Improving the phlebotomy process for the collection of pre-transfusion specimens

A hematology/Oncology nurse at a medical center in Cleveland is currently working on a quality assurance project for improving the phlebotomy process for the collection of pre-transfusion specimens. Their team is looking to establish a standardized checklist, especially related to patient identification and verification. She wants to know if other institutions use a checklist to help standardize the blood collection (phlebotomy) process. She also wants to know if / how many hospitals are currently using patient/specimen identification schemes such as typenex bands, bar code readers, barrier systems, or require second sample collections so that a patient's ABO/Rh is never based entirely on a single patient specimen.

The following comments have been received.

ADDENDA Oct. 8, 2009

1. A colleague in Arkansas reports that they use the Typenex® system. Their experience is that the system improves patient safety when used correctly. HOWEVER. when not used correctly, it is useless! In their experience, scanning barcodes on ID bands has not been helpful (currently using for POC testing) as nurses have sheets of barcodes on the charts and simply scan the charts. The responding Arkansan knows of other institutions that require ABO/Rh confirmations from a second draw. The nurses quickly learned to draw two tubes at the same time, send one, pocket the other and send it down later as a "second" specimen. She is discouraged by this entire subject. The industry can work at developing better tools, but ultimately it is the culture that must be changed. They have a progressive disciplinary process in their laboratory that addresses patient ID errors that ultimately results in termination. Nursing has no such policy.
   
   
2. A medical technologist in Iowa reports that his hospital does not use a checklist other than the procedure from their phlebotomy SOP manual. That is not to say the document is physically carried on rounds. They use two IDs, usually name and date of birth (DOB). They believe that DOB is usually adequate in a 50 bed facility when applying a Typenex® bracelet. A second sample collection is done for non-group O patients without prior history.

ADDENDA Oct. 14, 2009

3. A blood banker who works in a sunbelt state reports that her institution uses the handheld Sunquest Collection Manager™ for all inpatient draws by the phlebotomists (barcode the patient armband, labels print based on orders present in the comuter system). This has reduced the incidence of mislabels but is not fool proof if not used as intended. The use of the handhelds by nursing staff is limited at this point. At one of their hospital systems, they also require a second specimen from individuals who appear to be other than group O if there is no ABO history in their computer system. For outpatients, they use Typenex® bands and do not require a second specimen to verify ABO. All 1st time patients are typed twice regardless of their ABO.

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