amym1586 Posted January 13, 2016 Share Posted January 13, 2016 So we currently do not write an issue time when we sign out products from blood bank. I can only assume that means we are NOT checking Issue time to start time/ or issue time to end time. Shouldn't we be doing that???? I assumed so. So I called our Blood bank provider and asked if we could add that to our product tags so we could write down issue times. They said sure and then sent me a bill. A big bill. Can someone assure me that we need to be doing that before I go plead my case to my lab director. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted January 13, 2016 Share Posted January 13, 2016 We certainly have to take a note of this time in the UK, and I would be surprised if this was not the case in the USA, although I don't know that for sure. amym1586 1 Link to comment Share on other sites More sharing options...
David Saikin Posted January 13, 2016 Share Posted January 13, 2016 I have always documented the time of release from the BB anyplace I workded - since 1971. kloggins and amym1586 2 Link to comment Share on other sites More sharing options...
Dansket Posted January 13, 2016 Share Posted January 13, 2016 1 hour ago, David Saikin said: I have always documented the time of release from the BB anyplace I workded - since 1971. Ditto! Link to comment Share on other sites More sharing options...
amym1586 Posted January 13, 2016 Author Share Posted January 13, 2016 Anyone know off hand if it's a CAP or AABB standard ? Link to comment Share on other sites More sharing options...
Matchead09 Posted January 13, 2016 Share Posted January 13, 2016 AABB Standard 5.23 Issue of Blood and Blood Components At the time a unit is issued, there shall be a final check of transfusion service records and each unit of blood an blood component. Verification shall include: (a list of items) 6) The date and time of issue. We record this electronically with a back-up (or down-time substitute) in the form of a sheet of paper signed by nurse and blood bank tech at time of issue. amym1586, kloggins and David Saikin 3 Link to comment Share on other sites More sharing options...
amym1586 Posted January 13, 2016 Author Share Posted January 13, 2016 phew! He didn't give me the boot. tbostock, Malcolm Needs and David Saikin 3 Link to comment Share on other sites More sharing options...
tricore Posted January 13, 2016 Share Posted January 13, 2016 We have a Blood Product Issue program in the LIS. Records the time of issue, issuing tech, to whom issued. Is there a paper blood request, i.e, check out slip? Can you record it there? A long time ago we used to record it on the transfusion tag. amym1586 1 Link to comment Share on other sites More sharing options...
Dr. Pepper Posted January 14, 2016 Share Posted January 14, 2016 (edited) Your are correct that for a variety of reasons it's advantageous and sound practice to know what the timeline is surrounding the transfusion: time specimen drawn, time received in lab, time pretransfusion testing was completed, time issued, time transfusion started, time completed. Issue time is captured in our LIS like Tricore. We also record it on the crossmatch form that accompanies the unit, a carryover from the old days when that time started the countdown for the now discredited 30 minute rule. Again echoing Tricor - if you don't issue in the computer, don't you have some sort of paper log on which to record the time/date/inspection results/tech/who or where the unit is going? If you are issuing in the computer, isn't that captured there? Precomputer we had 4-copy crossmatch forms on which we recorded patient and unit info and, when issued, issue data. First copy was the permanent record of the transfusion for the chart - it was full size and had room for the nurses to record pretransfusion check and transfusion data. The other copies were 1/3 size. Second copy was the bag tag. Third copy we saved and transferred the issue data to our permanent crossmatch log. Fourth copy went to billing with the appropriate charges checked off. I did not see a specific CAP requirement to record the time issued. Phil Edited January 14, 2016 by Dr. Pepper amym1586 1 Link to comment Share on other sites More sharing options...
amym1586 Posted January 14, 2016 Author Share Posted January 14, 2016 14 hours ago, tricore said: We have a Blood Product Issue program in the LIS. Records the time of issue, issuing tech, to whom issued. Is there a paper blood request, i.e, check out slip? Can you record it there? A long time ago we used to record it on the transfusion tag. It is recorded in the our blood bank program with a paper slip that goes out with it. However with the pathologist reviews the paper slips there's no record there of when it was issued. Link to comment Share on other sites More sharing options...
David Saikin Posted January 14, 2016 Share Posted January 14, 2016 19 hours ago, amym1586 said: phew! He didn't give me the boot. He's probably glad someone is bringing his BB up to standards. I always tell my manager tha quality is not cheap (when it comes to $$ quality helps assure that you are not wasting any but usually costs a bit to implement). AMcCord, tbostock, kloggins and 2 others 5 Link to comment Share on other sites More sharing options...
R1R2 Posted January 14, 2016 Share Posted January 14, 2016 33 minutes ago, amym1586 said: It is recorded in the our blood bank program with a paper slip that goes out with it. However with the pathologist reviews the paper slips there's no record there of when it was issued. As long as you are documenting the time of issue in the LIS you are good to go. I would not add another layer to your process by manually writing the issue time on a slip or paper or where ever. "ain't got time for that" is my 2016 motto. Link to comment Share on other sites More sharing options...
amym1586 Posted January 14, 2016 Author Share Posted January 14, 2016 6 minutes ago, R1R2 said: As long as you are documenting the time of issue in the LIS you are good to go. I would not add another layer to your process by manually writing the issue time on a slip or paper or where ever. "ain't got time for that" is my 2016 motto. It's not in the LIS though. That issue time doesn't cross over from our separate blood bank program. So the only way to check an issue time would be to physically come in blood bank and look up each patient to see when blood got issued. That's not happening so no one is checking to see if the units are getting transfused in 4 hours. So, I'm still feeling like it's necessary. tbostock 1 Link to comment Share on other sites More sharing options...
