Blood Bank ID# =LIS Specimen # - Stroke of genius or stupidity?

[Kathy]

I have what I think is a brilliant idea, although I know that it can't be this simple.

 

Why not make the LIS generated specimen number be the BB ID number? 

 

What I mean is that instead of taking a BBID# from a manufacturer (Typenex, Shamrock, etc.), the phlebotomist would place a red band on the patient with an insert that has the LIS label for the blood bank specimen.

 

Reasons I can think of why this is a great idea:

• Fewer steps in the process=fewer opportunities for error
• The LIS specimen number is already barcoded = lest cost (no need to purchase special numbers)
• The LIS specimen number is unique to the patient and it is linked to the date, time and collector

 

Reasons why it might not work:

• LIS downtime or printer not working (you would have to use a commercially generated barcode in that case)
• If the phlebotomist labels the tube with the wrong specimen label (WBIT), you would never know (but, in fact you would, because the patient would be wearing a hospital band with their actual name and a red wristband that had a different name)

Feel free to poke holes in this idea.  Thanks!

 

 

[David Saikin]

You would have different number for every specimen is the way I see this.  We use a bb id code which, theoretically, stays with the pt for their entire stay.  It is a separate wrist band and only it has the code AND the BB specimen.  Nursing cannot infuse red cells if the codes do not match (BloodLoc system - this is also considered a barrier system so that 2 separate blood types are not essential for transfusions).  I have seen Nursing be complacent with BBID#s - in my experience, since "they always match" pts receive blood which is not set up on their specimen (thank God everyone was O+).  When Nursing is forced to be attentive to the entire transfusion process there is increased compliance = increased pt safety.  If you have a system of multiple checks and balances you had better make certain that the first one works because, since it usually does, the secondary systems are usually ignored.  Human nature.

[Joanne P. Scannell]

You would have different number for every specimen is the way I see this.  We use a bb id code which, theoretically, stays with the pt for their entire stay.  It is a separate wrist band and only it has the code AND the BB specimen.  Nursing cannot infuse red cells if the codes do not match (BloodLoc system - this is also considered a barrier system so that 2 separate blood types are not essential for transfusions).  I have seen Nursing be complacent with BBID#s - in my experience, since "they always match" pts receive blood which is not set up on their specimen (thank God everyone was O+).  When Nursing is forced to be attentive to the entire transfusion process there is increased compliance = increased pt safety.  If you have a system of multiple checks and balances you had better make certain that the first one works because, since it usually does, the secondary systems are usually ignored.  Human nature.

 

The purpose of a BB Band is to assign a unique number to the specimen that is definitively associated with the body wearing the matching number.  The idea is that no matter what we call the patient  (e.g. Mary vs Jane), the blood in the tube is that of the body wearing the band.  It is really the only true link between patient and sample because the band was applied at the time of draw.  Remove that band and you've removed the link = no transfusion.

 

To have a consistent BB# does not serve this purpose, i.e. multiple specimens bear the same 'unique' number, which can be argued is no different than using the hospital #.

 

I want to know that the specimen being used for pretransfusion testing truely belongs to the body that it came from because that body is the body that will be transfused with blood crossmatched using that very specimen.  A one-time-use-only unique number on the patient matching the specimen matching the Unit Tag is my only assurance of that.

[BankerGirl]

This would definitely not work with our LIS.  We have Meditech and it recycles numbers periodically.  The specimen number recycles yearly and the specimen barcode recycles less often. 

[R1R2]

I think it would work.  Does you accession number print on your unit tags? 

[David Saikin]

The purpose of a BB Band is to assign a unique number to the specimen that is definitively associated with the body wearing the matching number.  The idea is that no matter what we call the patient  (e.g. Mary vs Jane), the blood in the tube is that of the body wearing the band.  It is really the only true link between patient and sample because the band was applied at the time of draw.  Remove that band and you've removed the link = no transfusion.

 

To have a consistent BB# does not serve this purpose, i.e. multiple specimens bear the same 'unique' number, which can be argued is no different than using the hospital #.

 

I want to know that the specimen being used for pretransfusion testing truely belongs to the body that it came from because that body is the body that will be transfused with blood crossmatched using that very specimen.  A one-time-use-only unique number on the patient matching the specimen matching the Unit Tag is my only assurance of that.

