Call me crazy or temporarily brain-dead  but I thought there was an AABB standard requiring retypes on patients with no HX and that included the second draw being done at a different phlebotomy event from the first. I found only the CAP standard for retypes that lists this as an "option that might be considered" but I can't find anything in our AABB standards, in the 42 CFR or just by Googling. I don't have access to JCAHO standards. Where might this be found? Thanks

There is no AABB or Joint Commission regulation that requires this.

I know that you are not asking about other countries, but there is in the BCSH Guidelines in the UK, unless waiting for the second sample will compromise the outcome of the patient's treatment.

You are thinking of the CAP standard which wants a process to verify that you are transfusing the correct patient when there is no history and the pt is not group O and the transfusion is not urgent. TRM.30575. I believe there a few other posts on this topic.

Thanks all. Yes David, I have the CAP standard but I was sure there was something else out there. I have a paper from the UCSD Medical Center that says "Current FDA guidelines and JC and CAP Accrditation standards REQUIRE a second ABO/Rh for confirmation....."and it was about the patient, not the donor unit. So I'm thinking that they must have gotten that somewhere. I plan to try and email someone there and see what they say if nothing else pans out.

You have to have a second type by AABB standards to perform electronic crossmatch.  Although our policy states it must be a second specimen, AABB does not get that specific.

Not for nothing (as they say in Little Rhody), but it's a splendid idea.

In the US, under JCAHO and FDA, even if you are doing an electronic crossmatch, there is no requirement for a redraw for the second typing on patient without a history.  However, many facilities may choose to  require a second draw, like possibly these UCSD chaps you are refering to. 

 

How old is your reference? I think at one time back in the dark ages of the last century, before the electronic crossmatch even, there were institutions that routinely required two draws, (or a bedside check before transfusion) even on patients with histories.

 

Scott

Good question, the date on the reference is unknown at the moment. Bottom line is that we need to improve the process here where I work and I find that being able to quote a standard makes all the difference in compliance. Just saying 'best practice" or "suggested by CAP" may not hold a lot of water.

 

Thanks Dr Pepper for the laugh. I live in Mass. so I wasn't aware that this was a RI saying. Learn something new every day.

There's a term we use in healthcare quality: GAPS or generally accepted practice/performance standard.

 

The hospital accreditation standards for TJC don't mention anything as specific as two types, but the laboratory accreditation standards might, they seem pretty specific. I think Cliff's hospital is TJC lab-accredited but I can't think of too many others on these forums, he might be able to reference their standards book.

Our hospital Lab (JCAHO) redcently completed an inspection, and we are going to start doing electronic cross matches soon. There is no JCAHO requirement to draw two separate specimens routinely for patients without a history.

Its optional even for e-crossmatches. We asked JCAHO specifically if there are more strenuous regs coming soon regarding these, and they would not comment. We are going to do a repeat typing for ABO-Rh, something we already do.

 

I am adding here that we do have our own armband/labeling system for BB, and for the most part, only Lab phlebots draw for T&S's, so we do not have a real worry about having to verify that the blood in the tube really belongs to the patient it is labled for.

Scott

Edited June 1, 201411 yr by SMILLER

Transfusion Services should be very concerned about how to avoid WBIT (wrong blood in tube). There are two approaches to this problem, 1)one approach is to focus on testing errors and the other is 2)to focus on specimen collection errors. Repeat testing of the same blood sample (by the same person or different persons) will only detect testing errors. Testing a second blood sample (preferably collected at a different time and by a different phlebotomist) will also detect specimen collection errors, i.e., blood samples collected from wrong patient or blood samples labeled with wrong patient demographics.

Well you won't hear any arguments from me about that Dansket. I am always surprised by both nursing and lab staff who insist that they couldn't possibly make an error identifying a patient. Currently we have two people in the room, one draw, and each of the staff in the room put their initials on one tube each. I am saying to them that this doesn't prevent the patient from being wrongly identified just because two of you are in the room.

I wish I had a solid standard to back me up as I move this hospital towards 2 separate draws on new patients- oh well! Thanks again to everyone!

We will use a specimen from anywhere in the lab so long as it's a different draw time, so most of the time it doesn't even involve sticking the patients again.

And for those not from Rhode Island, "Not for nuthin'" is generally followed by "but", then an unsolicited opinion. (Rhode Islanders may be woefully ignorant of the subject material, but that never prevents them from having a strong opinion on the matter!)

(Rhode Islanders may be woefully ignorant of the subject material, but that never prevents them from having a strong opinion on the matter!)

I must be from Rhode Island originally..

I must have some connection to RI myself.  

Is someone going to say "I have a little Rhode Island in me?"

No, but we used to raise Rhode Island Reds!

OMG, just checking into this thread again and having a good laugh that I needed. For what its worth, I worked in Providence for a few weeks before I realized that the accent I was hearing was not  from people from New York. Grew up only 30 miles away in Mass and never knew that RI'ers had their own accent. Dollar is Dalluh, What is Wha (no T) and I'll leave it at that. Then there is the issue of crossing the border from RI to Mass which rarely is done without very good reason. LOL

My son in law is from RI so I have to behave now. And my soon to be born grandson will be half-RI'er so I'll have to educate him as soon as he starts talking. LOL again

I live in New Hampshire, born in Mass. You would be amazed at how many folks think that all New Englanders have the same accent.