R1R2 Posted January 14, 2016 Share Posted January 14, 2016 1 minute ago, amym1586 said: It's not in the LIS though. That issue time doesn't cross over from our separate blood bank program. So the only way to check an issue time would be to physically come in blood bank and look up each patient to see when blood got issued. That's not happening so no one is checking to see if the units are getting transfused in 4 hours. So, I'm still feeling like it's necessary. the FDA requirement is not that blood transfusion is completed within 4 hours of issue. The FDA requirement is transfusion is complete within 4 hours of start of transfusion. You may need to update your policy? Link to comment Share on other sites More sharing options...
amym1586 Posted January 14, 2016 Author Share Posted January 14, 2016 1 minute ago, R1R2 said: the FDA requirement is not that blood transfusion is completed within 4 hours of issue. The FDA requirement is transfusion is complete within 4 hours of start of transfusion. You may need to update your policy? Oh. But what if they get it out of blood bank and set it in a room or a refrigerator for an hour before they start? Link to comment Share on other sites More sharing options...
R1R2 Posted January 14, 2016 Share Posted January 14, 2016 (edited) Nursing should have a policy not to do that and it should be part of their annual training. I could audit that on occasion - blood issue to time started. Edited January 14, 2016 by R1R2 amym1586 1 Link to comment Share on other sites More sharing options...
Dansket Posted January 14, 2016 Share Posted January 14, 2016 20 minutes ago, amym1586 said: Oh. But what if they get it out of blood bank and set it in a room or a refrigerator for an hour before they start? FDA, CAP, AABB are all minimum requirements. Your policy can exceed FDA minimum requirements. I have always used the 'issue' time as the start of the 4 hour clock for units not issued in a cooler. amym1586 1 Link to comment Share on other sites More sharing options...
tbostock Posted January 14, 2016 Share Posted January 14, 2016 (edited) 1 hour ago, R1R2 said: the FDA requirement is not that blood transfusion is completed within 4 hours of issue. The FDA requirement is transfusion is complete within 4 hours of start of transfusion. You may need to update your policy? It's 4 hours from the time it leaves a refrigerator or monitored cooler, not when the nurse starts it. Edit: this is found in the Circular of Information Edited January 14, 2016 by tbostock amym1586 1 Link to comment Share on other sites More sharing options...
goodchild Posted January 14, 2016 Share Posted January 14, 2016 Circular of information states verbatim under the "Instructions for Use" section: "Transfusion should be started before component expiration and completed within 4 hours." Later, under red blood cell administration, it states: "It is undesirable for components that contain red cells to remain at room temperature longer than 4 hours. If the anticipated infusion rate must be so slow that the entire unit cannot be infused within 4 hours, it is appropriate to order smaller aliquots for transfusion." We go with 4 hours from start time. Link to comment Share on other sites More sharing options...
amym1586 Posted January 14, 2016 Author Share Posted January 14, 2016 36 minutes ago, goodchild said: "It is undesirable for components that contain red cells to remain at room temperature longer than 4 hours. But wouldn't that prove you need to start the 4 hour count from when it leaves the refrigerator ? tbostock 1 Link to comment Share on other sites More sharing options...
goodchild Posted January 14, 2016 Share Posted January 14, 2016 That's definitely how that line could be interpreted. The other two lines could be argued to point to a four hour timeframe from start. Link to comment Share on other sites More sharing options...
amym1586 Posted January 14, 2016 Author Share Posted January 14, 2016 1 hour ago, goodchild said: Circular of information states verbatim under the "Instructions for Use" section: "Transfusion should be started before component expiration and completed within 4 hours." We used to say, the component expires 30 minutes after leaving blood bank. Is that true? Link to comment Share on other sites More sharing options...
SMILLER Posted January 14, 2016 Share Posted January 14, 2016 A four hour timeframe from start doesn't seem to make sense to me. There has to be a line drawn at some time after the unit is removed from an appropriately monitored storage area where it is OK to transfuse before that time, but not after. This seems to be set at 4 hours. The start time is not the point. Otherwise an unhung unit could sit at the patient's bedside for an indefinite period and still be transfused. ("No problem Mr. Peters, we'll just let it sit on the radiator for a few minutes so you won't get a chill...") Or, I could be wrong. I would be interested in anything someone has actually heard from a regulator on this. Scott amym1586 and Sandy L 2 Link to comment Share on other sites More sharing options...
goodchild Posted January 14, 2016 Share Posted January 14, 2016 I recall a lot of discussion on these boards about the relevance and history of the 4 hour timeframe. amym1586 1 Link to comment Share on other sites More sharing options...
SMILLER Posted January 14, 2016 Share Posted January 14, 2016 Me too. But I do not remember if any of them come from somebody who works for the FDA, CAP, JCAHO or AABB... Scott amym1586 1 Link to comment Share on other sites More sharing options...
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