So we currently do not write an issue time when we sign out products from blood bank.  I can only assume that means we are NOT checking  Issue time to start time/ or issue time to end time.

Shouldn't we be doing that????

 

I assumed so.  So I called our Blood bank provider and asked if we could add that to our product tags so we could write down issue times.   They said sure and then sent me a bill. A big bill.

Can someone assure me that we need to be doing that before I go plead my case to my lab director. 

We certainly have to take a note of this time in the UK, and I would be surprised if this was not the case in the USA, although I don't know that for sure.

I have always documented the time of release from the BB anyplace I workded - since 1971.

1 hour ago, David Saikin said:

I have always documented the time of release from the BB anyplace I workded - since 1971.

Ditto!

Anyone know off hand if it's a  CAP or AABB standard ?

AABB Standard 5.23 Issue of Blood and Blood Components

At the time a unit is issued, there shall be a final check of transfusion service records and each unit of blood an blood component. Verification shall include:

(a list of items)

6) The date and time of issue.

 

We record this electronically with a back-up (or down-time substitute) in the form of a sheet of paper signed by nurse and blood bank tech at time of issue.

phew!  He didn't give me the boot.  

We have a Blood Product Issue program in the LIS. Records the time of issue, issuing tech, to whom issued.

Is there a paper blood request, i.e, check out slip? Can you record it there?

A long time ago we used to record it on the transfusion tag.

Your are correct that for a variety of reasons it's advantageous and sound practice to know what the timeline is surrounding the transfusion: time specimen drawn, time received in lab, time pretransfusion testing was completed, time issued, time transfusion started, time completed.

Issue time is captured in our LIS like Tricore. We also record it on the crossmatch form that accompanies the unit, a carryover from the old days when that time started the countdown for the now discredited 30 minute rule. Again echoing Tricor - if you don't issue in the computer, don't you have some sort of paper log on which to record the time/date/inspection results/tech/who or where the unit is going? If you are issuing in the computer, isn't that captured there?

Precomputer we had 4-copy crossmatch forms on which we recorded patient and unit info and, when issued, issue data. First copy was the permanent record of the transfusion for the chart - it was full size and had room for the nurses to record pretransfusion check and transfusion data. The other copies were 1/3 size. Second copy was the bag tag. Third copy we saved and transferred the issue data to our permanent crossmatch log. Fourth copy went to billing with the appropriate charges checked off.

I did not see a specific CAP requirement to record the time issued.

Phil

Edited January 14, 20169 yr by Dr. Pepper

14 hours ago, tricore said:

We have a Blood Product Issue program in the LIS. Records the time of issue, issuing tech, to whom issued.

Is there a paper blood request, i.e, check out slip? Can you record it there?

A long time ago we used to record it on the transfusion tag.

It is recorded in the our blood bank program with a paper slip that goes out with it. However with the pathologist reviews the paper slips there's no record there of when it was issued. 

 

19 hours ago, amym1586 said:

phew!  He didn't give me the boot.  

He's probably glad someone is bringing his BB up to standards.  I always tell my manager tha quality is not cheap (when it comes to $$ quality helps assure that you are not wasting any but usually costs a bit to implement).

33 minutes ago, amym1586 said:

It is recorded in the our blood bank program with a paper slip that goes out with it. However with the pathologist reviews the paper slips there's no record there of when it was issued. 

As long as you are documenting the time of issue in the LIS you are good to go.   I would not add another layer to your process by manually writing the issue time on a slip or paper or where ever.  "ain't got time for that"  is my 2016 motto. 

6 minutes ago, R1R2 said:

As long as you are documenting the time of issue in the LIS you are good to go.   I would not add another layer to your process by manually writing the issue time on a slip or paper or where ever.  "ain't got time for that"  is my 2016 motto. 

It's not in the LIS though.  That issue time doesn't cross over from our separate blood bank program.  So the only way to check an issue time would be to physically come in blood bank and look up each patient to see when blood got issued. That's not happening so no one is checking to see if the units are getting transfused in 4 hours.  So, I'm still feeling like it's necessary. 

1 minute ago, amym1586 said:

It's not in the LIS though.  That issue time doesn't cross over from our separate blood bank program.  So the only way to check an issue time would be to physically come in blood bank and look up each patient to see when blood got issued. That's not happening so no one is checking to see if the units are getting transfused in 4 hours.  So, I'm still feeling like it's necessary. 

the FDA requirement is not that blood transfusion is completed within 4 hours of issue.   The FDA requirement is transfusion is complete within 4 hours of start of transfusion.   You may need to update your policy?

1 minute ago, R1R2 said:

the FDA requirement is not that blood transfusion is completed within 4 hours of issue.   The FDA requirement is transfusion is complete within 4 hours of start of transfusion.   You may need to update your policy?

Oh.

 But what if they get it out of blood bank and set it in a room or a refrigerator for an hour before they start?

Nursing should have a policy not to do that and it should be part of their annual training.   I could audit that on occasion - blood issue to time started.  

Edited January 14, 20169 yr by R1R2

20 minutes ago, amym1586 said:

Oh.

 But what if they get it out of blood bank and set it in a room or a refrigerator for an hour before they start?

FDA, CAP, AABB are all minimum requirements.  Your policy can exceed FDA minimum requirements.  I have always used the 'issue' time as the start of the 4 hour clock for units not issued in a cooler.

1 hour ago, R1R2 said:

the FDA requirement is not that blood transfusion is completed within 4 hours of issue.   The FDA requirement is transfusion is complete within 4 hours of start of transfusion.   You may need to update your policy?

It's 4 hours from the time it leaves a refrigerator or monitored cooler, not when the nurse starts it.

Edit: this is found in the Circular of Information

Edited January 14, 20169 yr by tbostock

Circular of information states verbatim under the "Instructions for Use" section: "Transfusion should be started before component expiration and completed within 4 hours."

Later, under red blood cell administration, it states: "It is undesirable for components that contain red cells to remain at room temperature longer than 4 hours. If the anticipated infusion rate must be so slow that the entire unit cannot be infused within 4 hours, it is appropriate to order smaller aliquots for transfusion."

We go with 4 hours from start time.

36 minutes ago, goodchild said:

"It is undesirable for components that contain red cells to remain at room temperature longer than 4 hours.

But wouldn't that prove you need to start the 4 hour count from when it leaves the refrigerator ?

That's definitely how that line could be interpreted. The other two lines could be argued to point to a four hour timeframe from start.

1 hour ago, goodchild said:

Circular of information states verbatim under the "Instructions for Use" section: "Transfusion should be started before component expiration and completed within 4 hours."

We used to say, the component expires 30 minutes after leaving blood bank.   Is that true?

A four hour timeframe from start doesn't seem to make sense to me.  There has to be a line drawn at some time after the unit is removed from an appropriately monitored storage area where it is OK to transfuse before that time, but not after.  This seems to be set at 4 hours.  The start time is not the point.  Otherwise an unhung unit could sit at the patient's bedside for an indefinite period and still be transfused. ("No problem Mr. Peters, we'll just let it sit on the radiator for a few minutes so you won't get a chill...")

 

Or, I could be wrong. I would be interested in anything someone has actually heard from a regulator on this.

 

Scott

I recall a lot of discussion on these boards about the relevance and history of the 4 hour timeframe.

Me too.  But I do not remember if any of them come from somebody who works for the FDA, CAP, JCAHO or AABB...

Scott