title: Implementation of a two-specimen requirement for verification of ABO/Rh for blood transfusion.
abstract: BACKGROUND
  This study presents our implementation of a two-specimen requirement with no prior record of ABO/Rh to verify patients' blood type before transfusion.
  
  
  METHODS
  Blood type verification was introduced, discussed, approved, and implemented over a 12-month period (May 2007 to May 2008). Potential barriers and impact on benchmark indicators were identified and tracked.
  
  
  RESULTS
  Inpatient identification and/or specimen labeling for nursing and laboratory phlebotomists baseline corrected error rates were 1:467 and 1:5555, respectively. This study therefore sought and obtained approval to initiate a new policy of blood type verification before blood transfusion. Compliance in turnaround time (TAT) before and after implementation for completion of STAT type and screen/crossmatch within 60 minutes worsened marginally, from 90% to 80%. The impact on use of O-, uncrossmatched blood was found to be manageable. Seven (of 25 total) recorded electronic complaints were received after implementation. The corrected error rate for nurse phlebotomy draws after implementation was 1:630.
  
  
  CONCLUSIONS
  Despite the lack of an instigating event, verification of blood type before blood transfusion was successfully implemented. An impact on resources and benchmark indicators such as TAT can be anticipated and managed. Further process improvement efforts will be needed to ensure safety (e.g., at time of blood transfusion) for patients receiving blood transfusions. ABO/Rh verification may be necessary even after future implementation of bar coding and/or RFID chips, because human errors continue to occur even with systems improvements.
authors.affiliation: Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5626, USA. ltgoodno@stanford.edu
authors.forename: Lawrence T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: Maurene
authors.initials: M
authors.lastname: Viele
authors.forename: Magali J
authors.initials: MJ
authors.lastname: Fontaine
authors.forename: Christine
authors.initials: C
authors.lastname: Jurado
authors.forename: Nancy
authors.initials: N
authors.lastname: Stone
authors.forename: Peter
authors.initials: P
authors.lastname: Quach
authors.forename: Lee
authors.initials: L
authors.lastname: Chua
authors.forename: Mei-Ling
authors.initials: ML
authors.lastname: Chin
authors.forename: Robert
authors.initials: R
authors.lastname: Scott
authors.forename: Irina
authors.initials: I
authors.lastname: Tokareva
authors.forename: Kevin
authors.initials: K
authors.lastname: Tabb
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
mesh_terms: D000017:ABO Blood-Group System; D001788:Blood Grouping and Crossmatching / Q000379:methods*; D001800:Blood Specimen Collection / Q000379:methods*; D001803:Blood Transfusion; D006801:Humans; D010355:Patient Identification Systems / Q000379:methods; D012204:Rh-Hr Blood-Group System
chemical_list: D000017:ABO Blood-Group System; D012204:Rh-Hr Blood-Group System