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A no armband system for transfusions?


snvoh

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I would be very interested to know how other facilities are handling specimen collection on preadmission patients who do not have hospital armbands. We have always used Typenex bands but of course the patients don't want to wear them and practically speaking, they fall apart after a few days. Our pathologists want us to completely move away from Typenex armbands and not necessarily have ANY armband. But what steps do you use to ensure patient identification? When products are issued what is the link back to the specimen? How are your preadmission registrations performed? Is the patient present? Is there positive identification such as a palm scan or photo ID when the patient physically presents at the hospital and is this confirmed later before transfusing? I would greatly appreciate any feedback.

Thanks much,

Suzanne Voh

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We have always used Typenex bands but of course the patients don't want to wear them and practically speaking, they fall apart after a few days. Our pathologists want us to completely move away from Typenex armbands and not necessarily have ANY armband. But what steps do you use to ensure patient identification? When products are issued what is the link back to the specimen? How are your preadmission registrations performed? Is the patient present?.Suzanne Voh

As of now we require the BB armband.I am not comfortable with just regular ID only as it is proven too often mixed up in general lab. If the patient does not want to wear the armband we ask that they come in close to the date of surgery telling them that if there is a problem with the workup there may be a delay in the surgery. We also will draw day OF surgery with the same disclaimer. No blood bank armband, no available T&C.

FOR ID I want something specific that is only for BB that is only found on the patient. Then I know that the ID has actually been looked at. I have been told our new computer system comes with a positive ID to print the labels at the time the patient armband is canned while they are drawing. If this is actually true and proves reliable we may drop the second BB Band. But if there is anyway to circumvent this scan and label of tubes..... then I won't trust it anymore than current system.

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If you get a barcode hospital ID band system, I can almost guarantee that someone will find a way to work around it when it is more convenient. Nothing is foolproof if people get to take shortcuts. And they will take shortcuts if they don't agree with the value of the system.

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We have no problem with patients once admitted, they all have a hospital wristband and we use the MRN as an armband number throughout their stay. What is being proposed is no armband what-so-ever for preadmits which are like outpatients until the day they actually arrive for their procedure and are then admitted. For facilities who don't use an armband, what process do you use to confirm the patient registered is the same person who comes later to have pre-op blood drawn and is still the same person receiving a transfusion later?

Yes, right now we use the Typenex band and we know the patient doesn't wear it and often forgets it. But if the nurse comes to pick up blood without the Typenex number we redraw the patient and repeat the testing. Our pathologist wants us to completely forgo the armband and somehow have such a good patient identification system that we don't need an armband. The problem is that the lab does not perform the registration for these preadmit patients. The patient is usually not physically present until they come for pre-op blood and they complain about the armband. Then they actually arrive for their surgery days later and by-pass the lab completely.

The whole thing is just scary.

Suzanne

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If you get a barcode hospital ID band system, I can almost guarantee that someone will find a way to work around it when it is more convenient. Nothing is foolproof if people get to take shortcuts. And they will take shortcuts if they don't agree with the value of the system.

Mabel, I totally agree and yet I may be over-ruled by those above me. Cerner says they have NEVER had a patient ID mixup EVER and my bosses appear to agree with them. It is hard for me to believe there is a system that can not be bypassed by some overworked employee trying to meet impossible turn a round times. I guess time will tell how it works here. Does anyone who have CERNER with Scanned ID for labels (print at bedside) had a problem of any type?

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If you get a barcode hospital ID band system, I can almost guarantee that someone will find a way to work around it when it is more convenient. Nothing is foolproof if people get to take shortcuts. And they will take shortcuts if they don't agree with the value of the system.

Mabel--I have seen it with the Pharmacy system that you must Barcode Wand the wristband every time you open their medicine drawer. The RN's print a barcode label for each patient and keep it on the med cart. In my opinion, the only hope of compliance is to "Keep It Simple St**id.

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I have also seen many examples of "cheating" by caregivers, mostly perceived as necessary for efficiency, not deliberately to compromise safety, although that is the end result.

