Typenex bands

[bldbnkwnmh]

Hello!

 

I was hoping to gain some incite in the use of typenex bands.  I came from a reference laboratory that also had an offsite transfusion service that based everything off the medical record number.  Now I work at a place that uses typenex bands and I will admit that I find them confusing.  The current practice here is band any patient that has blood bank testing ordered which will require product or think might require product.  These are technically good for three days.  However if more specimen is required, then we reband the patient (I know this sounds redundant but we do this to track each specimen).  We also band patients that are admittted as some type of alert be it stroke alert, etc because they are unknown at that point.  My question is...is the standard practice to reband anytime a new specimen is required or do you honor the three day rule and just label it with the current band label (in addition to the required patient information) until the three days are up?? Also if an unknown patient is admitted and blood bank testing is performed with patient labeled Jane Doe, how do you correlate the band labeled Jane Doe once the patient's information is entered into the computer system especially if more product is ordered?  Any help would be greatly appreciated.

 

Thanks 

[Mabel Adams]

Ah well, you have fallen into the amazing world of blood bank banding.  Places use both systems, either a new band with each specimen or a band number for the hospital admission and new specimens are assigned the same number.  There are pros and cons to each.  IMHO, no system is any better than another if the humans do not adhere to both the policies and the philosophy of proper patient ID.  A minimal system can be very effective if everyone follows it and a great high tech system can be deadly by giving a false sense of security to those in charge while those on the front lines find more convenient workarounds than using the system as intended.  

 

We have a policy of redrawing and rebanding trauma patients after they are identified.  There are regulatory standards that sample ID must match orders plus you don't want nurses to conclude that it doesn't matter what name is on the BB band so they ignore it when it is wrong some other time.  Otherwise, you have to update all of the records, specimen etc. and document that you have verified everything.  Some do the latter; we have chosen the former. 

 

There are some other threads on here that cover a lot of the same territory if you are interested in some other angles.

[David]

Despite my dislike of people who feel everyone else wants to know their opinion, you're gonna get mine, finally.  i have been an advocate of BB banding for most of my med tech career, which started when some of you were in diapers.  If you want stories where they prevented a mistransfusion let me know.  We band everybody that has BB orders, with a (very) few exceptions.  I understand the K.I.S.S. argument and when you find a system that everyone uses as intended every time, we can talk.  Until then I'll like some redundancey.  The fact that the band is labeled and applied to the patient at the bedside at the time of draw greatly increases my, and my staffs, comfort level that the unit of blood we return to the nurse will be given to the patient bearing the same number.  Can the system be 'jobbed' and not provide any benefit?  Sure, but since we've not had any transfusion accidents here in my 12 year tenure I think it does something good.  We transfuse   20-22,000 units/year so we have able opportunity to screw up. As Mabel points out, though, any system is only as good as the people using it.

[Brenda K Hutson]

I agree that there are Pros and Cons.  I have worked in Blood Banking 30 years, a number of places; some of which used these bands and some which did not.  A few of my thoughts:

 

1.  What I get the "most" frustrated with is places that choose to use them; but then don't use them as intended (i.e. if it is an outpatient or pre-op being drawn ahead of time, they don't band the patient at that time because the patients don't like to walk around with an armband on).  Sorry, that misses the point!  And it is because most of the places I have worked at that use these, refuse to use them as intended, that I can "take them or leave them."

 

2.  As far as re-banding with each new draw....again, that would meet the "intent" of the armband's use for safety.  It is supposed to be a closed system; meaning that "at the time of draw," while the patient is still in their presence, they should be labeling the specimens, applying the armband, and checking it all against each other.  Once the phlebotomist has left the presence of the patient, it is no longer a closed system.  So for example, if I want additional specimens because the patient ends up with an antibody, I require them to re-band the patient.  The tricky part there is performing your Type and Screen and Crossmatches on a specimen for which the patient has an armband on so it matches in the computer and the paperwork.

 

3.  I know of at least one instance where those bands saved the wrong patient from being transfused; because it was my error when I was a phlebotomist in college (wasn't grilled into me that you never go into the room and say "are you so-and-so;" you should always ask the patient to "state their name."  So a little old lady shook her head "yes" when I asked her if she was so-and-so; which she wasn't.  When the Nurse went to transfuse, there was no arband on the patient; that is because the "true" patient had been moved to another room.  Boy did I learn my lesson!  And to think I then became a Blood Banker! Ha Ha

 

4.  But all of that being said.....I have to say, I am not a big fan of those armbands.  Ironically, it has been the smaller Institutions I have worked at that use them; not the large Medical Centers.  And you would think; the more patients there are, the more risk of errors.  But I have seen errors everywhere; for a number of reasons (wrong patients drawn even with armband system; blood sent to floor on wrong patient; blood sent to floor on correct patient but Nurse did not do checks and hung blood on wrong patient; etc. etc.).  Sometimes I think there is a "law of maximums;" whereby the more paperwork and checks/balances involved to accomplish something; at some point, it becomes information overload and you can actually increase the chance of errors because people don't focus on the most critical elements.

