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Blood Product Check on Nursing Unit


Brenda K Hutson

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So the Director of Nursing is asking me if the 2nd person (that performs the blood check at the bedside with the transfusionist) has to be a Nurse?  So does it have to be 2 Nurses?  AABB Standards just states:  The transfusionist and one other individual (or electronic system) shall, in the presence of the recipient.....etc. etc.

Thanks,

Brenda Hutson, MT(ASCP)SBB

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     I think it depends on how the nursing policy has the witnesses defined. Most places have it set up as 2 nurses with the witness being able to be a LPN. Also state laws need to be checked. In the state of Pennsylvania, there has to be 2 witnesses even with the electronic.

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This subject came up recently at our facility and it was decided by our Patient Safety Committee, of which I am a member, that the co-signer would need to be qualified to administer blood.  This means, RNs, Perfusionists and Anesthesiologists.  The thought process was that if the co-signer is not qualified to administer blood, then they would not be knowledgeable enough to know exactly what they were verifying.

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In my experience, one of the reviewers needs to be licensed (RN, MD...)  the 2nd person does not.  They're reviewing to make sure the paperwork matches the recipient, anyone can do that.  The person to hang the unit and start the transfusion needs to ensure that the blood type is compatible and matches.... I struggle to find a single nurse who really understands that (unforrunately).

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On 2/14/2017 at 7:15 AM, BankerGirl said:

This subject came up recently at our facility and it was decided by our Patient Safety Committee, of which I am a member, that the co-signer would need to be qualified to administer blood.  This means, RNs, Perfusionists and Anesthesiologists.  The thought process was that if the co-signer is not qualified to administer blood, then they would not be knowledgeable enough to know exactly what they were verifying.

I wish our policy was this strict.

Our facility allows RNs, LPNs and nursing students to obtain and check blood products for transfusion. Only RNs and students may transfuse blood products. Students will always be directly supervised by an RN preceptor.

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On ‎2‎/‎14‎/‎2017 at 7:15 AM, BankerGirl said:

This subject came up recently at our facility and it was decided by our Patient Safety Committee, of which I am a member, that the co-signer would need to be qualified to administer blood.  This means, RNs, Perfusionists and Anesthesiologists.  The thought process was that if the co-signer is not qualified to administer blood, then they would not be knowledgeable enough to know exactly what they were verifying.

This is the same policy that we follow, although we do allow the patient physician to check also. Plus, I only allow RN's, MD's, and the anesthesia techs from the Heart OR to pick it up, in my opinion if they can't transfuse it they should not pick it up (minus the anesthesia techs).

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We've had surgery sent housekeeping to get blood on evenings and nights :eyepopping: and they have been furious when we've refused to issue blood to that person. If the OR call staff doesn't have someone free to come for blood, we will deliver but expect an RN to check it with us outside the OR door - that ticks them off, too, but I stand my ground on that.

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On 2/14/2017 at 8:15 AM, BankerGirl said:

The thought process was that if the co-signer is not qualified to administer blood, then they would not be knowledgeable enough to know exactly what they were verifying.

Forgive my ignorance.....I don't work in a hospital. In your facility, does the process of administering of other drugs require the concurrence of two "qualified individuals" at the bedside ?

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At our hospital, (medium sized level 1 trauma center) Transport, runners, orderlies, can pick up blood from the BB - they need to present patient name/MRN.

For the bedside check, hospital policy states "licensed" individuals - RN, LPN, MD, etc - to verify and sign off the double check.  You are correct in that some knowledge of compatibility is needed to sign off.

But pick up from the BB is simply a clerical check - that we are issuing blood for pt X.

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I initially brought up the subject after noticing that a nursing student co-signed a transfusion.  Our risk manager made the decision after some discussion (we don't employee LPNs in nursing roles here).  Granted, the nurses and physicians don't always know what blood types are compatible, but they are not shy about calling to ask us, and I don't know that a nursing student or similarly trained person would even notice the difference.  As for issuing from BB, we do the same as kate murphy.

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On ‎2‎/‎14‎/‎2017 at 8:15 AM, BankerGirl said:

This subject came up recently at our facility and it was decided by our Patient Safety Committee, of which I am a member, that the co-signer would need to be qualified to administer blood.  This means, RNs, Perfusionists and Anesthesiologists.  The thought process was that if the co-signer is not qualified to administer blood, then they would not be knowledgeable enough to know exactly what they were verifying.

Whether or not that is regulatory "fact," I think it makes a lot of sense!

Thanks

Brenda

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On ‎2‎/‎14‎/‎2017 at 0:21 PM, Smarty pants said:

In my experience, one of the reviewers needs to be licensed (RN, MD...)  the 2nd person does not.  They're reviewing to make sure the paperwork matches the recipient, anyone can do that.  The person to hang the unit and start the transfusion needs to ensure that the blood type is compatible and matches.... I struggle to find a single nurse who really understands that (unforrunately).

