Misidentification risk mitigation alternatives

[Christy Spence]

My facility currently uses the Typenex system. We've used it for years (at least 12+) and have had great success. Our CAP inspectors have been satisfied with our protocols so far. 

One of the main CAP Transfusion Med. individuals (not sure of the right title but I don't want to call them out by name...) stated very clearly during a recent webinar that typenex is not an acceptable method for misidentification risk mitigation (see TRM30375). Our inspection window starts in 2 months and I'm trying to gather as much info as I can on our options. I know I will get major pushback from our docs here if we try to push through a second sample verification system. Anybody else out there in the same boat? Please share your experiences and advice with transitioning to a different ID system! I'm wondering if getting a barcode scanner/printer for the bedside in addition to the typenex system would be the least impactful option at this point

 

[Mabel Adams]

We went with the second blood type but only on patients we are not giving group O blood to. Between that policy removing about half of the need, allowing use of another lab specimen from Hem or Coag and a lot of historical types on record, it hasn't been too bad.  We are AABB and TJC but not CAP inspected.  We made the change for patient safety at the time.  Now I think AABB is requiring something similar to CAP.

[David Saikin]

WE found bloodloc to be an acceptable alternative to typenex.  I have seen typenex fail.  BloodLoc requires a code attached to the pt sample.  The only place the code exists is on a separate bracelet attached at admission.  The blood is released with a combination lock.  The combination is the code.  IF the lock doesn't open either the xm is not on the correct patient sample or the tech entered the code incorrectly.  This is considered a barrier protection device.  Only requires one type.  Never had a problem.  Nursing has to buy into it and not cut open the bag if the lock doesn't open.

[mlapierre]

We follow the same practice as Mabel.  The second sample is required for all patients who do not type as Group O and we also use other lab specimens that were collected at different times than the original blood bank sample.

[mcgouc]

We used Typenex but also went to the second specimen drawn at a separate time or a historical record.  The transition was not as difficult as I had thought it was going to be. 

[AMcCord]

We were using Typenex bands with a very rigid policy and quality requirements. The band is not a barrier method, but with our quality program, we were passing CAP inspection for years. However, it was getting harder and harder to get through inspection with that, so we had to come up with a new game plan.

We've since added hand held devices to scan patient armbands at bedside for patient ID. Important for all specimens, not just Blood Bank. (And I will mention that we had a phleb, who no longer works for us, still manage to mislabel patient tubes with another name...twice...so don't think that is the solution that solves all problems.) Infusion clinic patients (some of whom are transfused) and some ER patients cannot be ID'd with the hand held device with our current computer system. Didn't solve our problem totally, but covered a lot of holes.

Next step was to add the FinalCheck bands/lock system, which is a barrier method similar to what David described above. The band is placed on the patient when the specimen is drawn.  Stickers with the code are placed on the specimen tubes when they are labeled at bedside. The stickers come directly from the patient's band which must be on an arm or leg at the time. The alpha code on the bracelet opens the lock on the bag the blood is placed in when we check it out for transfusion. Code appears only on the patient bracelet for nurse to see. Nursing staff was trained very specifically for the system before we rolled it out and it is a part of their annual and new employee training. Nursing service has a very clear cut and serious disciplinary action plan which would apply in any situation where a bag was cut open and they've made sure that all staff is very aware of it. I am happy to say that we have not had a single bag cut open since we started using the system over 2 years ago. Patient safety is a very important part of our culture, from the CEO down, so I think that helps.

Another bonus is that the alpha code also appears on the FinalCheck band as a bar code that is readable by the Echo. If we need to perform testing in emergency situations before we have orders in the system, we can use the FinalCheck barcode for testing.

I'm not going to suggest that this system is foolproof, because it's not, but we've closed a lot of holes. We've passed CAP and JC inspections since implementation with no concerns or issues.

[tbostock]

Agreed; getting a second type confirmation is not the big deal that clinicians think it is.  We use CBC specimens drawn by our own phlebs using the hand-held device.

[David Saikin]

For you folks who use a second specimen - if you are unable to obtain one (and I am assuming from a separate phlebotomy event), are you only distributing group O red cells?  Seems this would be the case for the majority of traumas (esp after you've transfused 8-20+ rbcs)?  Just seems like a waste of valuable group Os.  Where I come from it is hard enough getting O+ let alone O=.  I have run across situations where they ask you to type the blood on the floor in the ED . . . 

 

 

[mlapierre]

The second type must be from a separate phlebotomy event.  If we are unable to get a second blood type, which is rare,  we do use Group O cells.  We very rarely have problems getting Group O cells.

[Christy Spence]

On ‎6‎/‎7‎/‎2017 at 8:11 AM, David Saikin said:

For you folks who use a second specimen - if you are unable to obtain one (and I am assuming from a separate phlebotomy event), are you only distributing group O red cells?  Seems this would be the case for the majority of traumas (esp after you've transfused 8-20+ rbcs)?  Just seems like a waste of valuable group Os.  Where I come from it is hard enough getting O+ let alone O=.  I have run across situations where they ask you to type the blood on the floor in the ED . . . 

 

 

I'm interested in knowing this as well... We are not a level 1 trauma center so this isn't a huge issue for us but it isn't easy to obtain O units either.

[pbaker]

If we do not have 2 separate types, the patient gets O until we do.

[Mabel Adams]

The patient gets O until we get a second type.  If necessary, we can have a pathologist override and let us go to type specific on one specimen.  That would most likely be A or B neg female so we don't use up all of our O neg.  I think we maybe did that once in 3 years.  They are supposed to be drawing coags and/or iStats on our massives every half hour or so anyway so it is isn't like they aren't drawing more specimens.  It gets interesting when the redraw is after unxm O pos was given to a patient who is Rh neg because the second type will be Rh pos.  We have a policy for keeping the computer happy in these cases.