In any of your facilities do you allow nursing staff to pick up blood bank products if they have food or drink with them?  Is there a health and safety guideline that addresses this?

I am not sure what exactly OSHA or JCAHO would say about it, BUT IT SURE LOOKS BAD!  Years ago (back in the last century, people used to eat, drink and smoke-if-you-gotum in the Lab, but those days are long gone.  We do have some posted "clean" areas off the Lab for coffee and such, but food or drink (or even cosmetic application) are banned anywhere near specimens or testing of same.

 

It seems like your institution should already have some Infection Control guidelines for you.

 

Scott

We do not issue out any products if they have food in there hands. It specifically states in the nursing policy for admin of blood products that they cannot pick up products with food. I have turned many away for doing this (i.e., eating an apple at our issue window). I tell them that I am just enforcing their policy.

We do not allow food or drink in the lab proper.  Nursing would have to leave their consumables outside in order to p/u blood components

Just ew!

A few years ago one of our Lab associates was getting lunch in the cafeteria when she noticed a RN with a blood tag hanging out of her scrubs.  Turns out the RN had picked up a unit of blood from the Lab and was "just stopping to pick up lunch" on her way back to the unit.

 

Scott

From our blood administration policy:

 

NOTE: No blood components will be issued from the blood bank to personnel carrying any food

products into the lab. All lab staff have been instructed to stop any person entering the lab with

food or drink on their person.

 

Our secretary is very vigilant and strict on this policy.  Haven't seen them bring the blood to the cafeteria, but we still have nurses come to pick up blood after picking up their lunch.  They had no idea that was against policy.  (It is at the top of the policy, in bold type and highlighted in yellow.  Hmmm...)

There are some people who are blinded by the bold type and yellow highlighting - either they cannot physically see what is written, or the brain automatically blocks the message. Have not figured it out!

I have recently read about a thing called alert overload.  At it's worst, it can negatively impact patient care as workers are so used to ignoring "nuisance" alerts that once in a while an importnat one may be disregarded, resul;ting in harm.

 

This happened many years ago, but we still talk about the "experienced" associate (actually, I think she was a supervisor at the time), who caused alot of trouble simply becuase of the way we used to check BB refirgerator temps in the morning. 

 

These were the fridges that had a key with positions for OFF, ALARM OFF, and ALARM ON.  To avoid having the "door ajar" alarm go off when checking the inside thermometers, we would turn the key to the Alarm Off position (turning it back to Alarm On when were done).  On this particular morning, the tech turned the key all the way to OFF.  We did not notice till the next day when checking temps for that morning that the inside of the fridges were way, way too warm.  The tech had never turned the key back! We had to cancel surgeries, order blood STAT from our supplier, and threw out 1000s of $ worth of blood product.

 

That was the last time that associate worked in BB.

 

Scott

Long, long ago, I signed out a unit of blood to an RN.  The RN stopped in the cafeteria and got lunch before coming to the BB and left the tray with the lunch on it in our break room.

 

After finishing the sign out process I left the BB for lunch.  Ran into this RN in our break room, eating the lunch and there was the unit of blood on the tray.  his was an online occurrence report to say the least. After this occurrence there was nursing education re: best practice for picking up lunch.  This happened on a weekend, are you surprised?

 

We do not sign out units of blood to nurses (yes we still make them come to the BB to pick it up) if they are on the hand held phones or on their personal cell phone.

 

I have stopped the read back process and made them start over if they pick up the phone during this process.  Of course lots of eye rolls when I make them start over

Yes - it seems like the phones are even worse than the food problem now.  But how are you going to know if they stop in the cafeteria on their way back upstairs unless you just happen to run into them there?  Hummmm - maybe that explains that slow start time on some of those units when we get the unit review back.....!!!

