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Implementation of a two-specimen requirement for verification of ABO/Rh for blood transfusion

Authors

  • Lawrence T. Goodnough,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Maurene Viele,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Magali J. Fontaine,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Christine Jurado,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Nancy Stone,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Peter Quach,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Lee Chua,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Mei-Ling Chin,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Robert Scott,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Irina Tokareva,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Kevin Tabb,

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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  • Paul J. Sharek

    1. From the Departments of Pathology, Medicine, and Pediatrics, Stanford University School of Medicine; Stanford Hospital and Clinics; and the Department of Quality Management, Lucile Packard Children's Hospital at Stanford University, Stanford, California.
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Lawrence Tim Goodnough, MD, Department of Pathology, Box 5626, Stanford University Medical Center, 300 Pasteur Drive, Room H1402, M/C 5626, Stanford, CA 94305-5626; e-mail: ltgoodno@stanford.edu.

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.

MATERIALS AND 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.

CONCLUSION: 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.

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