I would like to know how do others manage test samples for FFP and Plts. If you have a current Type on file do you require a new Type if the patient's out patient billing account number changes? (i.e ER visit , out patient visit, inpatient)

No retype

give product and have transfusion committee review

We require a current type with each inpatient visit. If they are an inpatient for 12 days, one type is good for the whole visit as long as their Blood Bank ID bracelet is still on their person.

OP, ER - new type with each visit for most patients. However, we will make an exception for an OP who is receiving Plts (or FFP) multiple times per week. In that case, we allow the patient to receive product with one initial blood type as long as they have their ID bracelet on or an outpatient ID card with them (prefer the bracelet, if possible). That is an exception that is approved by me on a case by case basis with our medical director's blessing.

Another exception we'll make is for the occasional OP who gets admitted to the ER or as an IP before they've received product we've prepped for them. If their Blood Bank ID bracelet is on them when they come into ER/admitted, we will allow transfusion without additional testing. Just request a transfuse order from the hospitalist or the on call Oncology provider.

New account number, new visit, new type and screen.

1 hour ago, MAGNUM said:

New account number, new visit, new type and screen.

This is how we do it also, except for platelets.  We don't require a blood type prior to platelet transfusion unless the physician requests type specific and we do not already have a blood type on the patient.  For neonates, we use type AB if we don't already have a sample to type.  We would not stick for this patient population.

1 hour ago, MAGNUM said:

New account number, new visit, new type and screen.

Same here, except if they are just ordering FFP or PPH, we only require a type.  It seems easier to keep this standardized, since all of our techs (except me) are generalists.  Although we do give PPH regardless of type most of the time, since we only keep 2 A or AB in stock.

We require a new sample every 3 days.  This is only because we use BB ID bands.  Prior to bands it was done once a visit. 

If we have the pt's blood type in our computer records - that is what we use for pltph and FFP.  We do not BB ID band for plasma - only RBCs.  We are able to give type specific pltphs so rarely in this region anyway, this has worked for us.

Of course - the Drs often order a Type and Screen or Type and Cross anyway when they want just plasma, so we frequently get a new specimen then.  If we need a specimen for the Blood Type - it must be a new and unique (re-identified) draw from the pt - we will not share a prior Lab specimen for Blood Bank for an ABORh.

We get a sample that is good for 3 days following the draw. If the account number changes, as long as the patient still has the armband on, we use that sample. We just transfer the results to the new account number and credit one of them. It's a pain, but better than redoing all the testing.

We require a current sample for platelets and FFP also. I think the chances of someone using someone else's name/insurance are too high to take a chance not to do this, not necessarily for the platelets but for the FFP. 

We use encounter (visit) for platelets and plasma.  If they go home in the morning and come back in the evening, that is a new encounter, so a new blood type.  We do not require a screen for plasma products.  We do have lots of oncology patients that get a recurring encounter that is good for 30 days.  After that 30 days we do another type.  Red cell products require every 3 days or new encounter, whichever comes first.

When I was in the hospital, we had an instance where a patient was in the ER and the admitting individual "picked" the wrong patient from a list of names only distinguished by different middle initials.  Frozen plasma was ordered and when the tube from ER arrived in the BB, the type on the tube didn't match what we had on record.  After investigation, it was discovered that the wrong patient record had been initially selected.  New type on each encounter/admission is a good idea.

If I have no history I get an ABORh.  I also prefer one if a new admission even if I have a history.  It just helps to verify the patient.  I am not averse to transfusing either based on a historical type in my file.

We have gone to requiring a blood type once per visit for platelets and plasma due to the ID swaps by patients or by admitting selecting the wrong record (I've seen that a few times as Dragonlady describes).  I don't think it is so critical for platelets because we often have to transfuse plasma-incompatible platelets but we wanted to be consistent.  This has worked well because our computer system has allowed our OP transfusion patients to continue with the same series visit number for many months meaning we don't retype them for platelets.  We will soon have Epic and they will get a new visit # monthly so we will have to change plans.  I think we will just allow OP transfusions (of platelets only) to rely on a historical type regardless of the visit number.  Everyone else gets one type per admission for the yellow stuff.

On 5/31/2017 at 11:21 AM, cswickard said:

If we have the pt's blood type in our computer records - that is what we use for pltph and FFP.  We do not BB ID band for plasma - only RBCs.  We are able to give type specific pltphs so rarely in this region anyway, this has worked for us.

Of course - the Drs often order a Type and Screen or Type and Cross anyway when they want just plasma, so we frequently get a new specimen then.  If we need a specimen for the Blood Type - it must be a new and unique (re-identified) draw from the pt - we will not share a prior Lab specimen for Blood Bank for an ABORh.

We do exactly the same with no problems to date.  We also will issue Type specific plasma without the 2nd draw "Re-type" required for RBCs.  The issue of the wrong patient being registered is a bit disturbing though!

Same as AMcCord except inpatients are good for FFP and platelets with initial typing as long as BB armband is on and legible. New specimens for crossmatches and types and screens are collected every 72 hrs.

On 6/1/2017 at 7:51 PM, dragonlady97213 said:

When I was in the hospital, we had an instance where a patient was in the ER and the admitting individual "picked" the wrong patient from a list of names only distinguished by different middle initials.  Frozen plasma was ordered and when the tube from ER arrived in the BB, the type on the tube didn't match what we had on record.  After investigation, it was discovered that the wrong patient record had been initially selected.  New type on each encounter/admission is a good idea.

We pick up admission errors in Blood Bank on a fairly regular basis, especially with outpatient registrations. Patients with language barriers can cause admission problems - the name may change because someone misunderstood what the patients name actually is because it is unfamiliar in spelling or from a different culture. Similar names, clerical errors with spelling and birth dates, patients who self-identify differently one visit to the next, etc.  It is important to be very careful - admissions staff are not uniformly diligent about carefully confirming patient ID and making sure that the correct historic record is selected. Simple human error because of distraction or interruption happens. It can be a big problem for reference work because the only patient info we have at that time is what was received from the patient's clinic registration. When the patient is admitted through our doors later on we have to decided...same patient with errors or different patient. I preach to staff that we must never assume, always check.

Edited June 5, 20178 yr by AMcCord

We also require a new sample in every two days. 

We require a blood type with each account for plasma just incase there has been a registration error.  Usually a CBC tube is available for use or type and screen has been performed.  Historical type is sufficient for platelets.