Has anyone heard about a fairly new standard by the Joint Commision about all blood bank samples needing to have a secondary identifer in addition the the "standard" hospital labels?

Has anyone heard about a fairly new standard by the Joint Commision about all blood bank samples needing to have a secondary identifer in addition the the "standard" hospital labels?

I don't think there's any change...

here's a copy of the standard

Standard QSA.05.07.01 for 2011

The organization labels blood specimens drawn from a recipient for typing and crossmatching.

1. The organization has written policies and procedures addressing specimen collection for typing and crossmatching.

2. Policies and procedures addressing specimen collection for typing and crossmatching include the requirement that the recipient be positively

identified at the time of collection using two unique identifiers (neither of which is the patient room number).

3. Policies and procedures addressing specimen collection for typing and crossmatching include the requirement to label specimens legibly and

immediately upon collection, in the presence of the recipient.

4. The request forms and the specimen label for typing and crossmatching include the following:

- The recipient’s full name

- The unique identifying number

- The specimen collection date

5. Policies and procedures addressing specimen collection for typing and crossmatching include a consistent approach to identify recipients who are

unknown, incoherent, or unconscious.

6. The organization identifies the individuals who draw blood for typing and crossmatching.

7. The organization follows its policies and procedures addressing specimen collection for typing and crossmatching.

By identifiers, I think they mean name, date of birth, or MR#. Our hospital has selected name and DOB as our two identifiers (although we also require the MR# on the tube), since they can ask the patient to verify those; most patients would not know their MR#.

The AABB and CAP most likely prefer having a secondary armband.

I haven't checked current AABB standards but CAP's TRM.30575 "mechanical barrier" or electronic verification system" was given as an option to reduce misidentification.

The 21 CFR states.....

"(a) A method of collecting and identifying the blood samples of recipients to ensure positive identification"

The AABB and CAP most likely prefer having a secondary armband.

....."

AABB Standards specify identifying (5.11), sample labeling (5.11.2), recipient blood container identification (5.18.1), issue of blood and components (5.18.2) and transfusion (5.19.3) utilize two independent identifiers but there is not even a "suggestion" of use of a secondary armband......

Thanks to everyone for the info. I have a vendor that is trying really hard to sell us a secondary wrist band system.

AABB requires 2 unique identifiers - YOU get to decide what they are. . . pertinemt to your institutional policies.

CAP does not consider a second armband a 'mechanical barrier'. In fact, an earlier checklist seemed to state that a second armband did not meet the intent of the standard at all. I called and talked to someone at CAP at the time to clarify just what the intent of the standard was. Use of an electronic ID system seemed to be about all they did allow, the way the checklist was then worded. In that conversation, I was told that they were in the process of rewriting the checklist item because of the uproar they had triggered and they were backpedaling rapidly on the electronic ID issue - to strongly recommended, but not required. That was when I was told that a 2nd armband is NOT a mechanical barrier. A mechanical barrier would be something like a bag lock. In my last checklist, 2nd armbands are specifically noted as 'currently' acceptable, but 'probably not as effective' as 2nd type on another specimen or electronic ID.

(By the way, we use the 2nd armband and do find it effective as used.)

If you do not yet have one of the fancy electronic "at the bedside" barcode ID systems, a secondary band specifically for Blood Bank is a good choice. Yes, they are getting dated, but until you can really get a functioning (validated for Blood Banks -they aren't all ready for Blood Bank) barcode ID system - the secondary band will catch a lot of problems and really close the circle between the person who is drawn and the person who gets the unit. No matter how good your hospital ID bands are or what is used as your identifiers - the possibility always exists that the phlebotomist really doesn't look at it. Instead they get the information off of the "draw labels" (of whatever type) and just put them on the tube. With a secondary BB ID band - used correctly - they have to identify, draw and band the pt; the person picking up or delivering blood has to confirm the band number and the RNs giving the blood have to confirm the band # matches the number on the unit - a full closed circle. When the barcode system can supply that closed circle - I will be perfectly happy to change to that method, but meanwhile, I can't imagine issuing blood without a secondary ID specific to the BB specimen. In my opinion, it is simply too risky.

I wasn't too crazy about it when it we adopted the policy of a secondary/Blood Bank wristband a few years ago. (I prefer to keep things as simple as possible and for everyone to follow the procedure and rules properly.........Ah, I'm still young and can dream....)

However, now I totally agree with everything in scwickard's post.

Example: A phlebotomist delivered a sample to Blood Bank from pt "Smith" who was in the Emergency Dept. The ABO/Rh testing did not match our previous results. The BB Tech went to the ED and found the pt. The pt had a BB wristband labeled "Smith" on one arm and a regular hospital wristband on the other arm labeled "Jones". (ie: It was obvious: The phlebotomist had orders on Smith and walked into the wrong cubicle, didn't check the pt's hospital band, drew and BB banded the pt.) If we weren't using a BB band, it would have been much more difficult (or impossible) to figure out what happened and why.

Wow, scary! If the armbands are used correctly (in the sense of applying them to the patient and the tube at the time of draw), they can be a life saver. I know of an instance in which someone applied an armband after the tube and the patient parted ways. That resulted in a very bad outcome. Even if your method to prevent misidentification works 9 times out of 10, though, it is better than no effort at all. The electronic systems are coming along, but they still are not within everyone's reach.

Joint Commission some years back did issue a paper on BB ID and recommended a separate banding system. I think it was a Patient Safety goals write-up from about 2006 or so. That is probably what the salesman is referring to.

We have a bedside barcode system for phlebotomy now but I have come to realize that it is only as good as the system using it. There are certain locations in our hospital that aren't really using it and of course we have OP samples for oncology patients that don't have hospital bands to scan. If you get such a system be sure it is being used as you expect before trusting it with everything. If it is annoying, people will find work-arounds that seem to meet their needs but might not meet yours. Ours is much better now that everyone is used to it but we will probably wait to get rid of our BB banding system until they can read barcodes when they hang the blood as well.

You brought up many good points, Mabel.