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bevfranklin2000

Extending specimens past 3 days

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Right now our facility will extend PreAdmit patient samples for 10 days.  This means the patient hasn't had any transfusions or been pregnant in the last 3 months.  Also the patient would be having surgery within 10 days of the specimen being collected.  Now some of our Dr.'s would like to have patients come in as early as 28 days before surgery to have their PreAdmit labs drawn.  Is anyone else doing this?  If so how do you handle your manufacture inserts and transfusion reactions?  Do you perform crossmatches on the day of surgery?  Did you validate anything before swapping to a longer date?  Any information would be greatly appreciated.

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45 minutes ago, bevfranklin2000 said:

Now some of our Dr.'s would like to have patients come in as early as 28 days before surgery to have their PreAdmit labs drawn.

The very FIRST thing I would do is to sign a declaration that any patient who suffers either morbidity or mortality as a result of this change to your system is down to them (i.e. THEY take legal responsibility, and not you).  This will have one of two outcomes.  Firstly, they will sign such a document, and then you are free from accountability (as long as you record that you have explained to them the error of their ways), or secondly, they will withdraw to a private area to change their under-garments, and will abandon this plan.

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About half of our surgery patients are first timers to the blood bank.  Since we need two independent types, we use the pre admit type and screen as the first type and a heads up for any antibodies.  They always get redrawn the day of surgery for the type and screen we will crossmatch with.  That may be 28 days later or the next day.  We then have 2 independent types for our ABO/Rh confirmation.  We do not extend sample dates past 3 days without a really, really good reason and pathology approval.

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We have a process to extend the crossmatch that has worked for several years. It is complicated and involves 3 departments. Everything has to be exactly right. The patient comes in to pre-test. We have a form that is put with the pretest packet. On the top part of the form is the patients info along with today's date and expected date of surgery. The nurse asks the patient two questions- have you been pregnant or transfused in the last 3 months? The nurse signs her credentials and sends the form to us along with the specimen. 

We perform a T/S and write our info into a section for the BB. There is a spot on the form that we put whether we need a second type on the morning of surgery. We put a sticker on top of the tube to signify the tube has to be saved when specimens are thrown away. Two days before surgery, the night shift faxes the form to surgery holding so they can put the forms in the charts. The morning of surgery, the nurse scans the form to see if they need to collect the second specimen and they ask the patient if they have been pregnant or transfused since pretest. Nurse signs form and faxes to us and sends the 2nd specimen if required. 

We get the form, do the second ABORH, find the original specimen, look at form for all signatures, etc. If all the stars are alligned, we order a specific test in the computer which extends the crossmatch for 3 days, answer the specific things in the computer and  perform an electronic crossmatch if the physician wanted blood set up. If the patient had an antibody, we request a new specimen on the morning of surgery to do a new T/S and crossmatch the units we antigen typed before the patient arrived. Works great. Most are only T/S done 3-5 days before surgery with the occasional cancelled surgery that tries to get in at the end of the month. 

We tried to do 14 days but extended to a month (30/31 days hard stop) because the physicians kept pushing the envelope. We did 30/31 days because it is easy to see if the surgery was canceled for too long. If there is any question about ANYTHING, a new specimen is collected and we start over. It works well for us and we have had very few problems after the nurses realized it helped them

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Our facility has a similar process to DebbieL.  We have a form that is filled out on the day of PAT collection where the patient verifies they have not been tranafued or pregnant in the last 3 months.  Patient and Nurse both sign it and it comes with the specimen to the Blood Bank.  We will take specimens 14 days from the date of surgery and will extend them 3 days past that date.  If the patient is pregnant, transfused, or has an antibody they are required to come in 1-2 days prior to surgery to have another specimen drawn and an armband is placed on them to remain on when they are admitted.  We have not gone to 30 days but I have worked at other facilities that have. 

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We can extend specimens collected to 30 days as long as they have not been pregnant or transfused in the last 90 days and that they don't have an antibody (either currently or historically).

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Our PreAdmit patient samples are valid for 30 days after collection if patients have not been pregnant or transfused in the last 3 months. We usually perform the group and screen test on the day of collection and if applicable, antibody workup ASAP. If required, we usually do the crossmatch one the day before the scheduled surgery date. Previously, we had separated plasma from cells for all samples. After we did validation to show that the reactions strength of ABO antibodies in the unseparated samples on their 30th days is comparable to that in the separated plasma, we stopped separating plasma if the antibody screen is negative and only immediate-spin crossmatch is required. 

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Our policy states that as long as no transfusions or pregnancy in past 3 months the pre-assess sample is good for 30 days. If there are antibodies present we automatically xmatch antigen negative units, in case. The 96 hour window begins on the day of OR. We only separate the plasma if the surgery is >14 days from date of original type and screen so there is no hemolysis in plasma if they need blood day of OR.

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Preoperative patients who have not been transfused/pregnant in the past three months have a GS that expires at 28 days.  Any other patient GS sample expires at 96 hours.

When the patient is seen at their preop appointment they are asked if they have been at another hospital or transfused/pregnant in the previous three months.  The responses are recorded when the GS is ordered. 

It works great for us.  I should mention that we have MLA who collect the vast majority of samples using patient positive identification (Mobilab) so we don't have a lot of sample recollections.

I have posted on question on another thread looking for advice on using Meditech to record sample expiry :) 

s

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1 hour ago, AuntiS said:

When the patient is seen at their preop appointment they are asked if they have been at another hospital or transfused/pregnant in the previous three months.  The responses are recorded when the GS is ordered. 

It works great for us.

How do you know that the patient has not forgotten that they have had a transfusion due to, for example, undiagnosed dementia, was unaware of being pregnant or did not want to admit to having been transfused in the presence of others (for example, a Jehovah's Witness)?

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OK, here at our hospital in Michigan we go up to 10 days for preadmits, then we say the specimen for the screen expires at midnight on the third day.  But irregardless of whether or not the patient knows they have been transfused or pregnant (or what their name is for that matter) -- potentially using a specimen for testing that is 30 or 28 days old????

Scott

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22 hours ago, Malcolm Needs said:

How do you know that the patient has not forgotten that they have had a transfusion due to, for example, undiagnosed dementia, was unaware of being pregnant or did not want to admit to having been transfused in the presence of others (for example, a Jehovah's Witness)?

The patient seen in the preop clinic is supposed to be seen with an interpreter or family member, as required (dementia, language barrier).  As for the unaware of being pregnant or not wanting to admit to a pregnancy, well... I suppose anything is possible??

sandra

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I understand that it is easier to draw the bloods when the patient comes in for pre-op, maybe many weeks before the actual op.  Can I suggest that what would be sensible would be to bleed them then for a T&S - this way you will be prepared in case the patient turns out to have anti-nasties (this is a new scientific term coined by me as it's Friday afternoon); and then to bleed them again when they come in for the op - you will be then within the time delay as well as avoiding the patient having to come in three times (pre-op, 3 days before op, and for op); but still in time to react if there is a change between the two samples

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1 hour ago, SMILLER said:

How do you even know the patient is who they say they are?  We have had a few instances where a person using another's ID and insurance was caught because of mismatching BB records.

Scott

Here in our hospital in Ontario, Canada I don't believe we have had that happen. I'm not saying it couldn't, but I don't think it ever has. 

In a previous life, I worked in Saudi Arabia at a military hospital.  Those in the military and their family received free care from our (superior) hospital.  WOW - the card swapping!!!!  It was almost expected.

 

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 "We have had a few instances where a person using another's ID and insurance was caught because of mismatching BB records."

Yeah.  Well, here in the US, the most advanced country in the history of the world , we have not yet figured out how to make sure everyone has adequate health care (some of us are trying!), so things like this happen.

Scott

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On ‎6‎/‎24‎/‎2017 at 7:04 PM, MaryPDX said:

We can extend specimens collected to 30 days as long as they have not been pregnant or transfused in the last 90 days and that they don't have an antibody (either currently or historically).

We do the same.

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Thinking logically - if you are already extending specs 10-14 days, what would be different to extend to 28-30 days?  Yes they could go grab a pint (blood, not beer!) at another facility, but they could do that in the 10-14 day period, yes?  Is it that patients will remember something 2 weeks ago, but not 4 weeks ago?  Not likely.

If someone in pre-op is documenting the answer to pregnant/transfusion in the past 3 months, that someone could also document patient understanding to report transfusion between sampling and surgery.  So you just really need a 3rd question on whatever form/computer order (for us Epic folks).

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We're doing this with Cerner, we started out with 14 days.  Then realized someone had gone in and shortened the time to 7 days.  7 days doesn't seem like it's even worth the time and effort. 

We can see the three answers that come across, but the only part of the answer we see is  1) Pregnant? 2) Unsure of History: (History of what??  I have no idea. yes you're sure? no you're not sure  *Shakes fist*)   3) Transfusion: yes/no      I have no idea if they are asking them if they've EVER been pregnant/ transfused  and what are they unsure about.    

 

Anyone else have Cerner with Pre op protocol ?

 

We just went live with this new system and decided to implement extending pre op T&S at the same time.   I'm starting an Audit   right now to figure out what is going on.

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