The weather's getting warmer here in Indiana and that means that everyone's suddenly out shooting and stabbing each other again, which translates to an uptick in our Massive Transfusion activations.  We seem to have a rash of these lately where "they" never send us a sample for a type and screen.  For those of you who manage these often, can you please share the creative things that you do to help "them" remember to collect a specimen?  I don't think that refusing to give out products will win me any fans, nor can I send Blood Bank staff out to collect the sample. 

In our hospital, as soon as a Massive Transfusion Protocol is initiated, one of our phlebotomist goes to ER to draw a sample for Blood Bank. It is written in our hospital MTP policy that this will need to happen. In OR, The OR personnel is instructed to draw a sample for blood bank.

we are still in the process of refining our policy. We created a one page laminated placard that went to each department, describing what to expect during annMTP. Obtaining a sample for blood bank is mentioned on that placard. 

Do you not get a sample because the patient expires?   That is usually the case here in Chi Town.   When this happened in the past, I remind the ED staff that we have only so many units of O blood and if they had a couple of these MTPs going at the same time, we may run out of O if we can't change blood type.   

ED nursing staff draws rainbows labs on all patients, so once  labs are drawn a bb spec is included.

Most of the docs are good about lab notification and samples, being a priority. They know we only have so much blood in stock.

If we' get a call asking for a 2nd pair of o negs ( 3rd and 4th unit), before hanging up the phone we remind them we need a sample.

Sometimes we don't get one as some pt's are shipped out quick.

 

Yes, we don't get a sample sometimes when the patient expires.  Usually those cases don't go for too long...but there are some that have several doses with no sample.  We have a big Level 1 Trauma service and activate our Massive Transfusion protocol every 2.5 days.

The T&S is included in our MTP and full trauma activation order sets.  Both phlebotomy and blood bank are included in the page for both scenarios.  Unless a patient expires immediately after arrival, it is very unusual for us not to get a specimen within 10-15 minutes.

We get a page also in the Blood Bank, but we don't have phlebotomy teams and our Med Techs (who are dedicated blood bankers) don't draw samples.

You could enter a patient safety event.   This may get someone's attention.

Google the report (page 9) "Fatalities Reported to FDA Following Blood Collection and Transfusion Annual Summary for FY2015". Where it states "The number of non-ABO hemolytic transfusion reactions represents a count unchanged with four cases in both FY2014 and FY2015 (Table 3). These cases are comparatively less preventable as seen in FY2015, where all cases were transfusions due to emergent need, and antibody history was not always known." The less preventable part refers to a death due to ABO HTR that resulted from a mislabeled specimen. Table 3 shows 6 deaths in 2011, 5 deaths in both 2012 and 2013 due to non-ABO HTRs.

I would hope presenting an FDA report to the "powers that be" provides an evidence based reason for them to enforce or at least encourage prompt sample collection and delivery to the BB. Please note that the report is more detailed and useful than my (simplistic) paraphrasing.

 

we have very active level I trauma center...

all our trauma docs knows very well that we need a sample and invariably the sample get drawn for all out trauma protocols.

Sometime few minutes late to blood bank but we issue type specific almost >95% of the time.

Only few cases where the patients BP was so low that they could not draw specimen and we had to use O RBC and AB plasma that was several years ago....