Pre-admission testing

[goodchild]

This question is specifically for people who require two blood types on record to transfuse a patient (i.e.: second unique collection to verify blood type).

How many of you guys accept blood type testing records from outside laboratories as a "Retype" confirmation for your pre-admission testing people? The process improvement team from the OR has set their sights on us and in their eyes it is ridiculous that we require people to come specifically to our facility in advance for the type and screen, and draw a second specimen (if no previous history) on the morning of their surgery to verify blood type.

Anyone willing to share their facility's perspective, their personal perspective, or some other useful commentary? :tongue:

[David Saikin]

There are better methods to validate patient transfusion safety than 2 independent venipunctures . . . but I would not accept a blood type from an outside source (even the Red Cross).

[goodchild]

What do you see as a better method out of curiousity?

[David Saikin]

A barrier protection device - either RFID, BloodLoc or Final Check. With thte last 2 you get a combination lock, the code for which is on the pt's ID bracelet. The lock can only be opened at the pt bedside using the combination on the id bracelet. No bracelet, no blood. the lock doesn't open - either we are transfusing the wrong pt or the BB tech entered the wrong combination.

Remember, that CAP standard is only looking for a process to prevent misidentification - the 2 separate ABORhs were only one suggested way of accomplishing this. Barrier protection is the preferred method.

[John C. Staley]

David, one thing to keep in mind is that any system is only as good as the buy in of those using it. Most nurses have a pair of scissors in their pocket and your barrier is no protection against that. If they are in a hurry (see OR and ER for definition of "in a hurry" ) the scissors come out and the transfusion occurs. I'm sure you have safe guards in place but again, they are only as good as those using them. Nothing is fool proof and there is no end to the fools to prove it so in my book diligence and training are as important if not more so than the specific process used. Also, I'll say it again, compicating a process never made it better.

Personally, I think the barcode actived, dispensing refrigerators are the way to go. They are simple and hard to get around. Nurses can't access them with scissors. Down side is the expense but that should be getting better.

[David Saikin]

I agree John - and I am waiting with baited breath to get one of those blood bank vending machines (my v.p. thinks I'm daft).

[tbostock]

We don't accept a blood type from any other facility. Most patients have their PST testing at our facility, so the day of OR is our second specimen. If not, then the day of OR is the first specimen, and if they should need blood during surgery (which is very rare) they would be given type O until a confirmation tube could be drawn/tested. We don't give a lot of blood here during surgery, but in recovery or the next day, so there is usually a CBC tube drawn by then for us to use.

[Eoin]

We have a system which won't give access to the Issue Fridge without user ID and patient ID. It will then open if there is blood for that patient. Emergency O Negs are accessed through a different ICON. We have the tracking PDAs on the ward, so trhere is then a check between patient and unit and the good to go is given if it is blood for that patient. That unfortunately doesn't get around the WBIT (wrong patient bled initially). We shortly will be getting 2d barcoded patient armbands which will be put on at admission (waiting on the software). Then the PDAs can be used to scan that wristband and produce the labels at the time of blood draw. In the interim, we issue a transfusion armband (with 2D barcode) with the compatibility paperwork. British Committee for Standardisation in Haematology (BCSH) guidelines for this year now recommend second draw for confirmation, unless previous record agrees, so we may have to implement that as an interim measure. Unfortunately if you read SHOT reports, WBIT still occurs, so does need to be closed out. I would be interested in how many have a second nurse sign as having checked identity and labelled tubes, documentation at time of blood draw as a means of closing this loophole, and is it accepted?

Cheers

Eoin

[colebe2]

In our facility, we have patients come to Pre-admit testing (PAT) within 14 days of their surgery date. We have 2 phlebotomists available in our PAT lab for VP. At the time of collection, the patient's identification is verified by both phlebs, and their two unique identifiers are written on the tube. The sample is then sent to the BB, where 1 tech will perform the initial blood type, and a different tech will then perform the ABO recheck using the same sample. We will only abide by this protocol if the sample has both unique tech codes from the phlebotomists in PAT.

If in the event that only one tech has identified themselves on the sample, we require the patient to be stuck the day of admission prior to surgery to confirm the type.

I hope this is an appropriate idea for your facility.

Betsy Cole

BB (ASCP)

[DOGLOVER]

We do not accept a type from another facility unless it is one of the facilities in our system of 4 hospitals. We have computer look-up access to all of the 4. Otherwise it gets done again prior to surgery. If the patient came in for pre-op testing prior to 3 days before surgery the PACE nurses draw and order an ABORH confirmation sample. (We don't expect them to figure out if one will be needed or not). If within the 3 days and they do the Type and crossmatch we let the OR holding area know early in the AM who needs the confirmations drawn. Our medical director backs us on this and thats what makes it work.

[Sandy L]

We would never rely on a blood type from another facility as a 2nd ABO/Rh to qualify a patient for Electronic XMatch. We require ABO/Rh types performed in our facility on 2 separate samples. Until the 2nd sample is recieved, we would only crossmatch group O and would perform a serologic (Immed spin, if eligible) until 2nd sample is received.

[Dansket]

This question is specifically for people who require two blood types on record to transfuse a patient (i.e.: second unique collection to verify blood type).

How many of you guys accept blood type testing records from outside laboratories as a "Retype" confirmation for your pre-admission testing people? The process improvement team from the OR has set their sights on us and in their eyes it is ridiculous that we require people to come specifically to our facility in advance for the type and screen, and draw a second specimen (if no previous history) on the morning of their surgery to verify blood type.

Anyone willing to share their facility's perspective, their personal perspective, or some other useful commentary? :tongue:

Is your Transfusion Service accredited by STATE, CAP, AABB, JCAHO? Your accrediting agency (ies) may require that you possess a current copy of their CLIA license in order to use a specific reference laboratory test result for your facilites patients.

Do you have a Blood Bank computer system? If so, even if the test result form is compliant with the above, how would you get their ABO/Rh into your computer system in a reliable and timely manner? Direct entry of an ABO/Rh from a foreign document into your computer system bypasses all the ordinary checks and balances that your current processes incorporate.

We do a Type and Screen in advance and routinely collect a second blood sample (if indicated on the morning of surgery).