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TRM.41350 Compatibilty Label/Tag

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Help!! 

We are revising our emergency blood release process (including MTP)..  For those of you who are CAP - how do you comply with this in emergency situations?  I've gotten some feedback in a few posts, but nothing that we can use to work for us as of yet. 

It seems trauma specimens only require one identifier, but products need 2.   I've also included a response from CAP regarding my inquiry.  Thank you for any feedback :) 

"For blood products, even for trauma patients, there must be two identifiers as stated in TRM.41350. Typically emergency rooms use pre-defined "temporary" patient identification numbers that are later merged with the real patient medical record number once established. The CAP does not dictate the process for the temporary identifiers as long as the facility keeps them unique for the patients in question."

Thank you for your inquiry,
Lilly Petkovic, MT(ASCP)SBB
Laboratory Accreditation Program

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I think you need to follow the advice in the CAP response.  How does your ER ID patients when they come through the door?  They should already have downtime procedures for patient ID (as well as a John Doe ID procedure).  I believe our registration system assigns a new MR (Medical Record) number if there is no other admission on the system.  For John (or Jane) Doe names, we simply use a system that reflects the year and "Doe" number (Doe2018-14, John).  So our two identifiers are at the minimum the name and MR number.  Practically, we require a birth date for history purposes as well as date/time, etc.

I would think that you may want to start with ER and find out what they are doing down there for ID on these types of patients.  In the US, you MUST h ave two Identifiers for everything. 

Scott

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26 minutes ago, SMILLER said:

I think you need to follow the advice in the CAP response.  How does your ER ID patients when they come through the door?  They should already have downtime procedures for patient ID (as well as a John Doe ID procedure).  I believe our registration system assigns a new MR (Medical Record) number if there is no other admission on the system.  For John (or Jane) Doe names, we simply use a system that reflects the year and "Doe" number (Doe2018-14, John).  So our two identifiers are at the minimum the name and MR number.  Practically, we require a birth date for history purposes as well as date/time, etc.

I would think that you may want to start with ER and find out what they are doing down there for ID on these types of patients.  In the US, you MUST h ave two Identifiers for everything. 

Scott

Thanks Scott!  Currently, ED shows up with a 'Tag number' that is then used as the patient's Financial Number (or visit number).  I'm not sure at what point they are given an actual medical record number/name.  We do not have a refrigerator in ED - so we release a lot of coolers before the patient arrives.  The Tag Number is currently being used as an identifier on the specimen tube (which is OK per CAP in trauma situations, strangely.....) 

Which LIS do you use?  Do you wait and print unit tags once product is requested or are they pre-labeled with all info except patient?

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We are using Mediware's HCLL in the BB.  In general, ER will know through field triage what is coming so that they can use the registration system and give us a name/MR before the patient arrives.  It takes about 10  minutes to  order and print tags for a "initial resuscitation" cooler of 2 O neg RBCs and 2 AB FFPs. 

We are a level 2 trauma center so it is important that a patient can be registered before they arrive.  Like many facilities, we always have at least two AB thawed units of AB plasma on hand along with a 5-pack of plts, in addition to the O neg RBCs.

Scott

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We use the name/MR# which is assigned by Epic when the patient is registered as an unknown. When the patient is officially ID'd and if he/she has an existing chart in Epic, the record of the emergency visit is merged into the existing chart.

We use blood bank armbands, so even for those patients that are not yet in the system at all, as soon as a phleb reaches bedside (and that is pretty much immediately), we have a 'name' - which could be Male ER4, Female ER5, Male Red Hair ER3, or something similar plus the armband characters.  If we have any kind of registration from the ED, we use that with our armband giving us 3 identifiers. The blood bank armband stays on all our patients until discharge, so we always have that to link us with the patient/specimen.

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When issuing multiple uncrossmatched RBC, FFP, Plat for MTPs do you read the name, MR, donor numbers, donor type, expiration date/time for each unit?  It takes a long time to do on a unit that is not crossmatched or even type specific.  We do not have trauma packs in the ER and rarely use them except for drills.  There are 2 Nurses checking at bedside but our policy is to check everything in the BB at time of dispense.

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On ‎9‎/‎21‎/‎2018 at 11:31 AM, Patty said:

When issuing multiple uncrossmatched RBC, FFP, Plat for MTPs do you read the name, MR, donor numbers, donor type, expiration date/time for each unit?  It takes a long time to do on a unit that is not crossmatched or even type specific.  We do not have trauma packs in the ER and rarely use them except for drills.  There are 2 Nurses checking at bedside but our policy is to check everything in the BB at time of dispense.

There is no requirement that the info is read back to a person at time of issue. 

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Our trauma patients are given 2 identifiers; one a made up name(last name Doe, first name a type of car) and a MR# . The name will be changed to their real name as some point but the MR# stays with them.

Sheri

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We do not read back every unit at time of issue for traumas, emergency issue.  We do insist that they bring something printed with the patient name (real or made up trauma) and the medical record number.  We match that to the paperwork that goes with the units in the cooler and hand them the cooler.  They are still required to perform the bedside check and the time of transfusion.

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We have pre-determined Doe names -- we go down the phonetic alphabet with a different number as the "middle" name each time through the list, i.e., Doe, Alpha 35; Doe, Bravo 35; etc.  As a level II trauma center, we have 2 levels of traumas -- full and partial.  We usually have a name with the partial traumas, but the full traumas are assigned the Doe names and are given a new Medical Record #.  The admissions dept. quickly registers the patient when word arrives that the patient is coming in.  We use the Mobilab system, so the armband label is placed on the patient and labels made by scanning the armband are placed on the specimens -- so we have the two identifiers that are needed.  When the real patient ID is made, admissions puts in the name but leaves the Doe name in parantheses on the armband and other patient ID.  The new MR# given stays with the patient at least as long as that initial blood bank specimen is valid (72+ hours to midnight).  At that time, if there was a pre-existing MR# for the patient, the accounts are merged.

When uncrossmatched units are issued, we place them in a cooler and write the unit information on a cooler log sheet.  Since this is an extension of our blood storage refrigerator, the nurses sign the unit out of the cooler using the log sheet.  We have patient ID information on the log sheet, but we do not go over all of the unit information at the time the cooler is issued.

We use Meditech in our facility, and Barcode-enabled Transfusion Administration (BCTA) is used -- so one nurse can check the unit with the patient when using the computer for the other nurse.  We also use Electronic Crossmatch that makes our lives much easier.

This system works very well for us.

 

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