Manual Entry and 2nd tech review?

[Likewine99]

Yes Terri we are OCD, but we are the kind of people you want crossmatching your blood, labeling your tubes, etc.  If we were nurses, mislabeled specimens would be a thing of the past  .

 

No offense intended to any nurses that may be lurking in the background .  

[tbostock]

I love that Blood Bankers (the good ones) are all a little OCD.  We were joking at work one day that when we put an open bottle of ketchup in the refrig, we date it (some of us even initial it, which I found hysterical).

[seraph44]

Where I used to work previously we had 2nd tech checks and it eventually got to a 3rd tech check. This was an not the right thing to do. More tech became, comfortable that another tech would catch a mistake and more errors emerged. We went down to a 2nd tech to verify T&S and T&C. This we found to be a better approach; it also showed the benefits of having a second tech, because several mistakes are caught. The 2nd tech I like, It gives me better peace of mind. However, in a small facility, you don't have that luxury and must find other means. Where I am now, there is no second tech, but we do have an LIS that will cover most clerical errors. Catching mistakes is great, because it exposes our weakness and provides and opportunity for improvement, but not always will it be resolved by adding a step. Sometimes we must retrain the individual.

[SMILLER]

A note on confirmation bias.  I came across an article recently that suggested that a "read-back" confirmation with two people (such as at the bedside before hanging a unit) was not as reliable a check as you might think.  This was due to the not insignificant likelyhood of people tending to check off stuff when heard by ear from another without really verifying what they are looking at. 

 

In fact, they concluded that a safer "re-check" was for each person individually to a check between two pieces of documentation, and avoid the read-back altogether.

 

Scott

[AMcCord]

A note on confirmation bias.  I came across an article recently that suggested that a "read-back" confirmation with two people (such as at the bedside before hanging a unit) was not as reliable a check as you might think.  This was due to the not insignificant likelyhood of people tending to check off stuff when heard by ear from another without really verifying what they are looking at. 

 

In fact, they concluded that a safer "re-check" was for each person individually to a check between two pieces of documentation, and avoid the read-back altogether.

 

Scott

 

Can you give us the reference for that article.

 

I've been very interested in shifting our nursing bedside readback check to 2 independent checks for the very reason you mention...BUT...I need some good information before I tackle that dragon. I get monster push back from nursing when I - a mere lab rat - suggest that they might consider changing their practice. It's always great when I can wave JC at them, but sometimes I can get it done with the right articles. Thanks!

[SMILLER]

Looked for that article today online, could not find it, but I found out there are a number of hospital systems that do the double-check (as opposed to the readback) for things like meds and transfusions.  One of the hits was an old thread here on independent double check from 2013! (no references there either though)

 

I think it may have been in an old-fashioned paper-based journal that I read last fall.  The gist of it is a read-back may be appropriate for actually reading back a written order to a doc over the phone, but that it really is not so great for verbally checking a tag between two people when comparing it to an order for blood.  In the second case, there is really only one check being performed, and since it is between two people, there is too much room for missing something.

 

An independent double-check is a true double check.  A single set of eyes compares a number to a number or a name to a name on two pieces of documentation.  Then it is done again by another person, greatly decreasing the chances of missing an innaccuracy.

 

Scott

[AMcCord]

Thanks for checking Scott.

 

I attended an educational webinar presented by the ARC a few months back where the presenter kind of threw the 2 check thing out there in passing. I was DELIGHTED to here him make that point. I need to see if I can make contact with him cause I'll bet he had a specific source.

[ElinF]

Hi all, Sorry I am just getting back to this.  Thanks for your responses. 

 

As far as more info for our situation...We perform manual gel on all antibody screens and prenatal type and HDN ab screen.  We do tube ABORH on crossmatches because it is quicker.  We currently have 1 tech by herself after 10 pm.   We are in the works for getting automation- waiting for the Ortho Vision to come out this spring, but you know how that goes... We are building our case and have looked at other facilities and their automation. 

 

Our clerical errors occurred on patients that did not have any current history in our system.  We have an LIS that will catch errors.  We are also reading right from the medium.  Our crossmatch/transfusion policy is to have 2 types performed on the patient from 2 separate draws (unless they are type O and yes we would give women of child bearing age O neg blood if we only had 1 chance at an ABO before transfusion) so we are doing good there.  Many discussions in OB with that one!  

 

The problem with the 2 errors was #1 it was lone midnight shift tech working up a emergency release and she must have had O neg on the brain.  She reported O neg instead of O pos on the patient type.  A second look may have found this error. (the bad/good thing is was this patient was transferred out to a sister facility and they caught our error.  No harm to the patient obviously, but it is still an embarrassing error in which she felt horrible for). 

 

#2 was I believe a misread- mixing up 2 patients.  She reported out A pos for both patients instead of AB Pos for 1.  Again, clerical. We do have a 1 rack per patient policy, but she must not have followed it... 

 

 We currently review any result that gets manually entered for other departments (when we have to report them off printer tapes and such) so I think implementing this for blood bank is way overdue.   

 

Let’s see, I think I addressed most questions??  Thanks again for your comments and discussion!  Always so interesting to see what everyone else does! 

 

Elin

[ElinF]

I love that Blood Bankers (the good ones) are all a little OCD.  We were joking at work one day that when we put an open bottle of ketchup in the refrig, we date it (some of us even initial it, which I found hysterical).

 

 

I have started dating stuff in my fridge at home.  I hate not knowing when it was opened!  haha

[goodchild]

This is just my perspective:

 

So you're performing the test and able to concurrently document into the LIS which (I assume) provides a verification of entered results step and logic calculations to aid in interpretation.

I'm also assuming that since you're using an LIS there are barcoded specimens to aid in result entry/patient-specimen identification?

 

This seems more associate-specific rather than a process problem. I'm totally against the idea of two tech verification for all of the reasons mentioned. How does something like that even fit into a workflow? Especially if there are single tech shifts or even if there are two tech shifts but the other tech is on break.

[Auntie-D]

The second (or third in the UK) check doesn't have to be done by a blood banker, we get a lab assistant or chemist to do the final check if needed. The new UK guidelines state that there should be two independent checks and then a third checking the sample against the computer.

[YorkshireExile]

Dear Auntie-D, which UK guideline mentions the third check?

Thanks

[Mabel Adams]

But are your spices alphabetized in the spice rack?  

[mollyredone]

But are your spices alphabetized in the spice rack?  

Yes, the ones on my Tupperware spinning rack are!