take the tag in so I made an extra copy (total of 3 cabon copies)that can be discarded in the room. Any ideas on this?

[tbostock]

Phlebotomists, nursing techs, nurses and physicians all collect BB specimens. We currently use the BBID band but are discontinuing it due to all of the problems/mislabelings. We perform 2 independent blood types (one can be prior history) before giving type specific blood, if we don't have 2, they get type O until we do. And yes, even with the BBID band we had 2 WBIT (wrong blood in tube) in the past 2 years.

Unfortunately the BBID band has been used as a false sense of security here, and has been corrupted by nurses. It no longer is a safety mechanism and has caused many delays in transfusions when the nurses use it incorrectly. Blood Loc also would not work here because nurses have scissors and would absolutely use them if given the chance.

[Liz]

Sounds like we work in the same place Terri. But thanks for the info, I wanted to start the BBID, but always worried it would be too much. Wanted to get the Blood Loc but did hear that it gets torn open. Hmm what else, yes I am still debating on the label. I have all the info on a 3 non-carbon copy tag, ALL. We handwrite and the Transfuionist and Witness sign. There is also a Tx Rx section on it that will change and be separate. It is small. Wondering if it should all be changed. I do not label the bag with an adhesive label. Maybe I should.