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Thread: Is 'request form' a requirment to identify a pateint before transfuison sampling?

  1. #1
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    Is 'request form' a requirment to identify a pateint before transfuison sampling?

    In our hospital, request form with patient details are required to ensure patients are positively identified and details on wristband match with request form before bleed patients.

    A few months ago, printed BT request forms can be generated instead of hand written ones. We notice some of the G&S samples are taken 15-20 minutes earlier than the request form generate time. We reject these samples because these patients are not identified against request forms.

    As JPAC website4.7: Pre-transfusion blood samplingMisidentification at blood sampling may lead to fatal ABO-incompatible blood transfusion, especially if the patient has not previously had their blood group documented. Inadequately or mislabelled samples carry a significantly increased risk of containing blood from the wrong patient. Risk of misidentification may be reduced by electronic systems, but all sampling should be carried out in line with the following principles by trained and competent staff:

    • Patients must be positively identified and their details must match those on the request form.

    BT lab has lot of pressure from clinicians arguing during emergency handwritten or printed request form before sampling is not practical or possible.

    Is request form a requirement to identify a patient before transfusion sampling?
    Are there any clear guidelines or protocols to refer to?

    Don't think the BSH guidelines of 'Administration of blood components' clarify the issue.

  2. #2
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    Hi tangx,

    From BSH Guidelines 'Administration of blood components' :

    All patients having a blood sample taken must be positively identified. The collection of the blood sample from the patient and the subsequent completion of details on the blood sample tube must be performed as one continuous, uninterrupted event at the patientís (bed)side Ö

    Check what your hospital blood sampling policy states. If the request form is part of the patient and sample ID check at the bedside then this must be followed for the purpose of maintaining patient safety. During an emergency situation, following procedures will reduce errors. Itís usually when everyone is trying to be helpful that things go wrong!

    Does this problem only occur in a specific area? If so, perhaps the HTT together with the clinicians could look at practical solutions that will help; this is a team effort, not solely for the BBM to sort out.
    Has this discrepancy only become an issue after the implementation of printed BT request forms?

    Your lab staff are required to follow the Trust and lab procedures and this issue is for the Transfusion Practitioner and Consultant to raise at HTC/ Governance level
    .



    Last edited by Rashmi; 21st Mar 2018 at 09:55 PM. Reason: formatting

  3. #3
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    Hi Tangx, yes have to agree with Rashmi. We have both hand written and ICE generated forms. ICE generated have massively reduced our spelling issues, but when the PAS is wrong it gets messy! Both sets of forms have a sign off section re PPID and sample taker, including times. We allow a small tolerance for time on form and time on sample matching. We report non compliance across the trust which has halved our rejection rate, but it is still too high for my liking, but small steps....
    Simon

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    Hi Rashmi, thanks for your reply.

    Our hospital BT policy clearly stated that 'complete the sample request form and take this to the patient's bedside in order to positively identify the correct person to be bled'.
    Due to the handwritten request forms, the time of when the request form is completed is not possible to be identified. The issue has only be highlighted after OCS generated request forms because there is 'form generated time'. Some of request forms were generated 20 minutes or 30 minutes after the sample taken time (PDA labelled).

    For me, the collection of the sample is not performed as one continue, uninterrupted event at the patient bedside, and the patient is not positively identified to ensure he/she is the right patient to bled. It is not the first time patient was given wrong wristband at clinical area.

    As Simon Ennis said, the OCS printed request forms did reduce the reject samples compared with handwritten forms. However since BT starts to reject samples with time mismatch even though the details are correct, there are lot of pressure from clinicians.

    It will be discussed at HTT and HTC meeting and hopefully they can understand the importance of it.

  5. #5
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    Hi tangx,
    You are taking all the right steps and rejecting appropriately. Hopefully the HTC will not accept that these samples can be used-otherwise the Trust policy will need re-writing and risk assessing etc. Again, this is for your TP and Consultant to address with the Clinicians.

    Let us know how things go.
    bw

  6. #6
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    What does your IT department say? The times should be the same so any lag should be reported to them. I would have thought the labels wouldn’t print unless the request form was generated first it does seem out of order to me.

  7. #7
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    Not entirely sure what PDA labelled is? With IT we are entering into a brave new world, which isn't always a good thing! Unless it is done with considered steps.
    If using a full ICE system the form could be electronic? Scanning at the Bedside of the patients wrist band might instruct the sample taker to take a sample for Transfusion and contemporaneously produce a printed label with PID and Lab no. included....Ahhh.
    BUT whether electronic or hard copy the request MUST be timed prior to taking the sample.
    Practically here we sometimes have that problem as a Dr may complete the request a day before taking, this is where the manual sign off on the form comes in as that MUST match what is written on the sample.

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