Time limit for type and screens on outpatients

[jerriemc]

Does anybody extend the time limit for type and screens on patients having outpatient surgery? We have some new surgeons that want their patients to come in 1-2 weeks prior to surgery for their pre op lab work. Because of the time sensitivity of Type and Screens, they have started waiting until the actual day of surgery to order the type and screen. This just seems like a disaster waiting to happen. This morning our phlebotomist was drawing a patient's blood while the transporter was waiting to take them down to surgery. I was wondering how other hospitals had dealt with this same problem? Thanks for your input.

[BANKTECH]

We extend the expiration date on these patients for 7 days, assuming they have not been pregnant or transfused in past 3 months. This, of course, needs documented for us to extend the expiration date. I have heard of other facilities that use 30 day timeframe.

[EDibble]

We extend the expiration date on these patients for 7 days, assuming they have not been pregnant or transfused in past 3 months. This, of course, needs documented for us to extend the expiration date. I have heard of other facilities that use 30 day timeframe.

We do the same, but with a 14 day out date. Again, they have to say they have not been transfused or pregnant within 3 months. We have a standard form, the patient answers, is witnessed by an RN, and both sign. We get this form in the BB

[swede]

We extend for 21 days. We do the type and screen on the day it is drawn, but we have validated the testing to be done on 21 day old specimens if orders are changed from hold only to type and screen. We go by the same rules as above for pregnancy and transfusion.

[Justina]

My facility extends samples out to 14days or 3 days past the surgery date, whichever comes first. This is only if they have not been transfused or pregnant within the last 3 months. Another facility I worked at extended out to 30 days, as long as the criteria was met.

[dgibaud]

Swede

Does this mean you have 21 days + of stored patient specimens just in case you need to add units on the actual date of surgery?

[SMILLER]

The majority of our OR patients here walk in the day of surgery and have a T&S drawn by the pre-op unit. Needless to say, we are not real happy about this.

Years ago we used to do T&Ss as part of pre-admit testing--usually 3 or 4 days before the surgery. The patients had to go home with armbands on. I believe at that time we would do that for up to a week before surgery. Of course, if they lost the armband, the T&S had to be repeated the morning of surgery.

Scott

[Deny Morlino]

Same process here as EDibble.

[swede]

Swede

Does this mean you have 21 days + of stored patient specimens just in case you need to add units on the actual date of surgery?

Yes, We have a system of cups for future specimens and racks for current date. The cups are labeled Monday thru Friday. After a pre-surgical specimen is tested, we put it in a cup for the day of the week that the surgery is going to take place (so if the 15th is a Wednesday, it goes in the Wed cup).

We receive a tentative surgery schedule every day for the following day. We go thru it to see which patients need blood bank testing (based on our OSBOS). We find it in the cup and move it to our "daily" specimen rack. The racks are saved for about 12 days (based on refrigerator space) so we will have the specimen for at least a week after transfusion.

The cups are about 4 inches square and the racks hold 24 specimens (each day we fill one or two racks, three is a rarity).

It may sound complicated, but it really it isn't. It works for us.

[David Saikin]

We used to allow up to 7 days but are now changing to 3; we are not drawing for BB if the preop labs are more than 3 day prior. This was a "higher up the food chain" decision. I have seen places that freeze preops and save for up to a month. It all depends on your Medical Director's comfort level and the pressure exerted by the Medical staff. As long as there is no recent transfusion or pregnancy there is no regulated time limit to specimen validity.

[BBCLS]

Does anybody extend the time limit for type and screens on patients having outpatient surgery? We have some new surgeons that want their patients to come in 1-2 weeks prior to surgery for their pre op lab work. Because of the time sensitivity of Type and Screens, they have started waiting until the actual day of surgery to order the type and screen. This just seems like a disaster waiting to happen. This morning our phlebotomist was drawing a patient's blood while the transporter was waiting to take them down to surgery. I was wondering how other hospitals had dealt with this same problem? Thanks for your input.

We extend 14 days if order indicates no transfusion or pregnancies within 3 months.

[Gnapplec]

Same as BBCLS above. We do a lot of extended pre-op samples this way.

[OxyApos]

We do 10 days because that's what our doctor's requested. Perform type and screen day drawn. No preg/ transfusions in 3 months. File tube by future date of surgery. Set up blood the morning of surgery. We have to change their billing account number so that the crossmatch charges and possible charges for the components themselves will not be billed on a pre op charge from earlier. It works out quite well for us and the OR. Only 1 tech in our dept so having all the first cases show up at once for workups would be bad. If the patient doesn't return with their armband, its all repeated on a new specimen. We switched to the Typenex barcoded armbands for these patients and the compliance rate has been really good. I wouldn't go keeping specimens beyond 10-14 days and I wouldn't do what some places do...freezing plasma and thawing day of surgery so they can be kept for a month.

[pbaker]

We do a type and screen up to 30 days out. When the patient comes back day of surgery, we have a test called "P neg" meaning all pretesting was negative. If they have not been pregnant or transfused in the previous 3 months, we only perform an ABO/Rh and use the screen results from their pretest with a disclaimer stating that fact. Any units needed can then be added to this P neg specimen. If they have a positive screen, have been pregnant or transfusions, we do another TS day of surgery. If they pretest, we can be prepared if they have an antibody and get Ag screened units ready before the patient comes in for surgery.

[tbostock]

We used to extend it to 14 days, but then went back to all specimens being good for only 3 days. We had too many BBID band issues, and had to re-do them anyway on day of surgery. So now we do them at PST and again on the day of surgery.

