How far out from surgery do you allow a pre-op T/S collection?

[KMMinNH]

We currently allow a patient to have their type and screen (or crossmatch) drawn within 30 days of their scheduled surgery if they haven't been pregnant or transfused within the past 3 months (and verify this information upon admission).  I was thinking of changing that to only allowing them to come in within 3 days of surgery but it's not very "patient-centric".  Thoughts on the goods and bads of extending these pre-op samples....

 

Thanks.

[Cliff]

28 days if not pregnant or transfused.  The type and screen needs to be done with 7 days per our Tango.

[Dr. Pepper]

We had been using an arbitrary 14 days if not pregnant or transfused, but recently expanded to 21 days or the OR's request - too many redraws. I think the only limit is your own comfort zone and storage space for specimens for serologic crossmatches and/or keeping them for a week post-transfusion.

 

If you perform serologic crossmatches and transfer your serum/plasma to an aliquot tube while doing your T&S, I have noticed that once in a while there will be a turbid layer of microbial growth in the aliquot tube after several days' storage.

 

Our LIS electronic crossmatch requires an antibody screen within 72 hours but this can be overridden.

[David Saikin]

7 days, if not pregnant/transfused in past 3 months

[AuntiS]

We use 28 days if not pregnant/transfused here (plus the sample can be used up to 7 days post op) for a total of 35 days.  If there is any doubt, we get a new sample.

 

Also... we only use this for preop patients.  Any other patient defaults back to 96 hours (i.e. admitted in thru ER)

 

s

[mollyredone]

We've stuck with 3 days.  We are a small rural hospital and people are not driving a hundred miles to have surgery here!

[Maureen]

We use 21 days if not pregnant or transfused within 3 months.  We are occasionally asked to extend it beyond the 21 days, but I ask them to request a physician override of our P&P, so it hasn't happened yet.  One recurring issue is that the patient does not return with the ID band provided at the time of specimen collection, so the T&S must be repeated on the day of surgery.

Another issue, although infrequent, is a name change.

[Maureen]

We currently allow a patient to have their type and screen (or crossmatch) drawn within 30 days of their scheduled surgery if they haven't been pregnant or transfused within the past 3 months (and verify this information upon admission).  I was thinking of changing that to only allowing them to come in within 3 days of surgery but it's not very "patient-centric".  Thoughts on the goods and bads of extending these pre-op samples....

 

Thanks.

I would expect serious complaints and pushback for suggesting shortening the time frame, whether to 29 days or 3, from presurgical staff, surgical staff, physicians, patients and their representatives.  There is a lot of pressure to make our OR run smoothly and on time.  If you make it less convenient for pre-surgical blood work you invite same day T&S, with the risk of delaying the start of surgery. 

[Dr. Pepper]

I agree with Maureen about the potential feedback. The more lead time you have to sort out any problems, the better.

Welcome to the site by the way KMMinNH.

[Malcolm Needs ☆]

I didn't notice.  I echo Phil's sentiments.  Welcome to the site.

[DebbieL]

We implemented the "extended crossmatch"  several years ago after we had a very angry physician with a scalpel in his hand and a patient on the table with multiple antibodies that we found just before he started cutting. The patient had been prescreened for everything but BB about a week before. By the time we got our specimen and had completed the T/S, the patient was draped in surgery. Surprise! This process has made our mornings much easier and we get very few bad surprises now. We only do this process for pretest surgery patients and only if they have not been pregnant or transfused in 3 months.

 

It took a lot of education and some missteps to get the nurses and physicians to understand there was a process that had to be followed exactly. This is a process with lots of steps that has evolved over a long period and we seem to have it pretty much perfected now. Everyone knows what needs to be done but it wasn't easy to get to this point.

 

1. We have a form that is used at pretest if the physician wants a crossmatch or T/S for surgery. The nurse will ask the patient about pregnancy and recent transfusions. The nurse must sign the form indicating that they asked the patient the specific questions and send the form with the pretest specimen.

2. We do a T/S and historical check. We put a comment in the computer that the patient has an extended crossmatch. We put a colored round sticker on the top of the specimen as a sign that the sample should be held for longer than all the other regular specimens.

3. Two days before the expected surgery we fax the same form to surgery holding so the form can be placed on the patient's chart. The holding nurses know to look for the form when the patient arrives. If we need a second specimen for ABO recheck, we have a place to indicate that we need a new sample.

4. The morning of surgery, the holding nurse will ask the patient the same questions and sign the form in a different spot and collect any specimens we indicated we needed. They fax the form back to us with the second signature. We have the answers to the questions and any specimens we need before the patient goes back to surgery. We remove the comment from the computer and order a specific computer test for the extended XM if everything is signed and looks OK. We locate the pretest sample and remove the sticker from the top. The crossmatch now has a 3 day limit.

