Accepting RH type results on OB patients from other facilities

[knelson]

We regularly see obstetrical patients that have had their prenatal labwork done at another facility. The only documentation of their blood type we frequently have is maybe a hand-written blood type on their prenatal record. We recently decided that we will no longer accept hand-written results as we have found a few that were incorrect or illegible. We now require an actual copy of the lab ABORH report (from a CAP or CLIA accredited lab). However, we now are wondering if we should not accept these results either. What if the other facility made an error? Do we want to risk trusting that result? What if they reported the patient to be Rh Positive and they are really Rh Negative and a Rhogam candidate is missed? What is your policy regarding acceptance of Rh type results on obstetrical patients that were performed by another facility?

[David Saikin]

We accept them because the docs have treated their pts based on these results. The biggest issue I have with this is the fact that one of our nearby hospitals still performes Weak D testing - they are getting the pts to be positive. If we are fortunate enough to get a T&S order on these pts we are calling the Rh= and giving RhIg. It can sometimes get a bit ugly when we have a disparity of blood types . . . Also, all the hospitals around us have stopped doing obstetrics so we get ALL the deliveries in a 40 mile radius . . . at least there is only one place that does Weak D.

[Malcolm Needs ☆]

WE NEVER, EVER, ACCEPT ANYONE ELSE'S RESULTS - FULL STOP. Supposing the blood was a wrong blood in tube sample.

[R1R2]

We regularly see obstetrical patients that have had their prenatal labwork done at another facility. The only documentation of their blood type we frequently have is maybe a hand-written blood type on their prenatal record. We recently decided that we will no longer accept hand-written results as we have found a few that were incorrect or illegible. We now require an actual copy of the lab ABORH report (from a CAP or CLIA accredited lab). However, we now are wondering if we should not accept these results either. What if the other facility made an error? Do we want to risk trusting that result? What if they reported the patient to be Rh Positive and they are really Rh Negative and a Rhogam candidate is missed? What is your policy regarding acceptance of Rh type results on obstetrical patients that were performed by another facility?

Is this for the 28 week dose only?

[Steven Jeff]

We never accept anybody else's results either. All investigations are repeated and we act on those.

[tkakin]

I have a story related to this. I did the blood type on the OB patient, and noticed it was different from what the hospital had in there record for her. I repeated the blood type on a different specimen, and it matched my typing. I called the floor to ask where they got the typing record from and she told me, she just made it up. She would change it after she got the report from me. They don't get to put blood types in the computer anymore. I do not recommend taking blood types from other facilities. I have had discrepancies with other labs as well.

Teresa

[Mabel Adams]

Wowza, Teresa!

[AMcCord]

We started drawing every OB upon admission and performing a blood type, reporting only the Rh type. We do it at no charge because we would never have gotten the physicians to agree to it any other way. We have caught several Rh neg patients identified as Rh pos from weak D testing performed at a reference lab. We have also caught a couple a patients where a clerical error was made at the clinic when their type was handwritten into their chart from a reference report.

On the plus side for us, if the patient needs an unplanned C-section, we have that nicely labeled specimen in Blood Bank ready to use. No more rushing up to draw the patient. Improves our turn around time tremendously. Has been working well for us.

[SMILLER]

!!!!!

[estiner]

We accept a copy of the lab results from a state certified laboratory for the 28wk dose. Interestingly we only get the Rh negatives and would not see the weak D's if reported as Rh positive. Giving Rhogam to a weak D patient is the decision of the attending physician. We recommend giving it to weak D patients but not all our physicians agree. If there is no certified report we perform the T&S prior to giving the Rhogam. Since we do not perform weak D testing on adults, those patients would be reported as Rh negative. Upon admission for delivery, Rh negative moms only have a standard T&S ordered.

[BankerGirl]

We NEVER accept anyone else's results for anyting! We document it in comments as an fyi and will investigate if we receive a different result, but I like to quote Fox Mulder, "Trust No One."

[Sandy L]

We require a blood type on every obstetric patient on admission. We see discrepancies with transcribed prenatal results with some frequency and would never rely on outside results.

