patient's with no previous records....

[lab217]

When testing patients for a bloodtype due to "no previous record" with a request for transfusion, does anyone only focus on non-O patients?

[David Saikin]

No - we use BloodLocs - a barrier system; doesn't require multiple typings.

[tbostock]

At my previous hospital, we only retyped non-type O patients. At my current hospital, we retype all because in my LIS, it's all or none.

[ElinF]

We finally started doing this at our facility and I am so glad. But we took the "all or none" apporach too and retype everyone from a seperate draw that does not have history.

[swede]

We retype all patients without a history; we figure if we are catching misdraws, Type O people can be misdrawn too and other lab work may be involved with same "stick"

[Mabel Adams]

One could deal with the BBIS requirements by doing retypes on the same sample for O patients and requiring a new draw only for non-O's. It does seem worth hunting down a separate specimen that is already drawn on a group O patient to double-check on the other lab specimens and missed antibodies as stated above. This is a difficult one for us to adopt because we are a centralized transfusion service for a hospital 18 miles away so getting that extra sample drawn or even getting the extra hem sample requires more logistics than if we were only one campus. We will be joining the crowd with a second sample I think--even though we have barcoded wristbands--but we have to do a lot of education etc. so people don't try to do an end run around the system.

[Dr. Pepper]

We do retypes on just the non-group O patients. The idea is to prevent catastrophic mistransfusions. If the O is really an A no harm done. The trick is to determine if a second sample from a different draw time is really from a different draw time. Too often the ED will do the "rainbow" draw, a tube of each flavor, and then use the time the test was ordered/added on the label rather than the actual draw time, Mabel's "end run". We try to call and question and not assume, particulalry with the ED.

[swede]

When we first started doing confirmatory types, we had trouble with work-arounds, but after years of trying to out think them, we have a system that is working. We now send the tube to the floor (mostly ED and Labor) and they must use our "special" tube for the confirm type. We send a 5ml pink top; we use the 7ml for the type and cross. Blood bank is the only department that is allowed to order the 5ml pink top. We used to catch them taking caps off and using "saved" blood for the test. We now wrap a small strip of parafilm around the cap (making it tamper evident). Nurse managers are behind us, so anyone caught circumventing the protocol is disciplined. We don't have to have many confirm types drawn, we do look for a previously drawn cbc first. ED and Labor are our most frequent draws.

[Mabel Adams]

Now they probably stick a syringe needle into their saved tube, suck out the blood and inject it into the new tube without removing the parafilm. Nothing is foolproof because fools are so ingenious!

[swede]

Yes, Mabel, we know that ! We try to keep educating and are hoping for the best, its all we can do.

[Bill Sinn]

We do as Dr Pepper, above. The original CAP requirement from about 8 years ago allowed performing rechecks for non Group O patients only, and this would satisfy the requirement. The CAP wording has since changed, but we are still doing rechecks (2nd stick) on NEW non Gp O patients only. Again, this is to prevent major ABO mismatch.

Bill

[lab217]

Thanks to each and everyone for your responses, you have been extremely helpful.

[Gnapplec]

It makes me nervous be we are not required to do any re-typing of any kind. And similar to Mabel Adams' comment, our facilities that we provide Transfusion Services for are many many miles away. Probably 95% of our patients have no records and we issue units from one tech's type, one set of tubes quite often. Most of those samples are pre-operative and could at least be re-typed by a different tech to verify but our procedures allow our current practice. A few years ago finally went to barcoded wristbands.

[Dr. Pepper]

I was never a fan of the retyping the same specimen strategy - I would hope the first tech got it right, and, if not, subsequent immediate spin wet crossmatches would show an ABO incompatibility. I think that drawing the wrong patient or mislabeling the tube is more frequent, and you can type it as many times as you like but still give out the wrong blood.

[Gnapplec]

True, I am more nervous about our samples coming to us drawn by an independent phlebotomy service who we have to trust know the importance of positive patient ID.