A Better Blood Bank History
Blood bank is a dangerous department. Giving a patient the wrong unit of red cells can be fatal, something all techs who work in blood bank worry about. I’ve seen this happen once in my career. Truth is we don’t know how often this really happens, since two thirds of the time units will be ABO-compatible. Scary, huh?
Good blood bank practice adds hard stops to make sure the specimen is properly labeled, the order is checked, the unit tag matches the patient wristband, etc. The patient’s transfusion history must be checked, too.
I’ve always worked in labs with thousands of large, index-style history cards in filing drawers stacked in the department. When a crossmatch is ordered, a bleeder arrives in the ED, or an OB sample is received, we look for a card.
This system has always bugged me, for a few reasons.
- Cards are misfiled. Misfiling varies from one or two cards off to completely buried in another section of the file; mistakes happen in any manual filing system. Names change all the time, too. I’ve read as many as 12% can be misfiled. If a card can’t be found it’s gone.
- Duplicate documentation. Even if a card is found, it isn’t as good as the blood bank log itself. There’s a chance that a serological interpretation can be transcribed incorrectly. Mistakes happen rarely in this area, but it only has to happen once.
- Missing information. If a card is found and contains accurate information, it won’t matter if the patient has history elsewhere. A visitor may have received product at another facility, for example.
It’s a myth that we only need to work harder, pay more attention, and double check ourselves to prevent mistakes. The best techs will write down A when they are thinking O, file a card under the first name instead of the last name, and not know that the patient had a recent transfusion at another hospital. Random errors are unpredictable.
What we need is a better blood bank history. What does your lab do?
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