Please bear with me, this will be confusing to explain. We provide transfusion services for 2 different institutions - owned by the same corporation. These two institutions utilize separate Medical Records Numbers, one is an outpatient cancer center and one is and inpatient hospital. Often times, the patients will be drawn at the outpatient facility, and then due to their status, be admitted to the inpatient facility for transfusion. We've devised a policy, that when the patient sample is drawn they will put both Medical Record Numbers on the patient sample, so when they get the CBC results and dependent on patient status, the patient can be transfused at either facility. We just need to know which Medical Record Number to perform the workup under. This policy has worked reasonable well. However, recently we have had instances, where due to patient time constraints, or deterioration in status, they will transfuse one RBC as an outpatient, and then want to admit the patient as an inpatient the next day and continue to use the same blood bank sample. In this circumstance, we feel the patient should be redrawn. The workup was performed under one Medical Record Number, the patient was transfused under that Med Record Number, and then is admitted with a different Med Record Number and visit number. The facility does not understand why we are having the patient redrawn under these circumstances. We base our decision solely on the fact that the patient was transfused. If a patient were discharged and then re-admitted the next day, we would require a knew sample, and this seems to be a similiar scenario. Does anyone have an opinion, or function in a similiar situation where you are the transfusion service for places that utlize different Med record numbers? I cannot find any regulatory standards that address this type of problem. (We use a separate Blood Bank armband system for all blood bank samples and the patients know to keep this armband on.)

Since you use a separate BLood Bank armband there should be no need for additional samples. The MR# scenario might be a problem but if you are getting both #'s on the specimen I don't see it as one. Ditto for getting one unit as an OP and being admitted for additional - you are receiving accurate pt data (the 2 #s and your blood bank id). If you had an elderly pt and the doc wanted to give 2 units over 2 days would you make them be redrawn for the 2nd unit. Why not just bill the work under the MR# in use for that work, which may mean once admitted, they only get billed for the transfusion not the initial workup. The key, for me, is your BBID# - as long as the patient is wearing it you should feel confident that the transfusions are safe. What does your Risk Management team have to say about this?

I think David is correct. Your Blood Bank armband connects your patient to the specimen, whichever place the patient is transfused. If both MR#s are on the specimen when the crossmatch is done, then both would also be linked to the work done. Perhaps documenting both MR#s when the original crossmatch is done would take care of the problem. If that is too cumbersome, a policy written to allow the addition of the other MR# to work already performed (with suitable documentation) might be the answer.

Agree with both David and AMcCord. The fact that you use a blood bank band is benificial in that it keeps another consistant identifier throughout the process. AMcCord's suggestion sounds like a good one with regard to the MRN additions. Are you billing using a different billing number for each location? We run into that here as the patient may be drawn and the work in blood bank performed on one day with one billing number and return the next day with a separate billing number. We just bill what occurs on each calendar date under the appropriate billing number. Sounds similar to your 2 MRN's.

We have a similar arrangements with our several hospitals. We all share a computer system but each facility uses different MR#s. We use a BB armband but we also use the DOB for another identifier. We also use the MR# when we check out units but for the true identifiers we use name, DOB and BB band number. I don't like that DOB isn't unique but it does prevent problems like you have. You could also create a process so the BB staff have to verify that both MRN being used are assigned to the same patient record in the HIS computer before switching to the other MR#. As above, we make sure the units get billed to the account that the nurse will enter the blood administration charge on, but we don't mind if the Type and Screen is on a different account.

It is helpful to know how other institutions are handling things like this. We will need to train nursing that the MRN on the unit tag will not match the MRN on the admission armband, but it will match the MRN on the BB armband and they should verify that this patient has both MRNS in the computer system. Thanks again everyone.