Principle: | Procedure: | References:
In an emergency, Blood Bank personnel may not have time to follow normal Blood Bank procedures or policies. This policy supersedes all other procedures/policies in an effort to supply blood STAT in life-threatening situations.
The first part of this policy defines the steps involved in issuing uncrossmatched blood with no time for any work on the patient's sample. The second part defines the steps involved when a patient’s status changes and blood is urgently needed before testing is completed.
1. Stat Order - Uncrossmatched Blood Needed Now:
2 units of O Negative RBCs are manually reserved at each site for emergency issue to Doe1 and Doe2 (UCL designated unknown patients).
Note: O Negative blood may be issued without patient information.
A. Release of Blood
a. Remove O Negative blood from the site-specific emergency issue refrigerator/container.
b. Sign both copies of the Product ID Tag on the Tech ID line.
c. Save one copy of the Product ID Tag for the Lab record and reattach the second copy of the Product ID Tag to the unit.
d. Keep 3 pigtails from each unit (2 for the hold rack, 1 for a possible crossmatch).
e. Have the nurse/runner sign the Lab copy of the Product ID Tag.
Note: It is OK for lab personnel to deliver blood in an emergency.
f. Release the unit with the second Product ID Tag attached.
g. Document the time of issue on the saved Lab copy of the Product ID Tag.
B. Issue of Blood in SafeTrace
a. In the Patient/Order module, choose Product (menu bar), Emergency Issue, Unknown
b. The Emergency Product Issue – Unknown Patient window opens, with the cursor in the Last Name box.
c. Fill in as much as is known about the patient. If no name is known for the patient, click “Generate”, SafeTrace Tx® creates the appropriate pseudonym; Doe ###.
d. Indicate the appropriate Service Provider, M, F, or DV.
e. Record the “Issue Location” (use the “Find” option for specific hospital areas).
f. Record the “Release To” person (the person that signed out the unit on the Lab copy of the Product ID Tag). If lab personnel delivered the blood product use the Issue Location again.
g. Click the “Manual” tab and enter the product code and unit number.
h. Click “Accept”. If issuing more than one unit, repeat until all the units are entered.
i. Click “OK”; two Product ID tag(s) print. Attach one tag to the Lab copy of the manual Product ID Tag and place these in the designated Emergency Issue file. The second tag can be discarded.
j. No crossmatch is required if the unit(s) is given or wasted.
k. If the unit(s) is returned within 30 minutes and the patient requires blood “on call”, return the unit by pulling down the Product menu and choosing Return. Barcode the unit number and enter all necessary information. Place the tagged “Doe” unit(s) in the refrigerator and issue as needed while routine testing is performed on the patient specimen. Once patient testing is complete and type specific blood is set on the patient, “Release to Available” the unused tagged “Doe” units.
C. Update the Unknown SafeTrace Patient Record
a. In the Patient/Order module, go to File (menu bar); Open; Patient.
b. Type in whatever information is known. Click “Query”. One of the following occurs:
1. Patient Profile Window opens - Patient already in SafeTrace - review history.
a. If patient history shows an antibody or a special need contact a Pathologist for further testing instructions.
b. Print a copy of the Patient Profile and attach this to the DOE### unit tag(s) that were saved in the Emergency Issue file. These will have to be merged after supervisory review.
c. Bring Electronic orders in for the patient, using the correct name, and test accordingly. The Doe### units given will be linked to this patient after merging.
2. Patient options window opens – if there is a patient match, highlight the patient and click “OK”. Patient Profile Window opens and proceed as above.
3. Gnomatch message comes up.
a. Click Cancel.
b. Reopen the DOE### Patient Profile using the SafeTrace number from the saved Product ID tag. VERIFY THAT THIS IS THE SAME PATIENT.
c. Replace the DOE name with the Patient name. The Gender, Medical Record number and Account number are required to update the patient profile. The Social Security number and Birth date give warnings but are not required to save the information.
d. Save all information and close the window. Blood bank orders can now be brought into SafeTrace and matched to the updated Doe patient.
e. The DOE name will always be associated with this patient and can be found with the Patient Profile window open by going to Patient (Menu Bar), Prior Patient Names.
D. Restocking the Emergency Issue Refrigerator/Container
a. The Emergency Issue Refrigerator/Container should be restocked after a unit is issued to a patient, when time permits.
b. The Emergency Issue units are rotated per site protocol:
1. MMC-DV: at time of blood exchange
2. MMC-DBQ: every week
3. Finley: every 2 weeks
c. Use the freshest O Negative units to stock the Emergency Issue Container
d. On an Emergency Issue Product ID Tag, write the Unit #, Product Code, and Expiration Date
2. Stat Order - Urgent Blood May Be Needed:
A. Bring Patient orders into SafeTrace (Refer to “Patient Demographics and Orders (Electronic and Manual; Patient/Order Module: SafeTrace®” procedure) and review any Patient history.
Warning: If the patient has a history of an atypical antibody, notify a pathologist immediately. The pathologist may need to confer with the attending physician regarding availability of safe blood for the patient.
B. Begin the Antibody Screen as soon as plasma/serum is available. (Refer to the “Antibody Detection & Identification; MTS Gel Card” procedure.)
C. While the antibody screen is incubating, perform the ABO/Rh tests on the patient. (Refer to the “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards” procedure.)
D. Product Select units. (Refer to the “Donor Selection” procedure.)
b. Urgent - Antibody Screen not complete:
1. If blood is needed before the Antibody Screen is completed, do an Immediate Spin Crossmatch. If the results are Compatible, select the “EMER” Result Interpretation (Emergency Issue). The unit is not truly compatible unless the Antibody Screen is completed and negative.
2. The unit tag will print with the “EMERGENCY ISSUE” notation for Crossmatch Interpretation and under Prohibiting Factors it will state that “REQUIRED TEST NOT COMPLETE”
Warning: Only O Negative units may be released without an Immediate Spin Crossmatch. All other units must have an Immediate Spin Crossmatch completed before issue.
3. Issue the unit(s). (Refer to Product Issue or Return; Patient Order Module: SafeTrace Tx® procedure.) When the Antibody Screen is completed all SafeTrace records will be updated to reflect the completed testing.
4. If the Antibody Screen is completed before the blood is issued and no further testing is indicated, reprint the Product ID Tag to eliminate the Prohibiting Factors remark.
1. AABB Technical Manual. Latest version.
2. AABB Standards for Blood Banks and Transfusion Services. Latest version.
3. SafeTrace Tx® Patient Order Training Manual. 04/01/2001
i. December 2002 M. Burger, N. Combs, S. Rodriguez
ii. March 2007 S. Rodriguez (Revised: entire procedure)
Interim Review: September 2009 S. Hosch (no changes)