Pros And Cons Of Different Blood Bank Banding Approaches

[Mabel Adams]

I would like to try crowdsourcing to help me identify the pros and cons of two different approaches to using a BB banding system. Please include input on recurring OP transfusions, traumas, regular IP transfusions, use in multi-hospital systems, pre-ops drawn weeks in advance of surgery and anything else you can think of.

 

Approach A: One BB band is attached to the patient when the first BB sample is drawn for that admission and subsequent specimens have that same BB band # attached.

 

Approach B: One BB band is attached to the patient for each specimen collected and a different band with a different number is used for any subsequent specimens drawn.

 

Obviously share any other related wisdom as well, please.  Feel free to include if you use your banding system for all products or just crossmatched products (RBCs).

[KKidd]

We use Approach B. The armband number is attached to the specific crossmatch sample with the corresponding draw date/time and phlebotomist. This allows us to trace that information easier. When entering test results, we enter the armband number of the sample used. It is not used for plasma products.

[AMcCord]

We use approach A. An advantage for inpatients - once we've put that band on and performed a blood type, we can give platelets and FFP without additional testing until the patient is dismissed or the band is removed (we have nursing service well trained to leave bands on). If a crossmatch is ordered, the phlebs check in the LIS to see if the patient has had a previous Blood Bank test ordered. If so, they check with Blood Bank to make sure there is an appropriate sample (they know that 72 hours is the magic number for specimen outdate). We eliminate unneeded redraws. I've thought about the new band per sample, but I don't see a big advantage for it. We are not so large that it's complicated to keep track of specimen outdates - if we were having problems with that, I would reconsider. 

 

For outpatient transfusions, we put the same ID band on when we draw them and they wear it until they come in for infusion. If for some reason the infusion clinic patient is admitted, that ID band is good for additional inpatient transfusions. If they don't want to wear an armband we can offer them the ID system we use for pre-surgical testing. For pre-surgical patients, we have an ID card and a form that is filled out with patient info and signed by the patient. The card has to come back with the patient the day of surgery, at which point we ID the patient, have them sign the card in our presence to compare with the form filled out when they were drawn and armband them with the ID number that was assigned with the ID card/form. The ID band/number we use for pre-surgicals is the same one we use for inpatients. 

 

ER patients get the same armband, even if they are a John or Jane Doe. In the case of the Doe patient, they are assigned a MR# by ER when admitted. Once ID'd, if they are a patient new to us, we add the real name to their records. If they are someone we've seen before, then we have to merge records, but that armband for Blood Bank is still the same, still on their arm. Everything crossmatched for them is still available without a lot of fuss.

 

This system works well for us. We try to keep it as uncomplicated as possible by using the same armband for everybody and the same ID number throughout the admission. If a hospital armband is changed for some reason (admission error, fresh band but on wrong patient) and the name is not a match with the ID number we labeled the specimen with, we'll catch that when the patient is ID'd for transfusion. Our ID band number is on everything associated with specimen, testing and transfusion. If the number was changed with every draw, I don't think we'd be able to do catch those as easily.

[Deny Morlino]

Same here as AMcCord with the exception of the card system for PAT patients.  Ours wear the bands.  I do like the card system and will give that consideration!!

[PAWHITTECAR]

We use option B with a new armband for each specimen. no armband needed for FFP or Platelets.

[David Saikin]

We use option "A"; recurring pts get a new band with each new specimen.

[David Saikin]

 interesting that I have a line through my response . . . We use option "A".

[John C. Staley]

We use option "A"; recurring pts get a new band with each new specimen.

David, I just thought the line through it meant that this is what you were doing but didn't like it.  Subtle but direct!     

[Mabel Adams]

David, Deny & PAWHITTECAR can you share any benefits or risks of your current process or why you don't use the other one?

[PAWHITTECAR]

Mabel, truth be told I inherited this system when I took over last September but it was working so I have left it alone (too many other big things to tackle).  I do like the idea of tying the armband to one specific specimen rather than to an admission.  It makes them have to take a step back and check something else before a transfusion.  I think that causing them to slow down is a bonus.

 

We also do a verified type from a second "stick" before transfusion (if we do not have a history). 

[Deny Morlino]

Mabel,

Maintaining the same number throughout the "stay" is our historic practice.  Our phlebotomy team is VERY good about checking with blood bank to be certain that the BB number is still valid, adding the BB number to any EDTA tube drawn from the patient in case a new specimen is needed for testing, etc. 

The BB band is a lifeline during trauma/"Doe" situations.  We are a smaller hospital in a rural area so large number traumas are rare.  Using the BB number as our source of consistancy throughout the name change/confusion possibilities has proven to be invaluable on multiple occassions. 

We are not part of a multiple hospital system (very surprising today I know), so I have no information on that part. 

Our Pre-op is 14 days ahead of time with the exception of maternity.  The band remains on the patient the entire time.  This would be helpful in avoiding the "insurance card sharing" that has been mentioned on this site many times.

Hope this makes sense and helps.

[SMILLER]

Here we must have a blood band on the patient that matches the specimen that is used for the crossmatch.  When the unit is hung, the BB number on the tag is matched to the armband.

 

If the armband is removed, there is nothing to match with, so there can be no trasfusion until there is another specimen drawn (and armband applied) and the T&S and crossmatch is redone.

 

Exception with an armband removal is when the person removing the old band (for whatever reason - happens in OR occasionally) immediately applies a new one -- we have a armband change form for this that becomes part of the patient's record in BB.

 

For T&S on pre-admission outpatients, they wear the armband until they come in for the procedure, then we extend the T&S outdate 3 days if appropriate.

 

For plasma and platelets, as long as they have the armband on (current admission) we will transfuse.

 

Scott

[Mabel Adams]

Next question: what BB bands with barcoded band numbers have you found that remain legible after being on the patient for sometimes weeks?

[lalamb]

We use option B : new specimen, new TYPENX #.  We band for FFP.

 

Our bands don't stay on for weeks so I don't know...

[Eagle Eye]

Next question: what BB bands with barcoded band numbers have you found that remain legible after being on the patient for sometimes weeks?

I know typenex makes barcoded band. I tried their product once (regular not barcoded) but only for 4 days as our policy we keep the band for only 3 days. Some nurses complained that the ink was gone after patient took shower and it did not make sense as the band was laminated so I tried it. We write the information with the smudge proof ink.

What you can do is get some samples from typenex (or any other company), put them on as you would put on patient and see how they are after XX days. (do all the routines eg, taking shower with band on).

[tupton]

We use option B.  We are currently evaluating some of the new Typenex barcoded bands.

[Maureen]

Has anyone tried or are using a mechanical barrier - such as FinalCheck or Bloodloc - with a Bloodbank band?

 

If so, is the system effective?

Edited July 2, 2013 by Maureen

[mollyredone]

We use A.  As long as the BB info is legible it is used for the entire stay, with new specimens being drawn as needed.  Our phlebes also are trained to write the BB number on EDTA samples.  Our nurses have to document that they have checked the BB band number before they come down to get a unit of blood (it's written on the "unit ready slip" we send them)  We only also 3 days prior to surgery for OP, since we are a rural hospital.  It's not like they have to travel 100 miles to have surgery here!  As for other OP, we have a lot of frequent fliers from oncology.  They sometimes keep the same band on for three days and we will TS and crossmatch on Monday and they get transfused.  If they get transfused on Wednesday, we use the same specimen from Monday, and the transfusion date gets changed for billing.