TRAUMA SUPPORT

[LIMPER55]

Years ago --we had a blood bank refrigerator in OR--the units were placed there day of surgery.

JACHO?  I believe did not like that

My company is in process of building new trauma center and the surgeons want to go BACK to reaching into the frig for units.  They have dismissed the Haemonetics refrig as too much work/timely/uneccessary/ etc.

So-Dear Blood bank community--Does anyone know the regulations limiting the refrigerator in the OR? 

[tbostock]

It's regulation heavy, and every Joint Commission inspector I deal with is VERY happy that our OR does not have a refrig.  I would say Haemonetics or no deal.

[Mabel Adams]

If you require a process for checking the blood out of the fridge that is as safe as the Haemonetics it will not be as easy or fast as they want. The JC write up that discouraged OR blood refrigerators was about preventing sentinel events.  Those are supposed to be "never events" so they would need to explain some way that they can assure that they never would take the wrong blood out of the fridge for a patient--even if someone leaves blood in there from the day before and the new patient has the same name.  I know, they "always" check the ID at the bedside--except we have all seen the times when a name or band number error was not caught until the 3rd unit. Giving the wrong blood is indefensible--in the lay press, to the patient or family, to attorneys, to inspectors and the FDA (as well as our own consciences).  I have gotten the attention of nurses who are in too much of a hurry "saving lives" to follow protocols by asking them, "How often is it okay to kill a patient?"  Obviously, we all feel the answer is "never" but this question does help them think about rare errors being worth avoiding. 

[Mabel Adams]

Here's the link:

http://www.jointcommission.org/sentinel_event_alert_issue_10_blood_transfusion_errors_preventing_future_occurrences/

 

[R1R2]

I have seen some very serious patient safety events with cooler use too so they are no safer than fridges IMO.   The JC sentinel report listed a single fridge holding multiple patients' blood products as one of the root causes identified.    Perhaps you can have multiple refrigerators if you have a large trauma center so each Trauma bay has it's own fridge (this was identified as a possible solution in JC report).  IF you want a fridge in the Trauma unit then make sure you have put into place policies/procedures that include receipt, storage and return.  You should audit the process too.

[John C. Staley]

Just curious, is pneumatic tube delivery an option?  Much faster than hand carried and much safer than a refrigerator full of blood that everyone has access to. 

[LIMPER55]

Hi John, 

You are my favorite source!

We have a tube system in place, but only two units can be dispensed at a time. There is a cumbersome "read back" system in place for accountability.  We use Safe-T-Vue for temperature confirmation.

The surgeons are concerned about the time it takes.  Surgery is quite a distance from the blood bank.

Coolers are validated and used up to 4 hours on the scheduled surgeries.  We are a Level 1 trauma center.

Thank you for your continued interest. 

[David Saikin]

I have seen VERY SCARY things occur with BB ref in the O.R.  Like:  units tagged for a patient being ignored and unprocessed rbcs taken and transfused.  Yes unprocessed - security would bring blood boxes to the O.R. which would remove the units and place them in the refrig - "We knew they were for this patient".  How did we not kill anyone is beyond me.  I think the best way to go, if you have a BBIS, is to get one of the BB vending machines and put it in your trauma arena.  You could stock it with just group O (you'd have to determine the mix of pos/neg).  They make small ones (hold up to 9u) and large ones (over 100u).

My small hospital wants coolers and I am balking.  They are no safer than a refrig.

[John C. Staley]

4 hours ago, LIMPER55 said:

Hi John, 

You are my favorite source!

We have a tube system in place, but only two units can be dispensed at a time. There is a cumbersome "read back" system in place for accountability.  We use Safe-T-Vue for temperature confirmation.

The surgeons are concerned about the time it takes.  Surgery is quite a distance from the blood bank.

Coolers are validated and used up to 4 hours on the scheduled surgeries.  We are a Level 1 trauma center.

Thank you for your continued interest. 

First, thank you.  You made my day!  

Maybe you could look at that cumbersome "read back" system and possibly make it less cumbersome.  With out seeing your system in operation I really can not make any suggestions but my experience has been that any system described as cumbersome is in desperate need of retooling.  Secondly, how often are they actually hanging more than 2 units at once!  This should not really be an issue.  Our system was capable of transporting 4 PRBCs at one time but we didn't tell anyone that and maintained a fairly hard and fast rule of no more than 2.  We were a level II trauma center and 2 units at a time never posed a problem.  The biggest problem we had was having some one in OR waiting to remove the blood from the tube system.  And finally, can you define the distance to surgery from the blood bank in increments of time?  When we were validating the tube system in the new hospital in 2002 the time from pushing the send button to arrival at the most distant station was measured in seconds!  My guess is that the time concern of the surgeons has more to do with the cumbersome read back system and not the actual transit time.   Our tube system had the ability to set priorities and the blood bank had the highest priority in the facility.  When we pushed the send button everything else got out of the way.  

[tms8313]

We use the BloodLoc system on all of our blood products.  When we issue products to surgery, sometimes they go straight to the surgical room in a cooler and sometimes they go to the OR refrigerator.  The units are always locked up inside a BloodLoc bag.  Transfusing staff must take the products to the bedside where they get the Bloodloc code from the patient's wristband that they have to dial in to the lock on the top of the bag.  if they don't dial in the correct code then it doesn't open.

this is how we help ensure the patient's safety when products for multiple patients are stored in the OR refrigerator.

[mollyredone]

Can't the Bloodloc bags just be cut open?  That's not following protocol, but I could see OR doing that in a hurry.

[John C. Staley]

6 hours ago, mollyredone said:

Can't the Bloodloc bags just be cut open?  That's not following protocol, but I could see OR doing that in a hurry.

The scariest thing in the world is a nurse with a pair of scissors and an urgent need to use them.   

[tms8313]

we have a strict policy about NEVER cutting open a bloodloc bag.  I only saw it happen a few times in the first month or so after we started using them many years ago.  there was public shaming involved (haha) and reeducation done.  I am not aware of it happening again.

If for some reason they can't get it open, they return it to us for investigation.  This has happened several times and they are good about returning it to us.