My hospital is looking into expanding the surgical services. Part of this expansion will include placing a blood refrigerator in the Surgery department.  

In preparation for these changes, I would appreciate hearing your comments on this subject.  It has been a long time since I worked at a hospital with remote storage 

 

Thank you!

  At my last job we had a OR refrigerator. The nurses were responsible for taking the temperature every day and changing the chart weekly. We did the alarm checks quarterly and any other maintenance on it. If the alarm went off, the BB was notified and we had to check it out.

     We had a small red boxes that would hold 4 units in each. We would sign the blood out when the OR tech came to pick the blood up at the begining of surgery. They were responsible to return all the unused blood at the end of the day. We would check to make sure in the evening that it had been either transfused or returned.

     The open heart surgery unit also had a small refigertor that we monitored. took the temps, chnaged the graph, etc. The OHS patients blood would go with them to the heart unit and a BB tech would pick them up the next day,

   We had little problems with the nurses not taking the temps since the refrig benefited them.

        Kathy

You should have a process in place to monitor temps of units sent to the OR and then returned to you if you plan on returning them back into inventory,  i.e. Safe-T-Vues

My experience with OR refig is similar to those above. In the OR - that staff took daily temps; we did the maintenance and alarm checks. I STRONGLY recommend a temp monitor on each bag signed out to the OR. The staff there will remove the blood for the case and then return it. Unless you monitor closely your products will be compromised and you will not even be aware. Our OR staff insisted they never took the blood out - ALL of our monitors were ALWAYS converted. Your Medical Director will need to take a firm stand on this issue. Another anomaly I encountered was: at night, if we sent for extra blood, it was always brought to the OR ref and not the Blood Bank. I found surgical residents taking blood from the boxes and transfusing it when there was labeled, crossmatched product in their ref. Their comments were: "We know you got that blood for this pt." Can't believe we did not kill anyone.

Good luck and be firm.

I'm opposed to it. A few Joint Commission inspectors have mentioned to me over the years that they have removed many from ORs and they were glad to hear we didn't have one.

I agree that if this is a done deal, to try to have continuous monitoring on the equipment with temp indicators on the units. Having an electronic method to monitor the temp of that equipment would be preferable to taking manual temps every day.

Here are my experiences with having refrigs in the OR:

 

1.  Nursing staff in the OR don't/won't take the temps daily. You will need to be vigilant with this as it will fall back on you at inspection time.

 

2.  More than one patient's blood in a single refrigerator.  O pos units and B pos units on different shelves of the same refrig.  A recipe for disaster.  

 

3.  Blood left in the monitored refrig over a 3 day w/e.  Made inventory reconciliation a little difficult since units were to be returned to BB at the end of the case.

 

4.  Platelets placed in the refrigerator since they decided not to give them.

 

Again, if this is a done deal then so be it but hopefully these "deviations" I've experienced won't happen at your place.  Good luck!

I wish we didn't have one in the OR.  We have had similar issues as above and put Safe-T-Vue indicators on every unit.  We have an OR person take the temp, call it to us, and we record it daily.  That way we know for sure it is documented consistently.  We go up to change the chart weekly and also take care of the activations.  Good luck!

I'd look into one of the new blood 'vending' refrigerators. Expensive, but they have safety for the patients built in. Work kind of like Pyxis. They link with the blood bank system, so blood dispensed is controlled by you, not by them.

the BB vending machines are a great idea - - - I agree. If I had a BBIS I'd get one of those. HCLL supports a few different models (hold from 9-150 units).  

I'd look into one of the new blood 'vending' refrigerators. Expensive, but they have safety for the patients built in. Work kind of like Pyxis. They link with the blood bank system, so blood dispensed is controlled by you, not by them.

 

Here are my experiences with refrigerators in the OR:

1. The OR staff was responsible for taking temps. every day (I think one of the Technicians); but when we found that they were falsifying data, we pulled the refrigerators (i.e. forgot to take temps. one day...so took off chart next day). We caught it when we went to change the charts one week and they had not filled in temps. for the previous day. After we changed the chart (so they did not have the previous chart available to falsify), temps. for the previous day still showed up on the log)

2. If you store >1 patient in the refrigerator at a time, there is the "very real" risk of pulling the wrong patient and transfusing the blood; especially in an urgent situation. I have seen it happen.

Brenda Hutson

It is hard to have OR follow a thorough process for checking the blood out of their fridge.  They usually feel that the bedside check is good enough.  

 

At my previous workplace we removed the fridge from OR after a case where A Pos blood was left in it from the previous day's surgery and since it was the only blood in there was assumed to be the stat blood they had ordered.  They spiked it and then did the patient ID check and found that it was a different patient (who was group O and whose stat blood was not ready yet).  I have never heard anyone sound quite like that nurse anesthetist did when she called me to say what had happened.  It scared the devil out of her.  Never want to come that close again.

 

At least in your case, they noticed their error "before" transfusing. I have worked in places with OR Refrigerators where the patient was transfused with someone else's blood because the blood of "all of the OR patients for that day" was in the refrigerator (in their urgency, they grabbed the wrong unit; and that is the risk). Fortunately, the types were compatible.

Brenda

It is hard to have OR follow a thorough process for checking the blood out of their fridge.  They usually feel that the bedside check is good enough.  

 

At my previous workplace we removed the fridge from OR after a case where A Pos blood was left in it from the previous day's surgery and since it was the only blood in there was assumed to be the stat blood they had ordered.  They spiked it and then did the patient ID check and found that it was a different patient (who was group O and whose stat blood was not ready yet).  I have never heard anyone sound quite like that nurse anesthetist did when she called me to say what had happened.  It scared the devil out of her.  Never want to come that close again.

 

While I can relate to each of the negative issues associated with OR Blood Storage refrigerators I have concerns regarding the alternative - individual coolers in each OR room - with staff monitoring and documenting as required.

 

Has anyone implemented a better solution?

I believe the best solution are the remote refrigerators that are interfaced with Blood Bank systems (blood "vending machines").  They have been proven to be effective and safe.  However, they are extremely expensive.  My answer to OR would be "show me the money".  I would not want to sacrifice safety for their convenience.

Here are my experiences with having refrigs in the OR:

 

1.  Nursing staff in the OR don't/won't take the temps daily. You will need to be vigilant with this as it will fall back on you at inspection time.

 

2.  More than one patient's blood in a single refrigerator.  O pos units and B pos units on different shelves of the same refrig.  A recipe for disaster.  

 

3.  Blood left in the monitored refrig over a 3 day w/e.  Made inventory reconciliation a little difficult since units were to be returned to BB at the end of the case.

 

4.  Platelets placed in the refrigerator since they decided not to give them.

 

Again, if this is a done deal then so be it but hopefully these "deviations" I've experienced won't happen at your place.  Good luck!

 

 

 

My experience echos every one of these items.  (Including #4 when we placed a big yellow note "DO NOT REFRIGERATE" on the platelets!!!)

 

Donna