 

In my instance the blood is in a bag with a lock on it.  The combination of the lock is the id code on the pt wristband.  The combination is set using the code on the BB specimen (which is copied off the pt armband) - if the codes do not match the lock does not open . . . implying that the blood was set up on a different pt (or the BB tech set the code incorrectly).  In either case, the blood is returned to the BB where the discrepancy is resolved.  If for some reason admitting has put a new BB coded band on the pt all testing is redone starting with a new specimen.

[SMILLER]

Would not work here either, since the same BB armband is used over and over as long as patient is in house. Specimen numbers change, but the BB number links the patient to the current admission on the BB system. We generally don't like changing armbands if we don't have to. Too many oppourtunities for mistakes.

Scott

Edited August 21, 2013 by SMILLER

[whbb]

We use Meditech with BCTA (bar coding at the bedside).  We use the hospital id band (has a barcode).  When the user scans the barcode, if it is not for that patient, it will not allow scanning, and the RN should return the product to the blood bank.  We require a second separate draw on any non-type O patient prior to a red cell transfusion to confirm the blood type if we do not have a previous type type history.

 

We have been using this for more than 2 years, and it has been working great without a separate blood band.

[Kathy]

We do require a new armband with each draw and our specimen numbers don't recycle. We don't have the specimen number on the tag right now, but I could check into how difficult it would be to get it on there.

[Dansket]

I have what I think is a brilliant idea, although I know that it can't be this simple.

 

Why not make the LIS generated specimen number be the BB ID number? 

 

 

 

I am intrigued by your idea. 

 

We also use a new TYPENEX band with each specimen collected.  The TYPENEX code is printed on the form we attach to the blood container.  We also print the Meditech specimen number on this form (for our internal use at the time of blood issue).  The Meditech specimen collection labels we use are printed with a specimen bar code number (a six digit number) as well as a Meditech specimen number in the format 0821:BBnnnnnnn.  We could print the 6 digit specimen bar code number in the same place as is currently occupied by the TYPENEX letter-number code.

 

Nursing is required to match the TYPENEX code number printed on the form at the bedside with the TYPENEX code on the band on the patient, but they could just as easily match the Meditech 6 digit specimen barcode number on your "red band" with the same 6 digit number printed on the form attached to the blood container.

 

So currently, our phlebotomists affix a bar coded specimen collection label to the TYPENEX band which for them is an identical process as that which Kathy is proposing.

 

The TYPENEX band is constructed with a plastic overlay that waterproofs the Meditech label.  How to do this with a generic "red band"?

Edited August 22, 2013 by Dansket

[Kathy]

See what I mean?   If your specimen number is on your patient and your specimen, then putting another number (ie. Typenex) seems like extra work and extra expense.  If you could get that specimen number on your issue forms and you had a downtime procedure in place, it seems like this could work.  Banding the patient would be simple with a generic red band that has a card insert.  The phlebotomist would put the specimen label on the card, insert it into the band, and place the band on the patient.  When the nurse transfuses, they compare the patient's hospital ID wristband to the tag and the red wristband's specimen number to the tag.

[Kathy]

Update: my nurses nixed that idea because the specimen number is a little harder to find.

[R1R2]

Hi Kathy,

 

why not get rid of the BB armbands?

[Dansket]

Update: my nurses nixed that idea because the specimen number is a little harder to find.

Have you investigated printing a special label as part of the specimen collection label set.  This special label could be configured with large font making it easier to find and to read!

[Mabel Adams]

You would need to solve any specimens collected before the LIS label was available--maybe ED rainbow draws for traumas, spceimens drawn at oncology clinics for OP transfusions, any drawn as "holds" before the order gets placed.  If you draw pre-admits for surgery, make sure that system works.

[Auntie-D]

This is done in Scotland and they take it one step further - the request forms have 3 labels attached, one for the sample, one for the form and one for the wristband. This is great until some bright spark bleeds the patient again uneccessarily which makes any blood products unsuitable (as they don't match the wristband ID) and stops any further Electronic Issue until the new sample is processed. In England we just 'bounce' subsequent repeat samples as unnecessary, in Scotland we had to process them - makes it difficult in terms of TAT, workload and budget.

 

It's a great idea but don't get them putting it on the wristband - creates a minefield!