We have discontinued the use of a secondary ID band. We have a patient ID policy that is solid, but not all are compliant with it. We found those same individuals also found ways to corrupt the BBID band system.

We are now performing two independently drawn blood types before giving non-type O blood. So hopefully we are limiting the impact of mislabeling errors, but they continue as long as staff is not held accountable.

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Somewhere on here is the story of the lady that sent her friend to her pre-op appt including her blood draw because she had a hair appt and the hairdresser was really hard to get into. Of course, she could hand the friend the wristband to wear back in for surgery. I'm back to voting for the implanted radio chip.

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We are currently looking into PPID (barcoded armbands with all pt info), which will positively identify the pt when armband is scanned. We are going live next week with the regular blood collections, but we're not moving to using for the blood bank ID, yet.

In the meantime, we band our pre-ad pts. However, if the pt does not have a legible armband upon re-admission, the pt gets redrawn. We hope to avoid recollections with PPID.

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Still, any non-permanent armband, PPID-full or not, can be removed and maybe end up on the wrong bedpost or whatever. I am hoping that when the time comes, we go directly to tatooed barcodes.

At least until the get the microchip thing figured out.

Scott

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HI Folks,

No armband = no transfusion but -

We use pre-op clinics as much as possible, as it allows better work flow and cuts down the pressure first am or late previous evening when patients present for ops. We keep the Typenex armband with the pre-op testing (all goes into the patient chart for admission). To get over the chain of identity (as nurses admitting and putting on the armband were not the same as the person taking the pre-op testing), we introduced a Patient & Typenex check form. It has a blurb about checking patient identity, but also has a space for the patient having the testing taken to sign. A typenex number is placed on this form also. On admission, the nurse checks the usual ID positively and also asks the patient to identify their signature. The nurse then signs on that form as indication that these checks have been carried out and the Typenex has been placed on the patient. We are shortly going to 2D armband coding (as we use BloodTrack Tx PDAs on the wards etc), placed on admission & we are considering doing away with Typenex. Have to think about this problem first though. I will attach a copy of the form we curently use FYI.

Cheers

Eoin

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We are now performing two independently drawn blood types before giving non-type O blood. So hopefully we are limiting the impact of mislabeling errors, but they continue as long as staff is not held accountable.

I have been wanting to do this as well. However it requires support from administration/management above me to support it when there is a perceived delay. Not to mention our staff is so thin now, a redraw would not be a quick thing. Giving O blood because of slow 2nd redraw would deplete often hard to get O blood so I would want this to be kept to a real minimum.

AND I did work for a place where the Drs and Nurses drew the blood. They figured out the need for redraw immediatly and soon were drawing both tubes at the same time, waiting for us to call and say we needed a redraw. I once got physically attacked by a Dr who when I rejected the 'redraw' specimen for not being labeled came down and pushed me against a counter when I would not allow him to label in the BB. His response "I know which patient is which, I kept 'Mr Smith' in my left pocket, "miss Jones" is in my right pocket", pulled out another 'redraw' tube that I had not requested as we had a previous type. Security showed up before it went any further.

I can easily see phlebotomists doing this same thing to same themselves some work. If they aren't called for a redraw, the tube could go in the trash.

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We also ask PATs to come back within a day or two of surgery, at which time we band them and instruct them to keep it on in order to avoid delay on the day of surgery. We do not use a unique number - just the med rec number on the band. So far so good, except for the patient who went straight from the blood draw station to hyperbaric treatment in the wound center, where they removed the armband, and the lady who returned after one day with a band that looked like it had been been through a meat grinder... also we have a tech here who faints at the sight of blood being drawn (not kidding); years ago during her pregnancy she sent a friend to be drawn for her prenatal blood work (again - not kidding)!:eek:

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We will be moving to Cerner Millennium early next year and will use the PPID barcode scaners at the bedside that will print labels. I too have thought about dropping the Typenex armband but until we can get Bridge Transfusion (new at Cerner) I am not willing to drop the BB armband. Without an armband I just don't know how to positively keep the "identity chain" from specimen collection back to transfusing the patient. Currently we require the BB armband sticker be brought with the pick-up slip for blood. No number=no blood. The techs enforce this 100%. As for pre-op patients, we ask them to wear the armband, but if they really don't want to, they are instructed to bring it with them the day of surgery. If they return and either don't have it, or it is illegible, they are redrawn and we do everything all over again. Mabel, I like your idea of a radio chip!

