Procedure / 10.00.03 / Blood Bank Specimen Collection and Retention
ASCENSION CRITTENTON HOSPITAL
PATHOLOGY DEPARTMENTAL POLICIES AND PROCEDURES
Manual / BLOOD BANK PROCEDURE BOOK IProcedure / 10.00.03 / Blood Bank Specimen Collection and Retention
PRINCIPLE
Accurate patient identification is fundamental for patient safety. The number one safety goal Joint Commission has cited is accuracy of patient identification and the elimination of transfusion errors related to patient misidentification. Collection of a properly labeled pretransfusion blood sample from the intended recipient is critical to safe blood transfusion.
POLICY
When labeling samples for compatibility testing the following are required per CAP and AABB Standards:
1. All individuals drawing blood bank specimens will be trained and documented in proper specimen collection. The identity of the phlebotomist must be traceable back to the collected sample.
2. Individuals collecting specimens will positively identify the patient before collecting a specimen using two identifiers. If possible, the patient should be involved in verifying she/he is wearing the correct identification band by asking the patient to spell her/his name and state her/his date of birth.
3. In situations where there is truncated names on labels, the exact spelling will be compared on the hospital identification band, request order and on the addressograph before the name is acceptable.
4. Specimens will be labeled before leaving the bedside.
5. The following items will be on all blood bank specimens:
a. Patient’s first and last name (Full Name).
b. Medical Record Number.
c. Date.
d. Time of collection (military time preferred e.g. 1300).
e. Initials of hospital associate who collected specimen and second associate witnessing the identification process, collection and labeling.
f. Blood Bank Identification number (Chain of Custody number).
Misidentification or mislabeling a specimen could result in a fatal transfusion reaction. If there is any doubt about the identity of the patient or about labeling of the sample, a new sample must be obtained.
SPECIMEN
6.0 mL PINK top tube with blood bank band ID label. Two (2) 6.0 mL PINK top tubes with blood bank band label for Open Heart surgery cases.
Acceptable specimens must be:
1. Free from hemolysis and contaminating IV fluid.
2. Collected in a pink top tube, unless specifically requested to draw lavender or a red top tube.
3. Accurately and completely labeled without any discrepancies between the request slip and the tube label.
TESTS AND PRODUCTS that REQUIRE A BANDED SPECIMEN
· Type and Screen for possible transfusion or surgery within 3 days, counting drawn date as day zero.
· Crossmatch Red Cells or Packed Cells require a properly labeled blood bank specimen for up to 3 days after it is drawn.
· Blood Bank Specimen (BBS)—"Hold for orders."
· Labor and Delivery patients: Type and Screen, Rh and BBS.
· Transfusion reaction investigation.
· Plasma, Platelets, Cryoprecipitate and Autologous Red Cells require a banded specimen drawn on the current encounter or visit. Autologous red cells may be released any time after initial IS crossmatch as long as Blood Bank band remains on patient.
INPATIENT PROCEDURE
1. Recruit an associate to witness both the identification of the patient and the proper collection and labeling of the blood bank specimen.
2. Ask patient to verbally spell her/his first and last names and date of birth.
3. If the patient is unable to spell name, the caregiver in attendance of the patient or relative may identify the patient and sign the specimen as it is labeled.
4. Compare the spelling and the medical record number with the hospital identification band and request order:
a. Computer generated collection label (barcode label).
b. Addressograph label.
c. Written order.
5. Unidentified patients may require the “Unidentified, Patient Alias Naming Convention” described below under unresponsive/unidentified patient procedure.