4. If the patient is found to have antibodies at pretest, we know prior to the morning of surgery. We indicate on the form that is sent early to holding that a new sample is needed. We have time prior to surgery to screen or order antigen negative units and are able to crossmatch them with the new sample without much stress.

5. If there are any problems or concerns, we want a new specimen collected the morning of surgery and we start over with a new T/S. If the patient name or identification has changed, we can't find the pretest sample, the nurse didn't sign the pretest form and we didn't notice, etc.  

6. We tried to go with different lengths of extending (10 days, 14 days, etc) but finally settled on one month. Some patients would cancel surgery and come back after the extended date. It is easier for the techs to look at the pretest day and make a quick decision on the fly if we need a new sample. If it is close to one month we just tell holding we need a new sample but we already know the patient is negative for antibodies. Holding knows to call us if the patient had surgery cancelled so we can let them know if the sample was discarded or if it is close to or past a month. Most surgery is done within a week or maybe two of having the pretesting performed. Very few stretch it out to close to a month

 

If any of the steps are not followed as we require, the patient can't be extended. They have to follow our rules for all of us to be happy. The physicians are happy because they don't have to make a decision to continue surgery without crossmatched compatible blood.

 

We have found the occasional autoimmune problem prior to surgery using this process and we can easily discuss with the physician at his office and have all the medical release forms waiting in holding.  It is easier than trying to explain autoimmune to a physician with a scalpel in his hand.  

[amym1586]

We've stuck with 3 days.  We are a small rural hospital and people are not driving a hundred miles to have surgery here!

Ditto at my current hospital. 

 

My last hospital did a 10 day but it was more likely that people were traveling to have surgery there in a bigger city. 

 

[rmthorkelson]

We use 30 days as well with the standard "not pregnant, not transfused within 3 months" requirement.

 

I'm curious though, why you are considering the change from 30 days to 3 days?

[AMcCord]

7 days, if not pregnant/transfused in past 3 months

 

Ditto.

[AuntiS]

So... why is there a push to go from 30 to 3 days?

 

For everyone else who has 3/7/10 days for PREOP patients, why?  Is it a historical "we've always done it this way" thing?  Has there been a problem?  Do you worry you aren't getting a proper transfusion history?

 

We are a medium sized community hospital.  Not too big, not too small.  But, I cannot imagine the chaos if all our PREOP samples were only good for 3 days!

 

anti-s

[Dr. Pepper]

Another issue with shortening the preop window is that, although we do sometimes have departmental tunnel vision, there are other lab tests to be performed and acted upon besides pretransfusion testing. The whole point of getting the blood work done many days ahead of time is to get the abnormal glucose, creatinine, H&H, coag etc. sorted out before the day of surgery - not just antibody problems. So there would be less time to deal with these potential problems as well.

[goodchild]

Another issue with shortening the preop window is that, although we do sometimes have departmental tunnel vision, there are other lab tests to be performed and acted upon besides pretransfusion testing. The whole point of getting the blood work done many days ahead of time is to get the abnormal glucose, creatinine, H&H, coag etc. sorted out before the day of surgery - not just antibody problems. So there would be less time to deal with these potential problems as well.

 

In what world do surgeons/anesthesia review charts prior to the surgery?

[AuntiS]

 

Another issue with shortening the preop window is that, although we do sometimes have departmental tunnel vision, there are other lab tests to be performed and acted upon besides pretransfusion testing. The whole point of getting the blood work done many days ahead of time is to get the abnormal glucose, creatinine, H&H, coag etc. sorted out before the day of surgery - not just antibody problems. So there would be less time to deal with these potential problems as well.

 

In what world do surgeons/anesthesia review charts prior to the surgery?

 

LOL!

 

But... great point!  Speaking of tunnel vision - we really aren't the only department in the lab.  I mean, obviously we are the most important...  

 

We are lucky enough to have a Blood Conservation Coordinator here in our hospital, so a lot of the elective surgeries are seen quite far out

 

s

[Dr. Pepper]

In what world do surgeons/anesthesia review charts prior to the surgery?

Goodchild, you hardened cynic - why that would be the one long, long ago, in a galaxy far, far away, where they don't thumb through the chart while the patient is getting prepped and say "Holy bleep! His INR's 7, his platelets are 6, his hemoglobin's 5, his glucose is 4........."

 

Hey, I said that was the point, not that anyone did anything about it. But I LOLed too.