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I have been wanting to do this as well. However it requires support from administration/management above me to support it when there is a perceived delay. Not to mention our staff is so thin now, a redraw would not be a quick thing. Giving O blood because of slow 2nd redraw would deplete often hard to get O blood so I would want this to be kept to a real minimum.

AND I did work for a place where the Drs and Nurses drew the blood. They figured out the need for redraw immediatly and soon were drawing both tubes at the same time, waiting for us to call and say we needed a redraw. I once got physically attacked by a Dr who when I rejected the 'redraw' specimen for not being labeled came down and pushed me against a counter when I would not allow him to label in the BB. His response "I know which patient is which, I kept 'Mr Smith' in my left pocket, "miss Jones" is in my right pocket", pulled out another 'redraw' tube that I had not requested as we had a previous type. Security showed up before it went any further.

I can easily see phlebotomists doing this same thing to same themselves some work. If they aren't called for a redraw, the tube could go in the trash.

We don't allow the same dept that collected the first sample to collect the redraw. We usually send our phlebs, but honestly, this is extremely rare. The good thing about bleeding patients is they have frequent CBCs, so as soon as we see one, we use that as the confirmation blood type. And we don't have to use type O very often either. It works out pretty well for us.

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Our hospital requires a circle around the medical record number as documentation that the patient wristband matches the specimen label (name and MR#). All specimens are required to have this documentation. Then in the Blood Bank we only transfuse type specific if we have two matching blood types on two different venipunctures (BB history can be one of these). For our pre-admits, a wristband is placed on the patient arm for the blood draw and then removed and placed in the chart. Upon admission, the wristband is then rechecked and reapplied. Currently our outpatients do not have wristbands but must state their name, date of birth and ordering physician. Photo ID is required at registration.

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I hope she wasn't a tech yet when she sent someone else to be drawn!

No, not a tech yet - but a story that just goes to show that some people will do almost anything to get out of a blood draw; this person admits having done this, but how many do we not know about?

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We don't allow the same dept that collected the first sample to collect the redraw. We usually send our phlebs, but honestly, this is extremely rare. QUOTE]

In my current facility ONLY phlebotomists draw blood bank tubes. I could insist different phlebotomists draw when 2 are available, but that is not true for all shifts. AND it would cause a delay as phlebotomists are assigned to different areas, so someone would have to leave their area to redraw. Still I think this is the best we will be able to do if we go to 2 draws. Though as stated earlier mgmt loves the Hospital scan thing and thinks that will be non corruptable. We'll see.

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The good thing about bleeding patients is they have frequent CBCs, so as soon as we see one, we use that as the confirmation blood type. QUOTE]

This we currently do when available. However most our problems are ED patients (no second draw yet) and Pre-admit patients (coming into hospital for surgery) only originial draw. You can check the techs work by testing a second specimen from the same draw, but it is not a real check on the patient as technically the same specimen (drawn at same time by same person).

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  • 1 month later...

Same here as Barbarakym and SMILLER, we draw pre surgical samples on patients up to 14 days early and they have to keep the Typenex on. We threaten them that if they take off their wristband they have to come in and get drawn again and the surgery might be delayed. If a silly wristband is the most of their worries and complaints, I'd hate to be around for the actual surgical part. I SAY "Comply and deal with it". Sorry to be harsh but it's a little irritating to see how a "small discomfort" can somehow outweigh patient ID and safety. Most patients are ready to follow our request after the importance of the whole process is explained in detail. They see how it benefits them and ensuring they will receive a safe transfusion.

Edited by Gnapplec
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