6. Collect the specimen in a 6.0 mL pink top tube.
7. Label specimen at the bedside.
8. Peel the white label that contains the chain of blood bank identification number (chain of custody number) off the blood bank band and place it lengthwise on the pink top specimen. Then on the specimen, cover the white label with an addressograph or Cerner generated label. Do not cover blood bank band number (chain of custody number). The following items are necessary for specimen acceptance:
a. Patient's full name.
b. Medical record number.
c. Date.
d. Time (military time preferred, e.g., 1300).
e. Initials of phlebotomist (associate collecting and labeling specimen) and initials of second hospital associate who is witnessing the identification process must be on the patient label (addressograph/Cerner Label) that is placed on the tube.
f. Blood Bank identification number (Chain of Custody number)
9. If Blood Bank band is unavailable, write name, medical record number, date, time and initials on the permanent label of the tube. Immediately obtain a blood bank band, re-identify the patient and label specimen and band patient at the bedside without losing contact with the specimen
10. Then on the band, an addressograph or computer generated label will be placed in this open area. The medical record number and patient name must be visible on the patient wristband. The following need to be on the addressograph on the patient’s blood bank band:
a. Patient’s full name.
b. Medical record number.
c. Date.
d. Time (military time preferred, e.g., 1300).
e. Initials of phlebotomist (associate collecting and labeling specimen) and initials of second hospital associate who is witnessing the identification process must be on the patient label (addressograph/Cerner Label) that is placed on the tube.
f. Blood Bank identification number (Chain of Custody number).
11. Once both associates confirm all 7 items are on both the specimen and the band pull the backing off of the clear adhesive shield and place over wristband.
12. Attach wristband to patient's arm leaving a two-finger space between the arm and the band. Press the white clip on the band securely to fasten.
13. Detach the tail of numbered labels from the wrist band at the perforation by bending it back and forth to tear.
14. Send the specimens, tail of numbers and collection label in a zip lock bag to Blood Bank.
15. Send cardiothoracic Blood Bank specimens in yellow striped zip lock bag.
UNRESPONSIVE/UNIDENTIFIED PATIENT PROCEDURE
1. Recruit an associate to witness both the identification of the patient and the proper collection and labeling of the blood bank specimen.
2. The “Unidentified Patient Alias Naming Convention” policy will be followed when labeling unresponsive, unidentified patients.
3. Registration will register the patient with “Unidentified" as the last name.
4. Registration will assign the next available alias name (Color) from the Unidentified Patient Alias Naming Convention spreadsheet for the patient’s first name.
5. Obtain a medical record number, if possible.
6. Once the unidentified patient has been registered and blood bank orders have been placed both the associate collecting the specimen and the associate witnessing will compare the addressograph to the hospital band of the unidentified/unconscious patient.
7. Next, collect a specimen in a 6.0mL pink top tube.
8. Label the specimen at the bedside.
9. Peel the white label that contains the chain of blood bank identification number (chain of custody number) off the blood bank band and place it lengthwise on the pink top specimen. Then on the specimen, cover the white label with an addressograph or Cerner generated label. Do not cover blood bank band number (chain of custody number). The following items are necessary for specimen acceptance:
a. Patient's full name.
b. Medical record number.
c. Date.
d. Time (military time preferred, e.g., 1300).
e. Initials of phlebotomist (associate collecting and labeling specimen) and initials of second hospital associate who is witnessing the identification process must be on the patient label (addressograph/Cerner Label) that is placed on the tube.
f. Blood Bank identification number (Chain of Custody number)
10. If Blood Bank band is unavailable, write name, medical record number, date, time and initials on the permanent label of the tube. Immediately obtain a blood bank band, re-identify the patient and label specimen and band patient at the bedside without losing contact with the specimen
11. Then on the band, an addressograph or computer generated label will be placed in this open area. The medical record number and patient name must be visible on the patient wristband. The following need to be on the addressograph on the patient’s blood bank band:
a. Patient’s full name.
b. Medical record number.
c. Date.
d. Time (military time preferred, e.g., 1300).
e. Initials of phlebotomist (associate collecting and labeling specimen) and initials of second hospital associate who is witnessing the identification process must be on the patient label (addressograph/Cerner Label) that is placed on the tube.
f. Blood Bank identification number (Chain of Custody number).
12. Once both associates confirm all seven items are on both specimen and band, pull backing off of clear adhesive shield and place over wristband.
13. Attach wristband to patient's arm leaving a two-finger space between the arm and the band. Press the white clip on the band securely to fasten.
14. Detach the tail of numbered labels from the wrist band at the perforation by bending it back and forth to tear.
15. Send the specimens, tail of numbers and collection label in a zip lock bag to Blood Bank.
16. Send cardiothoracic Blood Bank specimens in yellow striped zip lock bag.
17. Upon receipt of proper identification of patient name Blood Bank will be called by registration with notification the name of the unidentified patient was changed to their legal name.
