Patient Preadmit Wristbands

[Bdawley]

Our Blood Bank is faced with a potentially new patient identification dilemma. I’m hoping someone out there can offer some advice or at least some anecdotal experiences of their own.

Our hospital is participating in a new state-wide (Michigan) agreement to standardize wristband colors for patients. Currently our preadmit Blood Bank patients have a red wristband which is attached prior to specimen collection. The wristband is barcoded and the specimen label is generated from the wristband. Our Blood Bank will use these samples for up to 7 days post collection for pretransfusion testing providing the patient has not received blood or been pregnant in the past 3 months. We currently use these wristbands even after the patient is admitted for transfusion purposes.

It seems a decision will soon be made to cut off any wristbands that a patient may have upon admission so that a single (white) wristband can be attached to the patient. This, of course, means that the Blood Bank wristband will be taken off. We would no longer be able to use the preadmit specimen for transfusion purposes since the “chain of custody” would be broken. We have 2 options to consider:

• Repeat all preadmit T&S testing with a new sample collected after the patient is admitted. This would add cost and additional tech time to repeat the testing as well as delays for surgery.
• Devise some documentable mechanism that would require accountability on the part of nurses who cut off the BB wristband and replace it with a new (white) wristband. The nurses could scan their ID badges as witnesses whenever a wristband is replaced. They could also scan the red wristband ID and the new white wristband ID before placing the new band on the patient to make sure there is a match. This could potentially all be documented in our HIS (Cerner Millenium). With this accountability in place, we would feel comfortable that the patient is being properly identified and we could continue to use our preadmit specimen for transfusion purposes.

Question: Has anyone else encountered a similar situation? Are there alternatives that other Blood Banks are using that I have not considered? Obviously any other wristband systems like Hollister, Typhenex, Securelink are not the solution either since these too would all be cut off upon admission.

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[swede]

We don't use any extra blood bank ID bands. Nurses were always cutting them off and wanting a new one (?!) We use the patient's medical record number as identification because it never changes from admission to admission. When a patient is drawn Pre admission, the phlebotomist fills out a "pink card", they stick an aliquot label from the specimen on this card, the label contains the MR number, the patients name, and patient birthdate. The phlebotomist signs the card (and the specimen), the patient signs the card and takes the card home. When the patient returns for surgery, they bring the card with them. The admitting nurse compares the card to the wristband that is being placed on the patient, signs the card and returns it to the blood bank. If the patient returns without the card, or if information is missing, wrong, etc....the patient is redrawn. We have been using this method for about 4 years now and have had few problems. We draw patient's up to 3 weeks prior to surgery

[Eoin]

Hi
We Use pre-admit clinics a lot. We use Typenex bands (which are now barcoded). We have aTCI Typenex & Patient Identity Check. TCI is for TO COME IN. This is signed by the phlebotomist, a small Typenex label is stuck on it with patient demographics sticker and the patient signs it also. At admission, this card is sent with the armband (all held in the BB Lab) and there is a statement "All demographics checks have been performed by me using positive patient identification". The patient has identified their signature, and I have placed the wristband on the patient". This area is signed by the admitting nurse, and the card is filed in their notes. A bit cumbersome but the reg authorities here were happy with it.
Best of Luck
Eoin

[PammyDQ]

We too do not use any specific BB wristband for inpatient, outpatient, or pre-surgical patients. For anyone interested in how we handle pre-admission(PAT) surgical specimens, it goes as follows:

Our preadmission surgical department collects the T&S specimen and interviews the patient as to any recent(3 mo) transfusions, pregnancy, or surgical procedures. This is recorded on a paper document which the "interviewer" (usually the person collecting the spec) and the patient both sign. The specimen label contains the patient's name, date, unique MR number, and signature of the person drawing the blood. They are sent together to the BB.

When rec'd in the BB, we review this information, perform testing, then catalog the specimens as to date of surgery, which must be w/in 14 days of collection. If the patient answers "yes" to pregnancy or transfusion, we require a repeat screen on the date of surgery, done free of charge. If a previous surgery is indicated for a procedure which often requires transfusion yet the patient answers "no", we will investigate (patients are often wrong).

Each afternoon we compare the signed documents to the next day's surgery schedule to make sure everything is in order and to notify the ambulatory surgery dept. of any ABO confirmations(for no history non "O" patients) or repeat screens that are to be collected upon admission. When the patient comes in for surgery, their identification is up to the surgical personnel. (This is as vital to surgery being performed as well, obviously). Any crossmatches ordered will contain the necessary identifiers to match order to the specimen retained in BB.

We are AABB accredited (since the 1940's) and have received no deficiencies for our last 2 or 3 inspections. I don't see anything in the Standards that distinguish outpatient vs. inpatient identifiers for pre-transfusion specimens.

[ltechlin]

I am at a Michigan hospital that also has changed to standardized armband colors. We were using red blood bank armbands (pre-admit and inpatients alike) but was told we needed to change our armband color. Yes, our hospital armbands are white also. We now use green blood bank armbands. I am told that blood bank armbands have not been assigned a designated color, but red was taken by something else (allergies maybe, I don't recall). At our facility, before we put a blood bank armband on a pre-admit patient, they have a white hospital armband put on by the registration staff.

When we have the need for an armband to be removed the person removing the band is asked to first contact the blood bank. We then send them a new band along with an audit trail form. At this point they can cut off the armband, complete the new band and place it on the patient. The form is a fill in the blank something along the lines of: "I, _____________, removed blood bank armband # ________ and replaced it with blood bank armband # ________ for __________________(patient name and medical record #) on _________ (date/time)". They must then return this form to blood bank immediately so we may update our records.

Good Luck!

[AMcCord]

We use a take home card, blending the procedures that Swede and Eoin report. It has worked very well for us for years. We reinforce with the patient that if they don't have the card when admitted that they will be redraw, surgery could be delayed (though really probably not), etc etc. They seldom forget to bring them back.

[Penny Thiel]

Hi there!
I would deeply appreciate knowing what type of banding system you all use - if any - and do you allow computer generated labels as opposed to hand written labels on your samples for transfusion.
Thanks so much for your time!
With a smile,
Penny

[AMcCord]

We hand label.

[Cathy]

We use Hollister (red) wristbands and do allow computer generated labels as long as the sample also contains the unique "R" number.

[PammyDQ]

Hi there!
I would deeply appreciate knowing what type of banding system you all use - if any - and do you allow computer generated labels as opposed to hand written labels on your samples for transfusion.
Thanks so much for your time!
With a smile,
Penny

Our labels are computer generated, but we will accept ANY TYPE of label as long as the information is complete!