Patient's sample drawn at one site and transfused at another

[TMGal 4]

Hi Everyone,

Does your facility/region allow for a patient to have their blood sample drawn for a T&S at Facility A and their transfusion given at Facility B? If so, how do you ensure the patient who had their blood drawn at Facility A is the same patient that shows up at Facility B for their transfusion? When I use the example of Facility A and B, they represent separate hospitals within a city; however, the labs are all under one institution and all follow the same P&Ps.

thanks.......

[David Saikin 1,452]

We do not do this.  Anyplace I have ever worked does not do this with red cells.  I can see it if both facilities are associated and both have the same BBIS and common registration.  Still suspect to my BB upbringing.

[SMILLER 870]

We do it for hospitals and some other facilities in our group.  These may be patients with pre-op work done at another hospital for a procedure here, or a T&S and XM done ahead of a patient coming in the next day for a transfusion. 

We use a BB armband for all of our patients who might be transfused.  For outpatients, this is made out and attached to a copy of their photo ID along with the order and a questionnaire regarding previous hospitalizations, recent transfusions, etc, and sent to the BB.  When the patient arrives for their transfusion or procedure, the paperwork is checked and the BB armband applied.  We do not transfuse patients without a BB armband.

Scott

Edited March 17, 2018 by SMILLER
for clarity

[pinktoptube 48]

Is one hospital performing the T&S and crossmatching, then sending the blood to the transfusing hospital? Or is the sample collected at one hospital and sent to transfusing hospital for testing? 

[Malcolm Needs ★ 4,933]

If you think about it, if a sample is sent to a Reference Laboratory, and this laboratory not only identifies the antibody, but also performs the cross-match, this happens all the time.

[SMILLER 870]

1 hour ago, pinktoptube said:

Is one hospital performing the T&S and crossmatching, then sending the blood to the transfusing hospital? Or is the sample collected at one hospital and sent to transfusing hospital for testing? 

Both.  In the first case, we have the patient drawn for the T&S (either here at the hospital, or at our outpatient facility), and then the testing is done here.  When the patient comes back, we usually send the units to our outpatient facility, as that is where we do almost all outpatient transfusions.

In the second case, a specimen for a T&S is sent with the proper documentation (as I mentioned above), as part of pre-admission testing for a procedure at our hospital.

Note that all of this is dependent on being able to create a BB armband with proper documentation at the time of draw, and have it all delivered to our BB with the specimen.  If that cannot be done for some reason, we would armband, draw and test the day of the procedure.

Scott 

[TreeMoss 71]

We accept specimens drawn at the oncologists' office and labeled with Temporary ID band labels with the TID band placed on the patient's limb. Otherwise, all patient specimens are collected at our facility with the armband being placed on the patient at the time of specimen collection.

[AMcCord 1,301]

We do allow specimens to be collected at a cancer center on our campus and sent to the hospital lab for crossmatch. We then issue a cooler with units to the cancer center for transfusion. The patient receives a blood bank armband when the specimen is drawn and that is what he/she is ID'd with prior to transfusion at the cancer center whether it is later the same day or a day or two later. If a patient is admitted to the hospital, we will transfuse using the specimen collected at the cancer center as long as the armband is still attached to the patient. If we were affiliated with another hospital, I think we would use the same process, though I would want to look at their specimen collection process to confirm that it meets our standards for patient ID and specimen labeling.

[Santa Beauchamp 10]

We follow the same procedure as AMcCord. we also have multiple "Outreach" clients who are not on our BBIS but we require the same specimen collection and labeling standards for those patients also; including that the armband is attached to the patient at the time of collection. 

On 3/17/2018 at 9:26 AM, SMILLER said:

We do it for hospitals and some other facilities in our group.  These may be patients with pre-op work done at another hospital for a procedure here, or a T&S and XM done ahead of a patient coming in the next day for a transfusion. 

We use a BB armband for all of our patients who might be transfused.  For outpatients, this is made out and attached to a copy of their photo ID along with the order and a questionnaire regarding previous hospitalizations, recent transfusions, etc, and sent to the BB.  When the patient arrives for their transfusion or procedure, the paperwork is checked and the BB armband applied.  We do not transfuse patients without a BB armband.

Scott

Just curious as to the rationale for allowing the BB armband to be attached separately from the specimen collection; seems this creates the possibility of a patient mismatch??

[AMcCord 1,301]

1 hour ago, Santa Beauchamp said:

Just curious as to the rationale for allowing the BB armband to be attached separately from the specimen collection; seems this creates the possibility of a patient mismatch??

We do have a process for PAT patients that sends them home with an ID card instead of a band on their wrist. Patients may not want to wear a bright red armband for days and even if they are willing to do that, sometimes the band doesn't survive the wear and tear of normal life.  The PAT ID card has a sticker on it from their armband tail and the form they fill out when the specimen is collected has their signature. When they come in for surgery, they present the card, we ID them following our normal process and ask them to sign the card. We match the signature with the form they signed when drawn and band them with the armband we've held in blood bank. We do occasionally use this process for transfusions as well.

[MOBB 31]

Our rehab hospital bands their patient, collect specimen and send it to our blood bank. We test and send units back to them for transfusion.

We would not allow a patient to have testing at hospital A and be transfused at hospital B, but I think if your system is set up with a centralized blood blood bank, it is possible.

When I lived in King County-Seattle, WA-only the blood center could do blood bank testing so we sent samples by cab and they would electronic crossmatch units in our blood vending machine or send cross matched units back by cab for us to transfuse.

[SMILLER 870]

23 hours ago, Santa Beauchamp said:

We follow the same procedure as AMcCord. we also have multiple "Outreach" clients who are not on our BBIS but we require the same specimen collection and labeling standards for those patients also; including that the armband is attached to the patient at the time of collection. 

Just curious as to the rationale for allowing the BB armband to be attached separately from the specimen collection; seems this creates the possibility of a patient mismatch??

We make a copy of the patient's photo ID at the time of draw.  The BB armband is attached to that copy, along with the BB number written upon it.  If the patient does not have a photo ID, they can either wear the band or have the T&S draw done at time of the procedure.  

Scott

[TMGal 4]

Thank you all for your comments. We do have a system in place for our cancer patients and PAC-OR folks which includes arm-banding. From what I am hearing, any patient considered an "out-patient" (ie. cancer, pre-admit, dialysis) who comes into a hospital and has a T&S drawn would then require some sort of arm-banding or alternative ID process if they were to leave the hospital then come back later in the day or the next day for a transfusion. Correct?

[SMILLER 870]

I am not sure what the various regulatory inspectors would say, or exactly what standards they would cite.  I do think that any facility that is going to do transfusions would want a armbanding procedure that established an unbroken chain of identification from the initial T&S draw, through processing and testing, to the transfusion.  As can be seen by the various responses here, this can be accomplished in a number of ways.

Scott

[AMcCord 1,301]

Agree with Scott.

[CSP0102 16]

We do it providing the sample was drawn by a facility associated with our hospital, they use our Blood Bank patient banding system and we do the testing. All products are associated with that alpha numeric number and before products are issued we verify that number patient name and birthdate  

[TMGal 4]

Thanks to all for your responses. There are some very interesting ideas here in which we can draw from.