18. The Blood Bank will review all orders and notify the Emergency Department if new orders and blood bank banded specimen are required.
CORRECTIVE ACTION FOR MISLABELED SPECIMENS
All mislabeled specimens must be discarded, redrawn and noted on variance board and event reports or blood bank process occurrence forms will be completed.
TRANSFUSION REACTION INVESTIGATIONS
1. Apply a new blood bank band following the inpatient blood banding procedure as noted above. Remove the old blood bank band.
2. DRAW FROM THE OPPOSITE ARM OF TRANSFUSION.
a. ONE Full PINK TOP.
b. ONE LAVENDER TOP.
c. BLOOD CULTURES, also if the patient’s temperature increased more than 3°F.
3. Send the specimens and empty transfusion bag with saline attached to the Blood Bank STAT.
PRETRANSFUSION TESTING AND OUTPATIENT TRANSFUSIONS SPECIMEN COLLECTION AND LABELING
1. Outpatients should present with a hospital wristband on. If they do not, call registration to come and place a hospital wristband on the patient.
2. Determine whether the patient needs a Blood Bank specimen drawn.
3. Apply a Blood Bank band and instruct the patient to keep both bands for when they present back for their day of surgery. (PAT patients drawn more than 3 days prior, counting today as day zero: do not band.)
4. Friday drawing for Monday surgery/transfusion = Blood Bank Band.
5. Thursday drawing for Monday surgery/transfusion = do not BB band, only a computer generated label or addressograph label are necessary if patient’s surgery is more than 3 days prior.
6. If banding a pretransfusion testing patient for surgery or an outpatient, recruit an associate to witness both the identification of the patient and the proper collection and labeling of the blood bank specimen.
7. Ask patient to verbally spell her/his first and last names and date of birth.
8. If patient is unable to spell name, caregiver in attendance of the patient or relative may identify the patient and sign the specimen as it is labeled.
9. Compare the spelling and the medical record number with the hospital identification band and request order:
a. Computer generated collection label (barcode label).
b. Addressograph label.
c. Written order.
10. Collect the specimen in a 6.0 mL pink top tube.
11. Label specimen at the bedside.
12. Peel the white label that contains the chain of blood bank identification number (chain of custody number) off the blood bank band and place it lengthwise on the pink top specimen. Then on the specimen, cover the white label with an addressograph or Cerner generated label. Do not cover blood bank band number (chain of custody number). The following items are necessary for specimen acceptance:
a. Patient's full name.
b. Medical record number.
c. Date.
d. Time (military time preferred, e.g., 1300).
e. Initials of phlebotomist (associate collecting and labeling specimen) and initials of second hospital associate who is witnessing the identification process must be on the patient label (addressograph/Cerner Label) that is placed on the tube.
f. Blood Bank identification number (Chain of Custody number).
13. Then on the band, an addressograph or computer generated label will be placed in this open area. The medical record number and patient name must be visible on the patient wristband. The following need to be on the addressograph on the patient’s blood bank band:
a. Patient’s full name.
b. Medical record number.
c. Date.
d. Time (military time preferred, e.g., 1300).
e. Initials of phlebotomist (associate collecting and labeling specimen) and initials of second hospital associate who is witnessing the identification process must be on the patient label (addressograph/Cerner Label) that is placed on the tube.
f. Blood Bank identification number (Chain of Custody number).
14. Once both associates confirm all seven items are on both specimen and band, pull the backing off of the clear adhesive shield and place over wristband.
15. Attach wristband to patient's arm leaving a two-finger space between the arm and the band. Press the white clip on the band securely to fasten.
16. Detach the tail of numbered labels from the wrist band at the perforation by bending it back and forth to tear.
17. Send the specimens, tail of numbers and collection label in a zip lock bag to Blood Bank.
EXCEPTIONS TO BLOOD BANK BAND EXPIRATIONS
Bands are routinely good for three (3) days, counting today as day zero and tomorrow as day one for red cell transfusion. The following would be exceptions to banding: