The Australian and New Zealand Society of Blood Transfusion (ANZSBT) Guidelines For Pretransfusion Laboratory Practice (2007) identifies that "... this aspect of transfusion practice is crucial to patient safety. Failure to correctly identify the patient at sample collection, prescribing the wrong product or transfusion of the wrong patient all remain significant causes of patient morbidity and mortality.
Reports from the the United Kingdom's Serious Hazard of Transfusion (SHOT) programme clearly show that incorrect patient identification or mislabelling of samples continue to be major causes of inappropriate transfusion or transfusion reactions.
ANZSBT provides very clear directions on sample and patient identification. Following is a synopsis of their guidelines. The full version is available on the ANZSBT website.
Requests For Blood Transfusion
Completing the blood request form accurately and legibly is an important step in ensuring that the right quantity and type of blood product is made available for the right patient at the right time in the right place. ABO incompatible transfusions are usually due to identification errors.
The following guidelines are recommended:
- Hospitals must have a written policy for blood transfusion requests, which includes who can prescribe blood
- The request form should contain the following information:
- A declaration regarding checking the identity of the patient
- Full patient name
- Unique patient identification number and/or date of birth
- Location of the patient
- Number and type of blood components and blood products requested
- Date and time required, including degree of urgency
- Relevant past obstetric and transfusion history
- Patient's diagnosis
- Indication for transfusion
- Identity and signature of the sample collector
- Hospitals must have a policy for the requesting of special blood requirements, such as CMV seronegative, leucodepleted, irradiated etc.
Patient Identification
Correctly identifying the patient, both during collection of the pretransfusion sample and before starting the transfusion, is vital in avoiding 'wrong blood' episodes.
The following practices are recommended:
- Hospitals must have a written policy on the requirements for patient identification
- All patients must have a patient identification number and wear an identification wrist band including this number.
- Patient identity shall be confirmed by asking the patient (if conscious and rational) to state their surname, given name(s) and date of birth and by checking that the identity label is securely fastened to the patient.
- Where the patient's identity is not known or cannot be accurately confirmed, an alternative reliable method of identification should be substituted and reliably linked to the patient's name once this becomes available.
- Notice of the updated identification must be provided to the transfusion laboratory and other relevant departments as soon as possible.
Collection of Blood Samples for Pretransfusion Compatability Testing
Pretransfusion samples correctly obtained from the right patient are extremely important. Requests may be for a ‘group and hold' ‘type and screen' or ‘crossmatch'. The sample type (clotted or EDTA) will be determined by the provider of your transfusion laboratory services.
It is vital that when the sample is taken that the patient is correctly identified. Giving the incorrect blood to a recipient can cause serious morbidity even death.
The collection of blood samples for pretransfusion compatibility testing must be in accordance with local standard operating procedures(1).
The following practices are recommended:
- Hospitals must have a policy on pretransfusion sample collection which includes who can collect samples for pretransfusion testing.
- Only one patient should be bled at a time to minimise the risk of error.
- The sample must be labelled immediately after the blood has been added, before leaving the patient.
- Sample tubes must not be pre labelled.
- The sample tubes must be labelled with the following:
- patient's surname, given name in full
- unique patient identification number and/or date of birth
- date and time of collection
- signature or initials of the collector.
- It is strongly recommended that addressograph labels should not be used, but if used they must comply with all the requirements of the above point.
- The collector must verify patient identification by signing both the request form and the sample label to this effect.
- The hospital blood bank must have policies for dealing with inadequately completed request forms, inadequately labelled samples and discrepancies between the information provided on the request form and sample.
- The hospital blood bank must verify the patient's ABO and Rh(D) group (and antibody screen if available) against previous records for the patient, and any discrepancies should be resolved before blood components are issued.
- The hospital blood bank must have a policy for documenting telephone requests.
- If the request form or blood sample identification is incomplete or incorrect, the request for blood grouping or crossmatching should be refused
References
(1) ANZSBT Guidelines for pretransfusion laboratory practice (2007), Sydney: Australian and New Zealand Society of Blood Transfusion Inc, 2007.