I am researching a good option to confirm the ABO typing of patients who are in the first care. We would like a bedside test, realized before infusing the blood into the patient. Does anyone know of a practical, quick and safe method that can be performed by nursing professionals, with no immunohematology laboratory experience?

If you have any other ideas for patient safety and can share, I'll be grateful.

My advise for safe patient care is confirmation of the patient blood type by a laboratory professional. 

Agree with AMcCord.   Can't and don't want to imagine nursing personnel performing this test.  

Thank you R1R2 and AMcCord by the contribution

As ABO typing is so important I think you will have difficulty justifying to your regulatory bodies this test done at the bedside by nursing professionals.

Who or which department are you researching this for?

6 hours ago, Ensis01 said:

As ABO typing is so important I think you will have difficulty justifying to your regulatory bodies this test done at the bedside by nursing professionals.

Gosh, one would hope so!

I see that you are not in the US.   In US, ABO typing is considered non waived, high complexity testing.   All those that do the test will need documented training, followed by competency assessment as well as documentation of education, i.e., diploma or transcripts.   Do you have similar requirements in Brazil? 

Years ago, I worked with a tech who had worked elsewhere where a tech went with the blood when it was issued and did a quick ABO slide type at the bedside just before the infusion was started. I never worked anyplace where this was feasible due to staffing and currently we need two types on file to issue non O  blood. 

I also worked at a facility that typically had the MLT students do a bedside slide test (after documented training).  They would also bring the slide back to the lab to have the blood bank tech verify.

I suggest you contact other facilities in your area and see what they have been doing.  You will want to know how they are satisfying any regulatory requirements with whatever method they use.

Scott

Nurses performing ABO/Rh testing, scary.  AMcCord and R1R2. 

On 25/03/2019 at 23:40, Ensis01 said:

Como a digitação ABO é tão importante, acho que você terá dificuldade em justificar para seus órgãos reguladores este teste feito à beira do leito por profissionais de enfermagem.

Quem ou qual departamento você está pesquisando isso?

Our transfusion team is composed of nurses. Pre-transfusion tests are performed at the transfusion agency. This bedside test would be a confirmatory one. In the proposal we received from a company, they claim that the tests are easy to perform and the card should be returned to the transfusion agency for registration.

We do not currently have a confirmatory test and we release identical ABO transfusion without a second sample. That scares me. 

It's a time bomb.

2 minutes ago, mpmiola said:

Our transfusion team is composed of nurses. Pre-transfusion tests are performed at the transfusion agency. This bedside test would be a confirmatory one. In the proposal we received from a company, they claim that the tests are easy to perform and the card should be returned to the transfusion agency for registration.

We do not currently have a confirmatory test and we release identical ABO transfusion without a second sample. That scares me. 

It's a time bomb.

So is having nurses "confirm" the ABO type at the bedside; believe me!

On 26/03/2019 at 09:51, R1R2 said:

Eu vejo que você não está nos EUA. Nos EUA, a tipagem ABO é considerada um teste de alta complexidade não dispensado. Todos aqueles que fazem o teste precisarão de treinamento documentado, seguido de avaliação de competência, bem como documentação de educação, isto é, diploma ou transcrições. Você tem requisitos semelhantes no Brasil? 

Yes, in Brazil too, but not for an additional test at the bedside. Either way, training is needed also.

On 3/26/2019 at 11:19 AM, mcgouc said:

Years ago, I worked with a tech who had worked elsewhere where a tech went with the blood when it was issued and did a quick ABO slide type at the bedside just before the infusion was started. I never worked anyplace where this was feasible due to staffing and currently we need two types on file to issue non O  blood. 

We have already thought about releasing red blood cells from group O until a confirmation, but it was not well accepted at the time. Do you have problems with stock due to red blood cell release "O" until confirmation? How do you do for underweight children? Do you wash the red blood cells to remove antibodies?

15 minutes ago, Malcolm Needs said:

So is having nurses "confirm" the ABO type at the bedside; believe me!