[Malcolm Needs ☆]

We NEVER accept anyone else's results for anyting! We document it in comments as an fyi and will investigate if we receive a different result, but I like to quote Fox Mulder, "Trust No One."

Not even your reference laboratory's results?????????????!!!!!!!!!!!!!!

[knelson]

Is this for the 28 week dose only?

This would be for any admission or antenatal dose. However, most of the time we run into this issue is when they are admitted for delivery.

[AMcCord]

Not even your reference laboratory's results?????????????!!!!!!!!!!!!!!

Them I trust ..... though with a tiny pinch of verification..... they are human. I love my reference lab, of course!

[BankerGirl]

OK, I was refering to Dr.'s offices and "regular" send out laboratories, and specifically the abo/rh types. But even our specimens that we send to the reference lab have had the abo/rh typing done here prior, and they have never been descrepant.

[Eagle Eye]

All our first time OB patient gets discalimer that they need to second second specimen to verify ABORH on the patient (this is based on CAP checklist).

We do not accept anyone's result.

Any specimen we send to reference lab, we always do type and screen on the same specimen before send out.

[Malcolm Needs ☆]

OK, I was refering to Dr.'s offices and "regular" send out laboratories, and specifically the abo/rh types. But even our specimens that we send to the reference lab have had the abo/rh typing done here prior, and they have never been descrepant.

That comment was tongue in cheek. Mind you, we are human too (Reference Labs) and nobody is perfect.

[aafrin]

We too never accept any other facility's blood group report. We have also seen way many wrongly written/typed reports to believe any of them. We also do blood groups for health check-up patients (package) at our hospital and almost every week one or two patients come to tell us that their group was different from what we've reported - some show us their typed reports, others their work I-cards - and their those records are always wrong. We repeat their groups by finger-***** and voila! their group is changed to what we’ve reported. So sorry, but we will only believe blood groups done at our BB.

[jayinsat]

We accept results from our sister facilites as our databases are linked. However, those results serve as our "retype". We still must perform our own testing. Antibody/antigen testing is also trusted from our sister facilities as well as our reference labs. As long as you are using outside results as a confirmation of your testing, you should be good. I don't know of any facility that would treat based on results not performed in their own laboratory, at least from a blood bank perspective.

[LCoronado]

Same here. Last year we had a doc send her patient to us 3 times: once for RhoGam work/up, twice to verify her type since we reported it as "Rh positive, not a candidate for RhoGam," while the reference laboratory supposedly reported Rh negative. It appeared that the doc was reading the [negative] result of the patient's antibody screen from the office chart and mentally equating the word "negative" with the need for Rh Immune Globulin.

Also, we draw a Type and Screen on all new OB admissions, then a Verification tube if they have no history in our system. The OB department has been one of the loudest protestors, but they may change their tune after this weekend when one of their nurses drew her own patient but labeled the tube with another patient's name. This was caught by comparison to previous records.

Never a dull moment!

WE NEVER, EVER, ACCEPT ANYONE ELSE'S RESULTS - FULL STOP. Supposing the blood was a wrong blood in tube sample.

[Abraham]

For any blood product issued from our blood bank, we perform the testing. Results from other facilities are not accepted.

[R1R2]

We accept blood type results from other laboratories for the 28 week dose. We have not discovered any discrepancies. We have written procedures detailing the process.

[Mabel Adams]

We don't hand out RhIG from BB so the docs do what they want for the 28 wk dose. Although we don't do a blood type at delivery admission, we do a Fetal Screen on any RhIG candidate which would clearly tell us if the patient were really Rh pos. We do almost all of our region's prenatal testing so we trust that we are not missing Rh neg patients. Obviously we could make a mistake or one of the samples could be mislabeled. Seems like it would be a hard sell to charge for it based on only standing hospital orders and it isn't really legal to do testing for free. Maybe the "two types on record" principle should apply here too. Hmm. Something more to think about.

[Changezi]

I REMEMBER we discuse the same matter on FFP transfusion on previous record .

and most of us agreed on having repeat the group on every addmission once the patient leave the hospital . so when we are Rechecking on our own record how possible to beleave on other hospital record , so many cases discuss on that thread .

So always better to repeat the group+screening on each addmission .

my question is WHY to take the Risk ... ?