Patient Re-types

[TreeMoss]

Our current procedures for blood type (and anything including that) state that we need to do a patient re-type if there is no blood type history on the patient.  We will just do a forward type on the current specimen.  We are going to be setting up electronic crossmatch (soon, I hope) and will be required to test a specimen collected at a separate time for the re-type.  I am seeking input on how you folks handle your patient re-types.  We are also currently doing the re-type on every specimen -- including cord workups.  We know that when we start the electronic crossmatches, we will not be getting a separate specimen on those babies for the retype.  What do you do for traumas, pre-ops who come in a few days before surgery and only blood bank ordered, etc.  Because we have been testing the same specimen for our retype, it adds on to that original requisition.  I will have to change the retype to make a new requisition.

Any suggestions will be appreciated.

 

[goodchild]

We include a field under the Type and Screen result entry field for Previous History Check: Previous History/No Previous History. This field is responded to immediately upon receipt for patient's with no history.

On a No Previous History result, a chargeless Retype test is reflex-ordered under a new requisition for the patient and loads on the phlebotomy team's draw list (or depending on the patient's location we'll notify the patient's nurse for collection). We don't reflex Retypes on anything but Type and Screens. We will perform and result a second front type on all blood types that are performed when a Retype isn't completed, one that stays on the same requisition, as a quality check/confirmation (e.g. cord bloods, ED vaginal bleed Rh type checks, patient's who depart ED without Retype collection, etc.)

[Dansket]

I don't like the term 're-type', our term is 'ABO confirmation'.  We do electronic crossmatch, but follow the algorithm below for all Type and Screens, whether or not patient qualify for electronic crossmatch.

Our specimen label includes patient history of ABO/Rh and antibody identification.  If no ABO/Rh printed on label, we test the uncentrifuged blood sample with anti-A,B.  The anti-A,B test result is entered, saved and filed in Meditech on the Type and Screen blood sample.  If the anti-A,B test is agglutinated, the test CONFIRM (red cell typing only) is automatically ordered on a new blood sample that requires a second venipuncture (regardless if patient is in Surgery, Trauma, ER, and Outpatient).

If the anti-A,B test is not agglutinated, the test CONFIRMO is automatically ordered on the same blood sample and serves as the second blood type for patients without a history of ABO type. We are not AABB so we don't require red cell and plasma typing.

[pbaker]

Our computer system looks for patient history and will automatically order a confirmation if it does not find one.  It does not order the confirmation until the first specimen is received in the lab to avoid having the 2 specimens collected at the exact same time.  The second specimen must also be collected by a different person than the original to help ensure patient reidentification.

To expedite treatment, trauma confirmations will be auto ordered at the time of T/S order but must still be collected by a second individual.  ER staff draws the original, lab staff draws the confirmation.  If the blood bank determines that a confirmation is not needed, they cancel the order.

Due to the nature of the specimen, infant cord blood confirmations auto order on the same specimen but must be tested by a different tech.

[tbostock]

If a patient has a history on file that counts as the "first type".

If no history, we obtain a specimen drawn by the Lab (do not allow the same dept who collected the first to also collect the second), CBCs are OK.  We order a no charge "confirmation blood type" test to be able to result it in our LIS.  If unable to get a second specimen, the patient gets type O until we can.

Cords: we don't get retypes as all of our neonates receive O Neg red cells.

Pre-ops: PST sample is the first sample, day of OR is the second.

Trauma: unless we happen to have a history and have time to complete the Type and Screen, they get type O uncrossmatched.

 

[Likewine99]

We are identical to tbostock.  Make sure your ABO confirmation is "no charge".  We also have the BBIS capture the "workload statistic" since we do not charge for it.

[SMILLER]

But...what is the point of a re-typing?  If you are using a specimen from the same draw, (a CBC and T&S drawn at the same time for example), what are you confirming?  You may as well do a repeat ABO/Rh on the same tube.

Scott

 

[Malcolm Needs ☆]

Agreed.  If the sample was taken from the wrong patient in the first place, with a different and incompatible ABO group, it doesn't matter how many times you type the red cells (and type them accurately), you are still going to end up giving the real patient blood of the wrong ABO type.

[Dansket]

30 minutes ago, SMILLER said:

But...what is the point of a re-typing?  If you are using a specimen from the same draw, (a CBC and T&S drawn at the same time for example), what are you confirming?  You may as well do a repeat ABO/Rh on the same tube.

Scott

 

I agree with Scott, there is no difference retesting a specimen or specimens from a single venipuncture.

The rationale for retyping is based on the premise that your current system has so many 'potential points of failure' that retesting the same specimen or specimens from the same venipuncture may detect errors in specimen identification and/or specimen testing at the workbench. Plus, CAP and AABB allow this to comply with their electronic crossmatch requirements!  The gold standard is to perform a second ABO typing on a blood sample collected from a venipuncture done after a second visit to the patient's bedside.  This will detect errors in specimen collection and patient identification committed at the bedside.

I am a strong proponent of automated testing done on a barcode blood sample because it  eliminates so many of the 'potential points of failure' associated with manual testing systems.  We don't retest blood samples (re-typing), we obtain a new blood sample from a second venipuncture.

[goodchild]

Yeah, we specify it has to be from a unique specimen collection and it's a code of conduct violation if we find someone trying to cheat the system.

[tbostock]

1 hour ago, SMILLER said:

But...what is the point of a re-typing?  If you are using a specimen from the same draw, (a CBC and T&S drawn at the same time for example), what are you confirming?  You may as well do a repeat ABO/Rh on the same tube.

Scott

 

No, it has to be a separately drawn second sample.  We would never use a CBC drawn at the same time, by the same person, as the T&S.

[gilmanch]

Does anyone have a policy to not require a second draw/specimen when your patient is blood type O? At my previous employer, we did not reytpe O patients, b/c only going to give that patient O blood and if 1st draw was wrong and patient was A, that truly A person can have O blood. D did not matter. I was thinking about having this here at my current place. I wonder if other places do this, and may be if they do they take in consideration D typing if woman, to get 2nd type on O pos woman under 45.

[goodchild]

We thought about doing that but ruled it out based on our workflow and volume.

[Teristella]

2 hours ago, gilmanch said:

Does anyone have a policy to not require a second draw/specimen when your patient is blood type O? At my previous employer, we did not reytpe O patients, b/c only going to give that patient O blood and if 1st draw was wrong and patient was A, that truly A person can have O blood. D did not matter. I was thinking about having this here at my current place. I wonder if other places do this, and may be if they do they take in consideration D typing if woman, to get 2nd type on O pos woman under 45.

That is what we do but we do not do anything special for women under a certain age.

We do also confirm them first if they are O and getting plasma.

EDIT: We do confirm them if possible, usually we are just grabbing a CBC from a different draw/phleb. We just do not go out of our way to get a second sample if they are O pos.

Edited February 18, 2016 by Teristella

[AMcCord]

We confirm all patients the same - nothing special by age/sex/type.

Edited February 18, 2016 by AMcCord