[Liz0316]

We use 21 day (3 weeks) for pre admission testing, as long as the patient has not been transfused or pregnant in the last 3 months, and it's documented on the PAT form.

[Mabel Adams]

We allow the patient to be drawn 14 days before surgery, then the sample is good for 3 days past surgery for a total of 17 days max. Same pregnancy and transfusion rules as above.

Joint Commission is pilot testing some standards around blood management. One of them was to require that the T & S test be complete before the patient is anesthetized. I think this was in the context of total joints. Not sure that they will become final standards anytime soon but you can see that they consider testing as the patient heads into the OR to be a bit late.

In my experience, total joints lose more blood via drains post-op so doing the testing during surgery is not so dangerous for them as it is for the aneurysmectomy patient that turns out to have anti-k. Where I used to work we did all the total joints as routines the morning of surgery. They could bump it up to stat if the patient seemed to be bleeding too much. The only problem was that it did create a bolus of work in the morning but since it wasn't stat it wasn't too bad. We did have to do some serious education with the pre-op clinic staff so they didn't try to do this with vascular surgeries or others that hemorrhage was more likely to be life-threatening.

[StephanieM]

We perform PAT extensions as long as the patient has not been transfused or pregnant in the past 3months, and the PAT testing is performed within 10 days of surgery. (i.e. if they come in 11 days prior to surgery, they are denied) The preadmit nurse must sign the questionnaire and a picture of the patient with the patient's signature with a witness signature must accompany all the PAT extension request paperwork and the blood bank armband. If the extension is approved, we send the approval form, patient picture, and armband to SDS. If it is denied, same day surgery will only receive the denial form. The denied patients will have to have the testing performed the day of surgery.

[Brenda K Hutson]

Do you extend specimens (given appropriate criteria) for your inpatient surgeries? If YES, why not use the same extended policy for Outpatients? Extending specimens has become the trend as Physicians try to better accomodate their patients; especially those that live far away and/or are very ill.

Brenda Hutson

Does anybody extend the time limit for type and screens on patients having outpatient surgery? We have some new surgeons that want their patients to come in 1-2 weeks prior to surgery for their pre op lab work. Because of the time sensitivity of Type and Screens, they have started waiting until the actual day of surgery to order the type and screen. This just seems like a disaster waiting to happen. This morning our phlebotomist was drawing a patient's blood while the transporter was waiting to take them down to surgery. I was wondering how other hospitals had dealt with this same problem? Thanks for your input.

[Josephine Merka]

We do the same. We extend our specimen 3 days after the actual day of surgery if:

1. NO.. recent tx (3 months prior)

2. NO pregnancy (recent or last 3 months)

3. No hx of Positive IAT, or antibodies..

[R1R2]

We do the same. We extend our specimen 3 days after the actual day of surgery if:

1. NO.. recent tx (3 months prior)

2. NO pregnancy (recent or last 3 months)

3. No hx of Positive IAT, or antibodies..

Can you explain #3? I would think you would want to include these patients.

R1R2

[StevenB]

Does anybody extend the time limit for type and screens on patients having outpatient surgery? We have some new surgeons that want their patients to come in 1-2 weeks prior to surgery for their pre op lab work. Because of the time sensitivity of Type and Screens, they have started waiting until the actual day of surgery to order the type and screen. This just seems like a disaster waiting to happen. This morning our phlebotomist was drawing a patient's blood while the transporter was waiting to take them down to surgery. I was wondering how other hospitals had dealt with this same problem? Thanks for your input.

"Because of the time sensitivity of Type and Screens..." I was wondering if you could explain this statement. Are hospitals held to a different standard, than...say...Reference Laboratories? As far as I can tell, there is not a separate section in the AABB standards that says "if you work in a hospital, Type and Screens are only good for X amount of days in the patient not transfused, or pregnant within the last three months and must be repeated after said time."

If you Type and Screen a patient, and they do not fall into the 3 month issue, that Type and Screen result IS GOOD until the patient gets pregnant, or transfused, regardless of how long that time period is. In the untransfused/not prego patient, there is ZERO reason to repeat the T & S.

Performing a Crossmatch on the individual who comes in on day zero for a T & S, and returns on day 20 (for example) for surgery is a whole other consideration. The question of whether the sample collected on day zero is still good to use on day 20 is impacted by couple of things (at a minimum): Can you tie-in the original sample with that patient and does the manufacturer's insert allow testing on a sample that old?

Perhaps I am just misinterpreting the question. But if it is standard policy in the hospital setting to repeat T & S's on patients just because some arbitrary time frame has been established, then, in my opinion, there is a whole lotta unnecessary testing going on out there.

Now, I do not work in a hospital blood bank, so I guess there may be some "standard" that I am not aware of. If so, I'd appreciate it if someone could give me a quote or reference so that I might educate myself.

[ckcheng]

extend T&S for outpatients is different from inpatients. Additional things need to consider, besides no transfusion in 3 months, negative Ab screen (both historical and current) and not pregnant, are

(1) same patient when come back weeks later?

(2) able to keep the original crossmatch sample 7 days after the transfusion?

CK Cheng

[Mabel Adams]

For all of you that are drawing samples more than 3 days before surgery, how do you document that the patient has been neither pregnant nor transfused in the prior 3 months?  Has anyone found a way to do this electronically rather than on paper?  If on paper, do you require the patient's signature?  Does this signature become part of the patient's chart?

[Dr. Pepper]

We ask that question during their preop interview. It gets recorded on paper, then we answer a lab-eyes-only test in our preop type and screen battery. No signature that I'm aware of.

Edited March 19, 2015 by Dr. Pepper