Sorry Malcolm, I did not get it. Is it better to have nothing than to leave them to do? Or simply is a bad option!

11 minutes ago, mpmiola said:

Sorry Malcolm, I did not get it. Is it better to have nothing than to leave them to do? Or simply is a bad option!

A very bad option.  Look at it this way.  You probably could not do their job.  They cannot do ours - and ABO matching is THE single most important in transfusion.  Most ABO types are, I agree, pretty easy, but some are most definitely not.  For example, could a nurse tell the difference between a group O and an O_h?  I have huge doubts.

19 hours ago, Malcolm Needs said:

A very bad option.  Look at it this way.  You probably could not do their job.  They cannot do ours - and ABO matching is THE single most important in transfusion.  Most ABO types are, I agree, pretty easy, but some are most definitely not.  For example, could a nurse tell the difference between a group O and an O_h?  I have huge doubts.

Our experience w/ bedside testing for glucose at bedside and for stool occult blood card tests by nursing staff demonstrates that they don't understand QC, don't understand that if things don't look right you don't report it, don't document what they should document, etc. The thought of letting them perform confirmatory blood types for transfusion therefore scares the living daylights out of me. You can train some to perform the steps reliably, but without the lab background, I don't think you can expect good performance in dealing with unexpected results and test system problems (QC failure, weak/missing reactions, discrepant results). Those are the things that can result in a hemolytic transfusion reaction.

There is also clotting to worry about.  I have had to watch for and account for clotting in every ABORh slide test I have ever performed from a fingerstick (healthfairs and quick ones done for "can you tell me what my blood type is, pleeeease?").  How does the company recommend performing the test?  If from a fingerstick - how much blood is needed, where does it go, how fast might it air dry and give erroneous results, what happens if it clots?  All questions that would have to be answered before it could be put into service.

I wouldn't trust a nurse in performing ABORH testing, they have a hard enough time with other point of care tests.

On ‎3‎/‎23‎/‎2019 at 10:42 AM, mpmiola said:

I am researching a good option to confirm the ABO typing of patients who are in the first care. We would like a bedside test, realized before infusing the blood into the patient. Does anyone know of a practical, quick and safe method that can be performed by nursing professionals, with no immunohematology laboratory experience?

If you have any other ideas for patient safety and can share, I'll be grateful.

Best patient safety care..DO NOT ALLOW NURSING TO DO THIS!

Thank you all for the answers. Unfortunately, some places here in Brazil employ nursing technicians to work in a blood bank.

Remind me not to travel to Brazil if I ever require a transfusion!  

On 3/28/2019 at 3:11 PM, mpmiola said:

We have already thought about releasing red blood cells from group O until a confirmation, but it was not well accepted at the time. Do you have problems with stock due to red blood cell release "O" until confirmation? How do you do for underweight children? Do you wash the red blood cells to remove antibodies?

I thought it would increase our group O usage, but it only increased it a couple of units a month. We had to work with different areas of the hospital. We could use properly labeled Hematology samples collected at a different time within last 24 hours for second type. That covered most in-patients. (We had a blood management program where reason for transfusion had to be documented and if the reason was anemia, we had to document the hemoglobin). We did the second type on all type and screens so if they decided to transfuse, we were ready.   If a pre-admit patient needed a second type, we ordered it for morning of surgery so it would be on our pending and had them put a note on chart. ER was a problem, but we worked through the managers and they adjusted.   Even there, they usually got a Hgb result before drawing the Blood Bank sample. 

We perform at bedside slide blood type for confirmation before starting blood at the hospital where I work.  A Blood Bank employee (Blood Bank Assistant/Transfusionist) takes the issued blood to the patient's bedside and participates in the starting of the transfusion with nursing personnel.  The slide type is an extra layer of patient safety.  Pre-transfusion testing is only as good as the quality of sample!  We have caught wrong-blood-in-tube (mislabeled) samples this way.  We also have computer confirmation with barcoding of units but that doesn't always catch WBIT samples.