JCAHO Advises Against Simultaneous Crossmatching of Multiple Patients?

On Tuesday, April 25, 2000 the following question was posed to the CBBS e-Network:

Has anyone redesigned their transfusion staffing model to comply with the suggestions of JCAHO in the 10th "Sentinel Alert" bulletin? In that bulletin the JCAHO appears to suggest "prohibiting simultaneous crossmatching of multiple patients by the same technologist"?

To which the following responses have been submitted:

1. When this issue was discussed with representatives of four of the largest hospital transfusion services in the Sacramento area, it was stated that nothing in the hospital’s SOPs prohibited the simultaneous crossmatching of more than one patient by a single medical technologist. Furthermore, none of these transfusion services currently has plans in the works to prohibit such practices (one of the services said that they are going to devote some thought to the matter; however, they admit that financial realities probably will prevent their changing their practices).
   
   
2. At a private Medical Center in Los Angeles it was reported that the hospital does not prevent a technologist from performing crossmatching on multiple patients. That hospital recommends in their procedure that each patient specimen be placed in a separate rack. Interestingly, this hospital uses crosstrained staff in the laboratory and has "bare bones" staffing on all shifts. The hospital management states that they could not possibly complete their work if they had to crossmatch one patient at a time.
   
   
3. One reply was from an expert who states that the message that JCAHO should have distributed was that errors/fatalities provide opportunities for each institution to evaluate its own systems for possible improvements. Any corrective action should be evaluated for effectiveness within that same institution.
   
   
4. This individual thinks that prohibiting the simultaneous crossmatching of multiple patients by the same technologist is an unnecessary "precaution”, since there have not been any published studies, data, etc that would lead one to believe that such a policy would result in greater patient safety. What prohibiting simultaneous crossmatching would do is unnecessarily lead to increased cost due to increased staffing levels.
   
   
5. A hospital blood bank reported that they do not prevent a technologist from crossmatching multiple patients simultaneously by the same technologist.
   
   
6. A regional group of Transfusion Service supervisors discussed this question at their last meeting in February 2000. At one of those supervisors' hospitals, the CLS's are trained to use one rack per patient when crossmatching to prevent error. This supervisor also comments that they are big, busy, and batching!
   
   
7. Another institution reported that crossmatching of multiple patients is necessary in a high volume transfusion service and is allowed at the facility with the following safeguards in place to prevent errors due to processing of multiple samples:
   1. A second blood type is required to be performed on a separate draw for all non-group O patients that do not have an historical blood type on file.
   2. The computer system compares the current blood type with the historical blood type.
   3. Patient is accessioned in the computer via the bar-coded label on the blood specimen prior to entering test results.
   4. There are strict requirements when checking primary and testing tubes prior to reporting results.

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Ira A. Shulman, MD
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