 

5.  But there are new, better systems coming out....and at my last place, the ER had started using a palm scanner!

 

Brenda Hutson, CLS(ASCP)SBB

[carolyn swickard]

I'm just going to say - I really don't ever want to work in a hospital without a Blood Band ID banding system.  Unless you have gone to one of the new (very expensive) systems that allow the patient to be identified by barcode scanners at every point of the procedure (and again, how many "shortcuts" can be found even to those procedures?) - the separate BB ID band is the only thing that closes the circle between the draw - the pt, and the unit that goes back up to the pt.  Yes, they are complex (we use the new Typenex barcoded band even though we do not yet have a BB qualified bedside barcode ID scanning system) and yes, we have redraws because the draw are not always completely correct (requires a redraw), but because we also require the RN to go back to the bedside and obtain that barcode number before they come down to pick up a unit and we compare the barcode numbers before releasing the unit, we have been alerted to errors several times that could have lead to a wrong patient getting the wrong unit.  In the more than 20 years I have been here - we have not had that error make it to the point of transfusion - for which I am infinitely grateful!  Yes - someone could still give the wrong unit to the wrong pt, but in order to do so, they are going to have to break a lot of rules - probably deliberately and I would have no trouble getting rid of someone who was willing to make that many "shortcuts" in the transfusion/patient ID processes.  Just my 2 cents worth.

[Richard Kriozere]

Are you all  using bar coded version of Typenex?  If soo, how do you read and verify the random bar code numbers on Typenex from bags to patient? I’m having a hard time seeing the relationship between the bar code numbers on the Typenex product and any way to scan/verify the bar coded number.   Mabel, thank you for replying to my question.  I’d love hear from anyone else on this topic?

 

Thanks so much!

 

-Richard

[Mabel Adams]

The only bedside transfusion module I have ever seen was a demo of the Meditech TAR.  It had a field where you could require the BB band number to be entered as I recall (in addition to scanning the barcode on the patient's hospital wristband to bring up the right patient to start with). The data from the Meditech BB module fed into the TAR so it knew whether that unit was crossmatched on the selected patient or not.  I assume, but can't remember, that you could require that the BB band number match the one that came from the BB computer as well before the system would allow you to proceed.  By having that number scannable you reduce the chance of typing it in wrong and getting an accidental mismatch and it is faster.  I don't know of any way that the barcoded BB band could take the place of a barcoded hospital band.

 

To respond to some earlier posts: I once issued blood  (May 1982 to be more precise) on the wrong patient and the nurse took it up and hung it on a patient with a different name, DOB, hospital number and BB band number than was on the bag.  In the follow-up she said she checked the BB band.  AB to an O.  Not pretty but not  fatal thankfully.  We improved our sign-out system significantly and I have been an ID Nazi ever since. I saw a couple other times where blood was hung on the wrong patient even though there was a band number that didn't match--sometimes the patients had similar names.  I also saw phlebs move a band and decide to use a new band with a different number (without drawing a new sample).  This error was caught when they hung the 3rd unit of blood! Fortunately it was the right patient.

 

Currently, we use a band number per visit system (not per specimen).  One thing that does is help verify that later samples came from the same patient because the phleb copies the band number off of the patient when labeling it.  This is also a double-check when drawing transfusion reaction specimens that the first sample was on the same patient.  Because the phleb gets the band number from the patient's arm on subsequent specimens, not a card saved in the lab or some such, there is still a "closed loop" for the specimen.  It also makes it easier if you use a band number for FFP and plts so you don't have to worry that someone will have cut off the band because it was outdated even though you could still use it for non RBC products.  You also don't accumulate numerous bands on a patient and have the nurses trying to find the right one.  With this system I have seen a tech not realize that the patient was redrawn and rebanded and set up the blood on the old specimen (OP transfusion 2 days later and he had cut the first band off).  The nurse hung it anyway because she didn't think the BB band number was that important because we sometimes called to see what band # they were wearing if the patient was getting only platelets.

 

I have seen a patient saved from an ABO mismatch by a last-minute ID check after the unit was spiked in OR but I don't know if the band number had much to do with it since the names were different.  I have heard reports at my current workplace that there have been "saves" by the band number.  I also see that people can get complacent about all other steps in the issue process because they trust that a band number mismatch will prevent mis-transfusion.