Well, I know that at least in 1 state (I checked with a former Medical Director there), state regulations are that the 2nd check can only be performed by an:   RN, MD, NP, PA, and certified perfusionists or autotransfusionist.  So I guess that is what I am trying to determine....a regulatory mandate (but having a difficult time filtering through my State Dept. of Health Services Policies to see if it also lists specific staff that can perform a 2nd check.  I checked with the FDA and they have no guidelines/ restrictions for this.....and am waiting to hear back from the AABB.

Thanks,

Brenda

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On ‎2‎/‎15‎/‎2017 at 9:49 AM, AMcCord said:

We've had surgery sent housekeeping to get blood on evenings and nights :eyepopping: and they have been furious when we've refused to issue blood to that person. If the OR call staff doesn't have someone free to come for blood, we will deliver but expect an RN to check it with us outside the OR door - that ticks them off, too, but I stand my ground on that.

Well, that is kind of a 2nd issue (picking up blood products vs. performing 2nd check at bedside).  At various places I have worked, there have been different restrictions on who could pick the blood up, based on our departmental process (i.e. if 2 Techs. perform a read-back in BB at time of issue, probably would not be critical who carried the blood back to the Nursing unit; on the other hand, if you are depending on that courier to be a 2nd check of product appropriateness, it should be someone who understands blood products and protocols).  We send our blood through the pneumatic tube.....so we do not deal with the issue of "who" can pick the blood up. 

But then there is the 2nd aspect of the check that takes place at the patient's bedside by the transfusionist.......if there is no computer system in that hospital that performs a double-check (i.e. scanning patient armband and label on blood product), then who is allowed to review with the transfusionist that this is the appropriate product for that patient?  If I had no regulation to answer to, I would think it should be someone with an equivalent knowledge of the transfusionist if you really want errors to be caught.  But therein lies my bottom line.....is there a regulation (either national, or in my state) that limits that check to specific staff?

Thanks,

Brenda

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3 hours ago, AMcCord said:

At my facility, we use a patient armband barcode to ID for drugs rather than a 2 person ID. Have done it that way for quite a few years now. I don't know how they did it before the barcoded ID band.

That would be great...my hospital just isn't willing to spend the money for that system at this point.

Thanks,

Brenda

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On ‎2‎/‎15‎/‎2017 at 10:54 AM, exlimey said:

Forgive my ignorance.....I don't work in a hospital. In your facility, does the process of administering of other drugs require the concurrence of two "qualified individuals" at the bedside ?

I believe we have that system set up for medications....we just have not purchased the LIS program that would allow us to also do that for blood products.

Brenda

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2 hours ago, kate murphy said:

At our hospital, (medium sized level 1 trauma center) Transport, runners, orderlies, can pick up blood from the BB - they need to present patient name/MRN.

For the bedside check, hospital policy states "licensed" individuals - RN, LPN, MD, etc - to verify and sign off the double check.  You are correct in that some knowledge of compatibility is needed to sign off.

But pick up from the BB is simply a clerical check - that we are issuing blood for pt X.

I have worked in a number of places so have experienced a lot of variations on the theme as far as picking up the blood products (anywhere from hospital transporter, to RN).  Also take into consideration then....are you depending on this person picking up the product to be a second check....or are you depending on a 2nd Tech. or the computer system as your 2nd check...in which case you are not as concerned with who picks it up.  But I will say this....even when we have limited it to Nursing, sadly, they often do not know what blood types are compatible (if not giving type-specific), or understand the "when" and "what" of attributes such as Irradiated or CMV- or antibodies and antigens.....so I am not sure how much safer it is in reality to require that the individual picking up the product is going to catch your mistakes.  That can even be true at the bedside....that most of what they are doing is making sure everything matches and that they are transfusing the correct patient??

Brenda

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We send most of our blood through the tube system, but will allow ED techs and CNAs to check out blood if it is not available.  Our policy states that a CNA can record vitals if the tranfusion is performed on paper.  But most of the blood is documented through Meditech in the TAR module.  Two nurses have to sign that everything was checked (consent, scanning of the patient and blood product barcodes) and only nurses can enter the vitals.

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22 hours ago, Brenda Hutson said:

That would be great...my hospital just isn't willing to spend the money for that system at this point.

Thanks,

Brenda

We have a huge focus on patient safety as an institution, so that helps prioritize money in to projects like this one, though the med administration system went in before we had made that culture change. The quality emphasis and culture change is driving other good projects that had been on a lower priority list because of money. It's all about where the priorities are...as lab people we know we are usually not at the top of the priority list - sadly.

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On ‎2‎/‎16‎/‎2017 at 9:50 AM, MAGNUM said:

everyone should think about how important this is, rechecks and everything. case in effect the nurse in the London Heart Hospital whose patient died because of a unit of incompatible packed cells.

Here is the article describing that incident that a colleague shared with us recently.  An awful story, but worth reading and recognizing the importance of the checks that are put in place to keep patients safe.  http://www.thecomet.net/news/nurse_from_stevenage_given_suspended_sentence_after_using_wrong_type_of_blood_in_transfusion_which_killed_patient_1_4883904

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