We do not allow food or drink in the lab proper.  Nursing would have to leave their consumables outside in order to p/u blood components

We just tell them no, they should not even be in the Lab. We did what David did, until we saw them put the unit of blood on their cafeteria tray on the way back. Ew!!! So now we tell them to go "consume their consumables" and come back later for the blood.

OK - I am going to play devil's advocate here.  So a nurse goes to pick up a unit of blood with no food and then goes to the canteen to eat her lunch before going back to the ward.  No problem in issuing the blood, right, as she had no food with her.  Nurse comes to pick up a unit of blood and has an apple in her pocket.  Even though she was going straight back to the patient with the blood bag, this is not Ok because the apple is going to jump out of her pocket and attack the blood bag. Or is it the blood that will jump out of the blood bag and attack the apple? I will go further.  Patient is given blood transfusion over 6 hours (several bags) and it's lunch time - patient not allowed to eat lunch (in his bed) because lunch might contaminate blood bag???????

Now I know it's easier to make blanket rules than specifying, but the danger then is that sometimes these rules are percieved as being stupid and then not obeyed - even in cases where it isn't stupid.......

Thankfully our pneumatic tube has rigid dietary restrictions and this is not an issue.

OK - I am going to play devil's advocate here.  So a nurse goes to pick up a unit of blood with no food and then goes to the canteen to eat her lunch before going back to the ward.  No problem in issuing the blood, right, as she had no food with her. 

 

No it's not OK as it means the blood is out of the fride

No it's not OK as it means the blood is out of the fride

 

I think what galvania is trying to say is how would you know? So you'd issue the blood.

I think what galvania is trying to say is how would you know? So you'd issue the blood.

 

But my point is that we need to stop making excuses for them.

I hate to say it, (really I don't) but this is one more argument in favor of pneumatic delivery of blood products to the nursing units.  Many years ago, as noted above, in the previous century, the facility allowed volunteers (pink ladies) to transport blood.  We had one of those transporters taking a cooler of blood up to L&D for a mom in serious bleeding trouble, hence the cooler full of blood.  This transporter elected to stop on the way back for a spot of lunch.  I will not go into the outcome other than to say that the practice of allowing any one other than nursing employees to transport blood was immediately halted.  

I think what galvania is trying to say is how would you know? So you'd issue the blood.

 

Exactly

Food in hand - no blood and they are advised to please get the food out of the lab. Infection control is strict here. What they do after that is outside of my control...unless I see them , which I usually don't as I am chained to my chair in Blood Bank. Policy here states that they must start infusing blood products within 15 minutes of checkout, which is closely monitored. That tends to curtail side trips to the cafeteria.

A&E brought food to the lab the other night here - for me when I had forgotten my own lunch and missed closing of the local takeaway due to a massive haemorrhage. They can be angels at times

I have got to add this to our policy!  I had some snotty guy come in drinking from a Styrofoam cup.  At the time I had only been the blood bank sup for about 3 days So I didn't feel brave enough to really tell him off but I told him in the future not to do it again.  He said nothing but glared at me with his cup.  He then barely even looked over the paper as I called it off and then folded it up before I was done.  IF he acts like that again he'll be getting a piece of my mind and a call to his boss!

When I review transfusions I indicate the time released and the time started.  It is up to the Nursing supv to investigate when the time between the 2 is excessive (>20 minutes, or so).  As long as the infusion is completed within 4 hrs of release this is a moot point for me.

I used to personally check every transfusion for  time checked out/time started/time finished and my pre/15/and post ( just as the BB bench tech)  At the hospital I'm at now I don't get to see any of it and I'm the supervisor.  It's weird.

We also used to review each paper blood admin record but now that we are going electonic (blood admin done in our EMR), I have to figure out how to get reports sent to me so I can review compliance with documentation. Some reports I want to get:

1. barcode overriding

2. transfusions with no end time

3. transfusions missing blood warmer info

4. transfusions over 4 hours

We'll see if I can get them. We'll also be doing a lot of audits for the first month or two for compliance.