[bldbnkwnmh]

^{I appreciate all the responses!    My main concern is when we have the "alert" patients that are unknown.  How do you all handle it when their information is later put in the computer system?  Do you re-band them at that time and repeat all blood bank testing such as the type and screen if more units are ordred?}

[AMcCord]

We don't reband them for Blood Bank, but we do verify their ID with the new hospital ID armband to make sure that the person they say is the trauma patient is the same patient wearing our band from the ER (or where ever). We can see the name change in Paragon from the trauma ID (which is a Typenex band number issued by ER). The next step is to match the trauma name/number we got initially with the new name at bedside and our Blood Bank ID band. If there is any doubt whatsoever or anything funky about the ID, then we would start from scratch - new band, new draw and retest.

Edited May 24, 2013 by AMcCord

[Mabel Adams]

AMcCord,

 

Do you change the name on the BB armband once you get accurate ID or just leave it with the trauma ID on it (assuming everything matches to your satisfaction)?  Do you change all ID on units already set up or leave it with the trauma name?  I worry that if they wear a BB band with a different name on it that nurses will decide that it is generally okay if the name on the BB band doesn't match the unit they are hanging.  And then they would be looking at band # R12336 and think it matches R12366 on a different patient and not worry about small discrepancies in the name and hang the wrong blood.  This is one case where using a new band for each specimen saves you from having this name discrepancy persist for weeks like ours would.

[AMcCord]

Our BB armband is currently a band that we make ourselves. It has 2 stickers on it - one says 'this belongs to Blood Bank - don't cut it off or else (politely, of course); the other is a sticker with a unique number (example:B39876). The unique number is covered with a protective clear sticker so they last longer. So, no name on the BB band, just the number. The format of the number on the BB band is not the same as the format on the trauma band or the hospital ID number, so it is truly unique. The number is never re-used at any point, so there would never be 2 patients with the same or a similar number. 

 

The trauma band is a yellow Typenex band, no patient name. The Typenex number IS the name until the patient is properly ID'd. When a unit is checked at bedside for transfusion in the ER, the yellow band number and the BB band number are the 2 independent identifiers. Once the trauma patient gets ID'd they get a regular hospital ID band. A tech correlates the trauma band ID with the hospital ID and the BB ID. There is a phlebotomist and usually a runner assigned to every trauma patient on days and evenings so the phlebs are almost always present to observe the rebanding/ID process. On nights, it can get a little trickier, though we still usually have someone in the right place to observe the ID process. If this part gets messy (bands missing before we get things matched up), we start over with the ID process, redraw, retest, though that usually isn't necessary.

 

We do not have a Blood Bank computer, so the original slips are often handwritten if blood is going out the door fast, typed if we have time. Once we have the real name, we retag any units that were tagged previously. Any newly crossmatched units are tagged with the new/real name and the BB ID band number, no trauma number. If a patient goes from ER straight to the OR, we may be transfusing under the trauma number/BB number in surgery and briefly in ICU. I can't remember the last time we had an unidentified patient admitted to a regular floor - we are lucky there. There should never be a name or number to ignore.

Edited May 28, 2013 by AMcCord

[Kathy]

While we are on this subject, we currently require all of the following information on the specimen, the patient blood band, and the big Typenex card: Patient name, MR#,DOB, Typenex #, phlebotomist ID#, witness ID#, date and time of collection.

 

I really wonder what is the point of putting all of this information on the big Typenex card. Would it be sufficient to have it on the blood band and the specimen?

[Richard Kriozere]

I would like to know if anyone actually scans the bar code on the new Typenex.  What device you use to do this and does this bar code have a matching in you blood bank computer system?

 

Richard

I would like to know if anyone actually scans the bar code on the new Typenex.  What device you use to do this and does this bar code have a matching in you blood bank computer system?

 

Richard

[Likewine99]

We used to use Hollister's banding system and the nurses hated the big cards because the felt the info was redundant and I saw more hand written mistakes that I could count.

 

They were also expensive so we moved to a home grown version which worked just as well.  In the many many many years I have worked in the BB I have seen many many many errors caused by both a nursing and BB staff.

 

It doesn't matter if you re-band at 72 hours or keep the original number.  The most important part is adherence to proper labeling AT THE BEDSIDE.  A dedicated blood bank number is by all means a great way to help reduce transfusion errors.

[AMcCord]

 

It doesn't matter if you re-band at 72 hours or keep the original number.  The most important part is adherence to proper labeling AT THE BEDSIDE.  A dedicated blood bank number is by all means a great way to help reduce transfusion errors.

 

This is my feeling also. Consistency and enforcement of policy are so important.

Edited August 8, 2013 by AMcCord

[Sandy L]

 

Richard

I would like to know if anyone actually scans the bar code on the new Typenex.  What device you use to do this and does this bar code have a matching in you blood bank computer system?

 

Richard

Edited August 9, 2013 by Sandy L

[Richard Kriozere]

^{Thanks...that was very good information and useful.}

 

^Richard