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Second ABO/Rh sample


cheru26

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Neonates first sample is usually O negative that does not require a second sample( exemption)

 ABORH  on second testing you have a history on first draw . So what is the complication?.

 

At 4 months there is antibody production that requires TS . But first sample drawn or second on heal stick.

 

We have a secondary Policy  PWS Phlebotomy Witness Statement  that requires two signatures upon witnessing the sampling or drawing of the blood at Bedside

Requires two person ID on drawn just as giving   besides ABOrecheck policy

 

and corrective action upon any deviation with computerized tracking of any deviation. 

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Our ABO/Rh test has a result detail "History Check" that has 3 possible responses: Previous ABO in HX, No ABO in HX, or Retype required.  All of these responses display in the patient's Medical Record.  For patients with no history we use the "No ABO in HX" for non-compatibility ABO/Rh requests and we use the "Retype required" if the ABO/Rh is for compatibility testing.  Retype required will automatically reflex an order for the patient to be drawn for the 2nd sample.

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Our computer system looks for a history and will automatically order an ABO confirmation if a history is not found.  The only exception to this is pre-surgical patient because we know they are coming back and will be tested again day of surgery, thereby creating 2 different specimens.  Our system will also not allow an electronic crossmatch without 2 separate ABO/Rh results.

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  • 3 weeks later...

In the UK the guidelines are that it has to be risk assessed - a 1:20,000 risk has been calculated that both samples are incorrect. The first sample must be both forward and reverse, but the second may be forward only. It really reduces the number of weak reverse group investigations in older patients when you do this ;)

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Our ABO/Rh test has a result detail "History Check" that has 3 possible responses: Previous ABO in HX, No ABO in HX, or Retype required.  All of these responses display in the patient's Medical Record.  For patients with no history we use the "No ABO in HX" for non-compatibility ABO/Rh requests and we use the "Retype required" if the ABO/Rh is for compatibility testing.  Retype required will automatically reflex an order for the patient to be drawn for the 2nd sample.

 We do this similarly. We have one "test" (lab eyes only) in the typing battery "PREVIOUS RESULTS CHECKED?" with only one response "Previous results checked", since you have to do it with every specimen. We have a second test "ABO VERIFICATION" with 4 responses:

ABO GROUP VERIFIED

1ST TYPE, USE O RBC

ABO VER BY AUTOL DON (if we have an autologous donation)

USE ONLY FOR ABO VER (for CBCs etc. that we have snagged just to do the 2nd type)

We also have a bright little sticker for the 1st time typings to help flag them.

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AABB standards require a forward and reverse type for electronic crossmatch (as well as primary testing of course). They don't address blood type verification by 2nd sample. Because we do electronic crossmatch we don't want to have 2 separate policies so we just do the complete type on the repeat draws also.  Most of them serve as the repeat type for electronic crossmatch requirements but we still do the full type even for the few patients who don't qualify for electronic crossmatch but need a 2nd type.

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There is nothing in the CAP standard that requires a disclaimer on any report issued to a provider.  You have to be able to verify that you have searched your records for previous encounters.  If you want to have a disclaimer as part of your policy, that is your perogative.  To me such a disclaimer sounds like you are stating that you are not certain of your result. 

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I have to disagree David. The CAP standard specifically says (paraphrased, but the actual verbiage is higher up in this thread):

if the laboratory performing the testing is not able to verify the result based on previous results (and if you had no previous history, you wouldn't be able to verify them with previous history), then the report shall be reported with a disclaimer.

 

While the use of 'shall' is intended to denote a mandatory requirement it use is under scrutiny. Refer to this post from the American Society for Quality: http://asq.org/standards-shall-should

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I have to disagree David. The CAP standard specifically says (paraphrased, but the actual verbiage is higher up in this thread):

if the laboratory performing the testing is not able to verify the result based on previous results (and if you had no previous history, you wouldn't be able to verify them with previous history), then the report shall be reported with a disclaimer.

 

While the use of 'shall' is intended to denote a mandatory requirement it use is under scrutiny. Refer to this post from the American Society for Quality: http://asq.org/standards-shall-should

And I must disagree with your misinterpretation of that standard, and I quote (and it is also quoted in the above statement you designated): 

 

. . . if the laboratory performing the testing does NOT (my caps) maintain records that would allow this check to be performed, the testing shall be reported with a disclaimer . . .

 

It does not say a disclaimer must be used if this is the first time you've seen a patient BUT only if you do not keep any records which you can compare current results to.  I doesn't say anything about not having a previous history, that is your interpretation/paraphrase. 

 

What blood bank/transfusion service (in the USA anyway) doesn't keep records?  Anyway, like I stated, if you want to put a disclaimer in - go ahead.  But don't misinterpret the standards.

 

I also think MUST is a mandatory requirement; SHALL can be argued as you probably should do it but . . . the semantics of legaleze.

 

I just had CAP with this current standard:  No deficiencies!

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Diatribe on Shall vs Must

 

1. "Shall" has three strikes against it.

First, lawyers regularly misuse it to mean something other than "has a duty to." It has become so corrupted by misuse that it has no firm meaning.

Second—and related to the first—it breeds litigation. There are 76 pages in "Words and Phrases" (a legal reference) that summarize hundreds of cases interpreting "shall."

Third, nobody uses "shall" in common speech. It's one more example of unnecessary lawyer talk. Nobody says, "You shall finish the project in a week."

For all these reasons, "must" is a better choice, and the change has already started to take place. The new Federal Rules of Appellate Procedure, for instance, use "must," not "shall."

Prof. Joe Kimble, Thomas Cooley Law School

Edited by David Saikin
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  • 4 weeks later...
On ‎10‎/‎20‎/‎2015 at 9:29 AM, Maureen said:

To ensure compliance with AABB Standard 5.16.2.2 if you use an electronic crossmatch you need to perform both front and back types (AABB 5.14.1).

Is there anything that says you must have 2 antibody screens done before eligible for an Electronic crossmatch ?

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  • 2 years later...
  • 3 weeks later...

When that CAP standard was 1st written it was worded differently and we interpreted it to mean that if there was no history for the patient, you had to have a disclaimer.  At that time we implemented the disclaimer.  We have a result field in our ABO/Rh test that we answer either "No ABO history found" or "Previous ABO in history".  Based on that result the LIS woud automatically add the disclaimer to the "no history" patients, all patients, not just OB.  After 1 or so years CAP revised TRM.40820 to indicate "add a disclaimer if history checks are not performed at all".  We called CAP and were told that this was written for reference labs receiving samples from many different facilities and that did not do the history checks for any of their patients ABO/Rh results.

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