EMERGENCY RELEASE OF O NEG UNITS

[DAWNA1983]

Can anyone out there enlighten me on this topic? - How does your facility deal with emergency release of O negative units or any units where NO SPECIMEN is obtained by the ER or lab for compatibility testing.  I just came a meeting where NURSING wants to change the policy to add a variance to our policy about this.

 

I'm quoted them the AABB policy for compatibility testing even if blood was issued by emergency release.  They are complaining about obtaining specimens.

 

Thanks,

Dawn Arnett, MT

Kings Daughters Hospital

Madison, Indiana

 

[Gnapplec]

Sounds like your nursing staff will have to just deal with it and continue to complain, I don't think they can make this call.  They need to talk to your facilities medical director/laboratory pathologist.

[Marilyn Plett]

I would also look at what the Joint Commission has to say about this.  Nurses will frequently accept Joint Commission regulations even as they complain about other regulations.

[Liz0316]

They can complain all they want; as long as your patient has not expired, a specimen should be collected at the same time, or better yet, before they hang the first unit. We issue emergency O neg units a lot. We are a midsize community hospital in a tourist area right off the interstate. We often issue O neg uncrossmatched units prior to the patient being transported by Life Star.

We have  form that we start in the BB, patient ID, units, if any testing has been started, etc. Issue with the units. We have a computer battery, so we can issue the units and do the XM later. The ED gets the physician to sign the form that the patient is emergent and waiting for crossmatched blood would be life threatening. They sign the form and return it to the BB. A XM or type & screen is ordered in addition for testing and further units. The ED is very good about getting a specimen as soon as they can because if they fail at this process I will institute a Trauma pack with typenex bands...and they don't want this!

Just because nursing doesn't want to collect a specimen is no reason to compromise blood banking high standards.

[Malcolm Needs ☆]

They can complain all they want; as long as your patient has not expired, a specimen should be collected at the same time, or better yet, before they hang the first unit. We issue emergency O neg units a lot. We are a midsize community hospital in a tourist area right off the interstate. We often issue O neg uncrossmatched units prior to the patient being transported by Life Star.

We have  form that we start in the BB, patient ID, units, if any testing has been started, etc. Issue with the units. We have a computer battery, so we can issue the units and do the XM later. The ED gets the physician to sign the form that the patient is emergent and waiting for crossmatched blood would be life threatening. They sign the form and return it to the BB. A XM or type & screen is ordered in addition for testing and further units. The ED is very good about getting a specimen as soon as they can because if they fail at this process I will institute a Trauma pack with typenex bands...and they don't want this!

Just because nursing doesn't want to collect a specimen is no reason to compromise blood banking high standards.

Edited July 2, 2013 by Malcolm Needs

[Malcolm Needs ☆]

I don't know what happened there, but I was trying to quote the final sentence and say just how much I agree with your sentiments.

[Gnapplec]

Yes, Liz's last line is key:  "Just because nursing doesn't want to collect a specimen is no reason to compromise blood banking high standards."

 

Also sounds like the nursing staff needs re-educated on the purpose and importance of these specimens.

[tbostock]

Ridiculous...if the patient needs uncrossmatched blood, they are obviously bleeding. That's enough reason to get a specimen.

I agree with Gnapplec above, they need to understand how important this is for patient care. Quoting Blood Bank regs at them usually isn't enough in my experience.

[DOGLOVER]

• I can't think of any transfusion service which allow them to not draw a specimen. At my facility we give them O neg uncrossmatched units, then heckle them if we don't get a sample in a reasonable amount of time. They are usually pretty good about it.

[carolyn swickard]

I am with the others - you need a specimen as soon as possible.  We have become a "Stabilize and Ship" hospital and I am beginning the have troubles getting a specimen from ER when the patient leaves in a hurry.  Still ridiculous -  our last patient was here over 1 hour and took 8 units here and 2 units to go and they still couldn't get me a specimen! 

 

If your hospital is Joint Commission accredited, look their standards over and see if you can find something to pound on them with, AABB recommendations are very clear on the subject and it does endanger the hospital as a whole if you can't prove the blood did not contribute to the death or injury of the patient.  That said, maybe your Risk Management dept. could help you out.

[aafrin]

Our Policy states that we can issue 4 O Neg units maximum without receipt of patient sample, otherwise we will stop giving units.

 

Our A & E and OT are quite good about it and send the sample as soon as possible - mostly when collecting 2nd unit. 

[Brenda K Hutson]

I agree that unless the patient has expired, you need a specimen! I'm sure many others have stories like this, but I worked the midnight shift one night at a large Trauma Center. We gave the ER 2 units of uncrossmatched blood; they gave us a specimen. As soon as the Antibody Screen was completed and found to be Positive, i called the ER and spoke to the Physician, suggesting they stop the transfusion. She said they were already on the 2nd unit and the patient needed it. I then asked her to try and get a history. Just as I finished identifying the Anti-E and Anti-c, the doctor called back and said "The patient said something about having an antibody ID card; would that help?" YES, about 1 1/2 hours ago! We kept a lot of Antigen Screened units on a shelf so I could have at least given 2 E-,c- Uncrossmatched RBCs. Oh well, at least we were able to provide compatible units for the remainder of her transfusions; and explain why her hematocrit might be expected to drop, as one of the uncrossmatched units was E+ (as per Murphy's Law).

Brenda Hutson, CLS(ASCP)SBB

[SMILLER]

One thing that helps us here is that our phlebots still repond to trauma calls in ER.  In fact, they draw virtually ALL T&Ss.  So we don't usually have to nag another depatment for a specimen, although this can happen with OR if the patient gets sent there befoe they can be drawn by Lab in ER.

 

The reason we have Lab draw all T&Ss (other than pre-op holding) has to do more with specimen ID than anything, however.  Other departments are just not very good with this.

 

Scott

[Likewine99]

Just because the nursing staff doesn't want to do something is absolutely no excuse for compromising patient safety.  You need physician involvement here, the pathologist, director of ED, someone with MD behind their name.  

 

You can quote Blood Bank regs all you want and they won't listen.  Don't try and fight this battle yourself.  Turn it over to your risk manager (hope that person is not an RN!)