Crossmatch after Type and Screen

[butlermom]

Our OB/GYN department is located in another building across the street from the main hospital (and lab) so all blood products must be sent via pneumatic tube.  All OB/GYN patients have an admitting type and screen performed. The physicians are later ordering crossmatches claiming they have to wait too long for the blood if only the type and screen has been done.  The C/T ratio for OB/GYN is very high because of this.  We are trying to define a smoother process in which the physicians can have confidence that they will get the blood in a hurry if needed.  They have defined "a hurry" to be about 8 minutes!  I'm wondering if this is even possible with all the steps we must go through:  find patient's sample (if not electronic) and select a unit, remove a barcode label and segment from the unit, perform an immediate spin crossmatch, print a donor tag, compare request sheet with donor tag, issue the unit in the  computer then wrap it in a plastic bag and tie it shut, place unit in pneumatic tube and send.  Of course, this requires no other distractions for the ONE tech like issuing blood to someone who comes to the window or answering the phone.  In theory 8 minutes sounds do-able, but in reality it isn't working.

 

For other facilities who have already performed the type and screen and then have a stat order for RBCs, approximately how long is your process from receipt of order (phone call and required paperwork) to sending the blood through the tube system?  We use electronic crossmatching where appropriate or immediate spin.  (Patients with antibodies already have 2 units fully crossmatched.)

Thanks for your input and/or suggestions.

 

Kathryn

[Dansket]

Our goal was issue 2 units of RBC in a cooler into the surgery dumbwaiter is less than 5 minutes using the electronic crossmatch.  Over time all staff could do it in 3 minutes or less and some could do 1 unit a minute.  Of course a cooler was not used for RBC issued into the pneumatic tube system...

 

The timer started ticking upon receipt of a request to issue blood component printed on our blood bank printer.

 

We scanned a barcode printed on that form into SoftBank, performed the electronic crossmatch, printed a crossmatch tag and then scanned the crossmatch tag and bag into the blood issue routine.  RBC unit bagged in biohazard bag and put into pneumatic tube carrier. 

 

This process above did not require use of the patient blood sample.  No serological testing was done for patients who qualify for the electronic crossmatch.

[rravkin@aol.com]

You might consider keeping O Neg Emergency Issue RBC's ( 2 to 4 or other; your choice) that are pretagged for Emergency Patient (in your case, would cover ER trauma, if needed, and/ or L&D, or separate emergency issue units available for each); segments prepulled and labled with unit# lable for crossmatch after issue; and cooler/ ice and/or other means of tranport predetermined.

[David Saikin]

With no distractions we can turn around an ISxm in less than 10 minutes.  What is the transit time in your tube?  Does blood have a priority in the tube system? 

[John C. Staley]

If I had a complete T&S and blood was needed urgently I issued type specific immediately and performed the IS XM when the dust settled.  No sense on wasting O Neg when you have a current T&S on record. 

[rravkin@aol.com]

If I had a complete T&S and blood was needed urgently I issued type specific immediately and performed the IS XM when the dust settled.  No sense on wasting O Neg when you have a current T&S on record. 

John, I deffinitely agree as far as inventory management is concerned. However, we have OBG clinic opperating in a separate building from the BB and the OBG docs, I would think, want some assurance that when they need PC's emergently, they will get them. These docs, as you know, can be very anxious when the BB is in the same building; imagine how anxious they are in a separate building, and all understandably so.

[DOGLOVER]

If you are doing electronic crossmataches, could you not stock a small Blood Bank refrigerator in the L-D area with 2 or 3 O neg units and do an electronic xm if needed. Have a printer next to the fridge which would print out the label/tag for the unit. Of course, the L-D personnel would have to be well trained in taking the correct unit and labeling it. (that's why I say only O negs). You would need to have someone monitor temps.

[David Saikin]

   If you have a decent BBIS you get put a BB vending machine over there - it does the ISxm and the blood pops out if/when the appropriate criteria are met . . .  tell that to your OB docs and let them buy it - you would have to stock and maintain but it sounds like the perfect solution for them.

[John C. Staley]

John, I deffinitely agree as far as inventory management is concerned. However, we have OBG clinic opperating in a separate building from the BB and the OBG docs, I would think, want some assurance that when they need PC's emergently, they will get them. These docs, as you know, can be very anxious when the BB is in the same building; imagine how anxious they are in a separate building, and all understandably so.

 

I'm feeling a little dense this morning.  I can't seem to follow your logic here.  It dosen't matter where they are located, if they need blood NOW (as they like to shout) and you have a completed type and screen why would you hesitate to send uncrossmatched, typed specific RBCs.  If it truly is an emergency they will sign for them just like they would have to sign for uncrossmatched O negs.

 

In 30+ years I have seen my share of OB emergencies, my wife spent most of her career as a L&D nurse, between the two of us we can tell you more than a few horror stories so I am familiar with what can happen when the happiest of times for a family can go terribly wrong. 

[rravkin@aol.com]

John, thank you for your post and your wisdom. It is their shout for their need of blood that I have experienced myself, and was certainly trying to address in my post. I think that DogLover, for which I am one as well, and David Saikin probably have the better ideas here. If I could speak further about the logic; here, as I stated, the logic would be that the OBG docs would have some assurance that blood products would be available when needed despite their operation being located in a different building. This assurance would come in a written policy, a procedure, and practice that would directly address their needs and concerns.

Edited June 29, 2013 by rravkin@aol.com

[John C. Staley]

John, thank you for your post and your wisdom. It is their shout for their need of blood that I have experienced myself, and was certainly trying to address in my post. I think that DogLover, for which I am one as well, and David Saikin probably have the better ideas here. If I could speak further about the logic; here, as I stated, the logic would be that the OBG docs would have some assurance that blood products would be available when needed despite their operation being located in a different building. This assurance would come in a written policy, a procedure, and practice that would directly address their needs and concerns.

 

But would this be the case only if a crossmatch were completed on every patient instead of just a T&S?  It takes no longer to issue uncrossmatched type specific than it does to issue O Negs which is what my original post alluded to.  Apparently we are having a failure to communicate here.    OK, I just re-read your original post.  Are you suggesting that they keep O Negs on site at the OB/GYN clinic?  If so that would open up an entire new can of worms for them and one I personally would not want to deal with.

 

 Having just re-read the post that started this thread I see 3 possible solutions: 1) crossmatch every patient instead of simply stopping at the T&S at great additional cost for little or no benefit, 2) convince the OBs that in the case of a complete T&S there is virtually no reason to not accept uncrossmatched RBCs in a true emergency.  (This assumes that if the antibody screen is, infact positive, the appropriate steps are taken.) or 3) Store blood (either crossmatched or O Neg) on site at the OB/GYN clinic but this is not one I would recommend.  I have seen no mention of the transport time via the pneumatic tube in this situation but I would imagine that it can be measured in seconds.

[Mabel Adams]

John, the only caveat to issuing type specific blood in an emergency is, in everyone's haste, they give it to the wrong patient.  Then it is more likely to do damage than universal donor.   I think that would be more of a concern in the ED than in OB/Gyn but I wanted to throw that into the pot.