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Labeling Uncrossmatched/Emergency Issue blood


rcollins

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Hi Everybody,

Opinions please...

For normal, crossmatched units we label our units with an adhesive hollister label that has all the required info (handwritten) and we send a computer generated "transfusion slip" (we have Meditech magic) with the unit (unattached). For emergency issue, I've told the techs that we just need to apply our bright orange "uncrossmatched" label and send the transfusion slip with the patient information on it. I've gotten some differing opinions who say that we should still apply the adhesive handwritten hollister label to the unit so it shows exactly who the uncrossmatched blood should be transfused to. I guess we'd have to cross out the "compatible" wording.

What do you all think/do? I believe it will take precious extra time to handwrite a hollister label and stick it on an uncrossmatched unit, but I certainly see the other viewpoint too, and I want to follow requirement guidelines also (we're CAP and AABB). We're a small hospital with not a lot of opportunity to issue uncrossmatched blood. Extremely small chance we'd ever have two traumas requiring emergency issue at one time.

Becky

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When I provide emergency release, uncrossmatched blood - it goes out of here with no paperwork and an uncrossmatched label attached to the unit. During our Trauma accreditation process we were lauded for this approach. As I told my techs - the pt needs the blood not the paperwork so we do not delay emergency release. The paperwork follows at a convenient pace. We usually get the MD signature for the emergency release after the excitement has died down. We are also a very small institution and so have few opportunities with the unxm process.

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Just don't ever issue type-specific uncrossmatched blood without very thorough patient ID.

Thanks Mabel, good point. Maybe that's just the compromise I was looking for. I think O negs will go flying out the door and anything beyond that will have patient specific information attached.

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No patient information at all attached to the O negs? It takes us about 5 minutes (mediware) to do a quick registration and assign four O negs to a patient, pack them in a cooler and head down to the ER.

With no patient ID on the units at all, how do you know what patient they are being transfused into? ER could hang them on anybody. Are your ER associates responsible to log what unit goes to what patient? I am surprised that CAP and AABB approve of such a process. I wonder what the FDA would say about it.

Having said all that, we are not to picky on getting the docs uncrossmatch release form back right away. we do not even send it down unitl after the situation has stablized.

Scott

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Here's one of my biggest worries with not worrying about ID on emergency released blood. What if the planets all lined up in your small hospital and you had to issue some crossmatched A pos blood to the ED around the time you issued the universal donor blood. What if the nurse grabs the A pos blood thinking it is the uncrossmatched blood and hangs it on the emergency patient without checking any ID? She/he is not likely to notice something that is missing like a a bright orange uncrossmatched blood sticker. The A pos unit would have patient ID on it but if she/he isn't looking to check it, would she notice? People's assumptions can be very powerful and often contribute greatly to major errors.

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Hi Everybody,

Opinions please...

For normal, crossmatched units we label our units with an adhesive hollister label that has all the required info (handwritten) and we send a computer generated "transfusion slip" (we have Meditech magic) with the unit (unattached). For emergency issue, I've told the techs that we just need to apply our bright orange "uncrossmatched" label and send the transfusion slip with the patient information on it. I've gotten some differing opinions who say that we should still apply the adhesive handwritten hollister label to the unit so it shows exactly who the uncrossmatched blood should be transfused to. I guess we'd have to cross out the "compatible" wording.

What do you all think/do? I believe it will take precious extra time to handwrite a hollister label and stick it on an uncrossmatched unit, but I certainly see the other viewpoint too, and I want to follow requirement guidelines also (we're CAP and AABB). We're a small hospital with not a lot of opportunity to issue uncrossmatched blood. Extremely small chance we'd ever have two traumas requiring emergency issue at one time.

Becky

Hi, Becky. We use Hollister system also but not for uncrossed units because they are not crossmatched. We set up 2 O neg for emerg release with paperwork attached. If there is a need, everything is ready to go. All we need is patient name, MR# and we issue. Once a week (or after use), we change out the 2 O negs to fresher units. This process works well for us (community hospital) and mimics the process in my previous trauma center experience,

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Thanks for your responses!

Scott, a transfusion slip with the complete patient demographics and unit information go with the unit, it's just not tied, attached, stuck on, etc. The patient's info is verified when they bring down their physician signed uncrossmatched blood form when they're picking their units up. The units are issued through the "emergency issue" function in Meditech Magic to registered patients. So all of the information is linked in our HIS. Certainly ER is responsible to "log what unit goes into what patient." When they're infusing, they match what is on the transfusion slip to the unit and the patient's wrist band.

After you do your 5 minutes in mediware assigning the units how do you actually label them?

Mabel, I see where you're coming from, but I think if a member of clinical staff comes into the blood bank with our standard form for blood for Mr. Apos, is issued and reads back form with Mr. Apos's info with BB staff, takes the Apos unit with Mr. Apos's patient information all over it and runs into some other room and hangs it on some other patient without looking at anything then we're in big trouble!

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Good positive patient ID as you have described should prevent errors. Not every place can require a pick up slip with patient ID because the patient may not yet be identified, but that is great that you have a system that is so thorough. It makes us all able to argue that we shouldn't give up good processes for speed.

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Our software, HCLL, will print out a sticker with patient info (as much as we have) on the label, and no indication that it is crossmatched. As a matter of fact, we have a stamp that prints "UNCROSSMATCHED" in caps and in red, so it is obvious that it is emergency released blood, either O neg or type specific.

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