I would be interested in learning how others are handling the new CAP Question TRM.30575 about implementing a system to prevent mistransfusion. Drawing a second sample opens a "can of worms" when that is not possible. Giving O's is not practical, and the mechanical barriers are undeveloped in this country.

A mechanical barrier can be an additional Blood Bank I.D. armband (with a distinct BB number) that is placed on the patient's arm at the time of phlebotomy. RN's are required to check this armband for patient ID prior to transfusion. If the wrong patient was drawn he/she would be missing this armband. You can call CAP for clarification- I did and our system, as discussed above, was acceptable. I just had my unnounced CAP inspection and had no issues with this standard.

Hope this helps, MWL

By the same note, a single arm band with unique identifiers and an adequate process in place works just fine. You don't really need a blood bank specific armband to be in compliance or a second sample tested. We don't have either and have not had an issue with it in any of our CAP inspections. You simply have to have a system in place that is followed and works at preventing mistransfsuions. Contrary to popular opinion, complicating systems do not make them better.

Dear Mary,

I am very interested in the response to your post. I am about to develope a policy concerning second samples.

As I read TRM.30575 it says that "simply using an additional banding ID system does not satisfy the intent of this checklist question."

My pathologist wants me to obtain a second sample on all pts without history that need a transfusion!!!!

We are a tiny (22 bed) hospital with nurses who won't draw blood. This means any tech working after 5:00 pm-6am will have to stick twice!

HELP!!!!!!

Babs in the lab in beautiful Bridgton Maine

At our institution, instead of drawing a second sample on the patient, we require that 2 staff members perform identification prior to the phlebotomy draw as well as at the time of transfusion. Both staff members are required to place their initials on the blood bank armband. The 2 staff members can be phlebotomists or nursing staff or a combination of the two.

Babs, can you simply make O cells the only product you stock? That should certainly meet the standard.

BC

Thank you for your reply rcurrie- we are a very small hospital with a very busy oncology, ED and OR schedule so I don't think it would be practical to try to stock only type O blood (I think my Red Cross rep would kill me) but please know I'm open to any ideas.

What I really think CAP wants is a barcode barrier system. That's not going to happen any time soon at my hospital.

elrusso, I'm going to run your idea by my pathologist. Thank you! Babs

We use typenex band and we had our CAP in september and didn't have any problem. We do not draw a new sample. WE perform second ABORH on all the pt's specimen without prior record at our institution. Second check is done by different tech.

Babs, since you have a busy Hem/Onc department, then a history check of the patient's blood type would suffice for your repeat patients. Mary Smith was A pos last time, she is A pos this time, we'll give her A pos and not worry about it. For new patients, you could give type O cells until you happen to get a routine second draw. Chemo is pure hell on veins, and you want to stay away from tapping patients unless absolutely necessary.

BC

We have had good experience with using a purple top, fingerstick microtainer on patients whose only type on record is A, B or AB, and who have no historical type to compare. This way we know we are getting an actual separate draw and not just another tube from the same draw that may have been mislabeled--particularly from the ER! (You know, draw an extra tube for BB just in case!) We ask for the fingerstick sample when we receive the actual order for blood, prior to blood issue. We send the microtainer in a ziploc bag with gauze, a bandage, alcohol prep pad and instructions.

In a couple of years, we have found close to a dozen WBIT (wrong blood in tube) draws with this method, mostly from ER or ICUs. This has prevented us giving non-O blood to an O on these occasions.

The rationale for doing this only for non-Os is that if someone types initially as an O, we're going to give O, so no harm will be done even if on a later type that person turns out to be a (whoops!) A.

MJ :cool:

We use the Bloodloc system which is a mechanical barrier. At the time the patient is drawn for transfusion, the nurse puts a three letter code on the patient's ID armband and the 3 letter code is written and underlined on the specimen. At the time of issue, we set the code in a plastic lock, lock the unit in a bag with this lock and it cannot be opened until the nurse is at the bedside and reads the code from the patient's armband. If they are at the wrong bedside, the lock will not open. It has worked very successfully at our facility for several years.

And Babs, some 40+% of your new patients will be O anyway so no need to recheck them. So how many patients would 60% of your new (no previous record) patients be? Maybe the oncologists would be willing to submit a sample for a blood type when they begin chemo or something and the patient is being drawn for some other testing anyway.