ABO/RH

[LCoronado]

In the olden days (when I was young) we did retest for ABO every time the tube was taken out of the refrigerator for additional crossmatching.  I think the reasons included all those mentioned above.  Now that >90% of our crossmatches are electronic, it really makes no sense.  However, for the few patients who require a serological crossmatch, the rule is still on the books.

[tricore]

I agree with the guru who says it should be correct the first time but we all know that we get mislabeled specimens. Did the guru state how to make the person drawing the sample "get it right the first time"? I never did figure that out!

The physician takes it "on faith" that that the group A unit we send for tansfusion is compatible with the patient.

[Dr. Pepper]

I respectfully (but silently, as I had to scoot out and drive 3 hours home after the lecture) disagreed with the guru. That HOW question is the kicker, and why we do the 2nd typing. She made reference to the time and expense of the typing. We average 30-40 "extra" typings a month, which is hardly going to break the bank. It's a very small price to pay for a large layer of safety.

[SMILLER]

Note that if a patient has the wrong armband, a redraw is not going to help things much. 

 

Scott

[Dr. Pepper]

Tattoos on the forehead (assuming, of course, we have a system to get it right the first time.....)

Edited November 12, 2014 by Dr. Pepper

[jthibs]

On performing your retype do you perform a front type only or both front and reverse?

[SMILLER]

Just the front, usually.

 

Scott

[tbostock]

Note that if a patient has the wrong armband, a redraw is not going to help things much. 

 

Scott

 

It would help because we don't allow the nursing unit who collected the first to collect the redraw.  Our phlebotomists always confirm the patient name and DOB verbally with the patient before drawing, so an incorrect wristband would be caught.

 

We do forward and reverse on our retypes.

[SMILLER]

Terri

If the phlebots always confirm the name and DOB with the patient at time of draw, why bother with a redraw to avoid WBIT?

 

I am just pointing out that if a mistake is made once, the same can be made again -- in fact it is likely.  If mistakes like misidentification of a patient are being made in a hospital, I think we have more of a problem than whether or not to recheck testing results!  In some cases being satisfied with "doing it twice" may even lead to a dangerous degree of complacency.

 

Scott

[Dansket]

Scott,

We use a secondary blood band that has a unique identifier(ABC1234). Our phlebotomists are required to document that code on the specimen container label of the specimen collected with the second venipuncture. On receipt, we enter that code into the computer system. Computer system checks that entry with the blood band code that was entered for the initial Type and Screen specimen. If the codes don't match, red flag on the play!

Dan

[SMILLER]

We do the same.  I believe that most hospitals now have a unique armband for BB.  In fact here, only Lab phlebots are allowed to armabnd and draw specimens that may be used for a crossmatch (exceptions are OR and pre-op).  If a decentralized phlebotomy area, even ER, needs a T&S drawn, Lab has to respond with a phlebotomist. 

 

I am not sure how much a repeat draw to validate an ABO/Rh can add to this as far as patient safety.

 

Scott

[Dansket]

I believe that collecting a second blood sample is the gold standard for preventing WBIT. It is CAP's first recommendation for the Transfusion Medicine Checklist item TRM.30575 Misidentification Risk.

The request to collect a second blood sample is generated internally (given a unique specimen number in Meditech) by our Blood Bank staff and only for selected patients (Non-group O patients with no blood type on file). We do not accept/test unsolicited blood samples.

Dan

[Auntie-D]

We do the same.  I believe that most hospitals now have a unique armband for BB.  In fact here, only Lab phlebots are allowed to armabnd and draw specimens that may be used for a crossmatch (exceptions are OR and pre-op).  If a decentralized phlebotomy area, even ER, needs a T&S drawn, Lab has to respond with a phlebotomist. 

 

I am not sure how much a repeat draw to validate an ABO/Rh can add to this as far as patient safety.

 

Scott

 

I think that attitude is rather complascent and frankly quite worrying. Everyone makes mistakes and an ABO incompatililty is not like a wrong FBC result...

[galvania]

Well, yes and no.  If you give out an Hb result that's falsely really low and the patient receives blood unneccessarily, then it's just as bad isn't it? Or, the contrary. I can remember after an op a nurse coming running in and saying that I was extremely anaemic after the op and needed to take a large dose of iron tablets (not a transfusion luckily).  It's only because I'm a stroppy individual and could argue the point that it was actually shown that I was not at all anaemic, but my neighbour was!

[Auntie-D]

Well, yes and no.  If you give out an Hb result that's falsely really low and the patient receives blood unneccessarily, then it's just as bad isn't it? Or, the contrary. I can remember after an op a nurse coming running in and saying that I was extremely anaemic after the op and needed to take a large dose of iron tablets (not a transfusion luckily).  It's only because I'm a stroppy individual and could argue the point that it was actually shown that I was not at all anaemic, but my neighbour was!

 

But you would know clinically, if the patient had a Hb of 50 when it was actually 140...

[Malcolm Needs ☆]

Well, in such an extreme case, yes, you probably would Auntie-D, but if you look at the last couple of SHOT reports, TACO (transfusion associated circulatory overload) is very high on the list of things causing patient morbidity and mortality.  Some, I must admit, are caused by blood being transfused too quickly to elderly people, but many are just plain over-transfusion.

[cthherbal ☆]

On performing your retype do you perform a front type only or both front and reverse?

We do forward and reverse- required if you use electronic crossmatching.

[Dansket]

Forward and reverse only required by AABB, not by CAP.

[SMILLER]

The whole point of all of this retesting is to avoid an ABO incompatibility transfusion, if I am not mistaken.   For the same reason, the first 15 minutes of a transfusion are the most critical as far as monitoring patient condition. This is far more serious than most other testing errors due to WBIT.

 

However, the only perfect way to avoid this type of situation would be to do a ABO/Rh at the bedside just before the unit is hung.  I believe some institutions used to do this.  Not sure how common it is now though.

 

Scott

[aafrin]

Terri

If the phlebots always confirm the name and DOB with the patient at time of draw, why bother with a redraw to avoid WBIT?

 

I am just pointing out that if a mistake is made once, the same can be made again -- in fact it is likely.  If mistakes like misidentification of a patient are being made in a hospital, I think we have more of a problem than whether or not to recheck testing results!  In some cases being satisfied with "doing it twice" may even lead to a dangerous degree of complacency.

 

Scott

 

I agree with you 100%. Two persons checking always causes problems because each of them thinks the other will check thoroughly and just skims through.

[Auntie-D]

I agree with you 100%. Two persons checking always causes problems because each of them thinks the other will check thoroughly and just skims through.

 

Unconscientious workers think this - the vast majority of workers do not think this way though.

 

Two people checking does find errors - one person checking twice less so.

 

We do three checks here - the third being against the computer system to ensure it has been booked against the correct patient.

[SMILLER]

I did come across a little study once that compared errors made with two methods.  One, with two separate associates checking the same two items individually, and the other (more common) where a read-back is done, with one individual reading say, the order, and the other checking the product. 

 

There were more errors made with the read-back method compared to the individual x 2 method.

 

Scott

[Auntie-D]

 

There were more errors made with the read-back method compared to the individual x 2 method.

 

 

Possibly as people tend to hear what they want to hear... Two (or 3) indpendent checks is best - in my view people will check the first time more thoroughly so they don't get pulled up for getting it wrong... Then you get the mercinary few who take delight in finding an error at 2nd check!

[Dr. Pepper]

How about the variation on the read-back where two nurses read the data simultaneously, in theory checking what the other is saying! Huh? Total cacophony. I have tried to discourage this variant.