Implementation of a two-specimen requirement for verification of ABO/Rh for blood transfusion.
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.
Goodnough
Lawrence T
LT
Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5626, USA. ltgoodno@stanford.edu
Viele
Maurene
M
Fontaine
Magali J
MJ
Jurado
Christine
C
Stone
Nancy
N
Quach
Peter
P
Chua
Lee
L
Chin
Mei-Ling
ML
Scott
Robert
R
Tokareva
Irina
I
Tabb
Kevin
K
Sharek
Paul J
PJ
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
D000017:ABO Blood-Group System; D012204:Rh-Hr Blood-Group System