Issue of Blood Components and Products to Patient Care Units

Prior to requesting the transport of blood products, the person administering the product should ensure:

The patient has an IV line established with saline and
The physician orders for transfusion have been documented and
The patient’s consent has been obtained
The patient is wearing the RTSIS band

Transfusion Medicine does not transport blood products to patient care units. The Distribution Services department provides portering services. Products may also be issued to and transported by PCU staff and volunteer personnel.

The following information will be provided to the hospital staff portering the blood product:

Patient name (last and first name)
Patient MRN
Location to where the product is to be taken
Product required
Volume of product required (number of units)

It is of critical importance that the proper steps be followed when issuing blood components and products. It is the responsibility of both the Transfusion Medicine staff and the hospital staff portering the blood that the proper patient identification be presented and checked to ensure that the requested blood product is issued to the proper recipient.

The designated hospital personnel arrives at the Transfusion Medicine department with one of the following patient identifications:

The patients hospital card or
A copy of the addressograph card or
A computer printout of the patient demographics or
A portering pager system message. PLC and RGH Transfusion Medicine receives a telephone call to provide patient’s information prior to the porter arriving to pick up the blood product.

The person portering the product ensures they are receiving blood products for the assigned patient by reciting back information on the blood product transfusion tag to Transfusion Medicine staff.
The Transfusion Medicine staff will collaborate the information recited from the tag to that contained on the patient notification and in the laboratory computer system. If the patient demographics and the transfusion tag information are identical, the technologist will dispense the appropriate blood product. Discrepancies shall be resolved before products are issued.
To issue the blood product, the technologist must enter the patient care unit, identification of the person portering the product, patient identification, and product identification into the laboratory computer system.
Products will be issued with a transfusion tag securely attached, indicating the identity of the product the patient for whom they are intended. The transfusion tag will include:

· Patient’s last name, first name
· Patient’s health record number (medical record number or PHN)
· Product type
· Product unique unit number, pooled unit number or lot number
· ABO and Rh of the patient for blood components
· ABO and Rh of the product for components containing red cells, plasma, and for platelet products
· Interpretation of compatibility tests for red cell components
· RTSIS number for red cell components

Information on transfusion tags may differ as follows:

Condition

Difference

Emergency units issued before the patient’s identification is known

Patient’s name will be the trauma patient name as defined by site ER procedures.

No RTSIS

Manufactured Products issued to stock locations

No tag
Patients with antibodies/ special requirements Specific antibodies will be listed, e.g. Fy^a, K CMV, IRR

Pooled products Number of units (or grams for IVIG) in the pool, unite expiry date and time

Crossmatched products Cancellation date (hand written)

The Transfusion Medicine staff will perform a visual check of the blood unit to ensure there is nothing unusual about its appearance.

Special Notes

1. One unit of red cells is issued at a time with exceptions for:

Patient care units or locations that have a controlled blood product storage refrigerators.
For transfusion to patients with multiple IV sites established for transfusion
Extreme emergency when multiple units may be transfused simultaneously, such as in the emergency department, intensive care units and surgical suites. (In this case the Transfusion Medicine staff will pack the blood in a CLS blood box.)
Products that do not require refrigeration
Plasma protein (fractionation) products to be transfused as a single dose
2 units may be issued to FMC renal dialysis patients for rapid transfusion (30 minutes per unit).

Blood must NOT be stored in Nursing unit refrigerators except those intended and controlled for this purpose.

2. Transfusions should begin within 30 minutes of the blood product being issued. If not, the blood product is to be returned to the Transfusion Medicine department. Exception: Those patient care units with a controlled blood product storage refrigerator may hold blood longer.

3. Platelets are stored at room temperature and MUST NOT be placed in any refrigerator.

4. Products that have reached their expiry date and/or time will not be issued. Short dated products (such as platelets) may be issued past their expiration time provided the physician has been notified that the product is expired and has agreed to the issue of the product. This notification and agreement shall be documented.

5. Products received from the supplier before the completion of donor testing may be issued with the knowledge and approval of the ordering physician. This shall be documented.

Following completion of testing, any abnormal testing results shall be reported to the attending physician or designate. This shall be documented.

Issuing Autologous and Directed Units

Autologous and directed units shall be issued before issuing other homologous units matched for the patient. A reasonable attempt will be made to ensure that autologous and directed units that have been issued to the OR have been transfused prior to issuing other homologous units.

Autologous units may be issued after the specimen outdate as long as the patient is still wearing the appropriate RTSIS band. If the RTSIS band has been removed, the pretransfusion testing must be repeated prior to issuing the autologous units.

Blood Storage Refrigerators in Patient Care Units

Patient Care Units in possession of refrigerators designed and operated for the purpose of blood product storage are responsible for the operation, maintenance and repair of the refrigerator.
Transfusion Medicine staff will check the operation of the refrigerator alarms, and back-up battery semi-annually.
Blood products will only be issued for storage in these refrigerators when Transfusion Medicine is satisfied that the temperature alarms and monitoring systems are operating correctly and that the refrigerator temperature is being maintained according to standards.
Temperature for blood product storage refrigerators must be maintained as directed on the "Satellite Blood Storage Refrigerator Use and Maintenance" instructions posted on the refrigerator. The refrigerator must be equipped with an audible alarm that will alert staff when the refrigerator has exceeded these limits.
When the alarm sounds, follow the directions on the “Satellite Blood Storage Refrigerator Malfunctions” instructions posted on the refrigerator. Once the alarm situation has been rectified, notify Transfusion Medicine.
Blood products will be issued for patients as close to the time of intended transfusion as possible. Patient Care Unit processes must provide for the timely return of untransfused units to Transfusion Medicine.
In ER at FMC, Transfusion Medicine staff maintains an inventory of red cells for emergency transfusion. It is the responsibility of the ER staff to ensure that the documentation indicating the identification of the patient is completed when the units are transfused.
Food or other items not intended for patient care are not to be stored in these refrigerators.

Fridge Locations

Site Location Comments
FMC OR 1
FMC 7^th Floor PARR
FMC OR 9
FMC PCU 94
FMC PCU 57A
FMC PCU 151-TBCC Out Patient Clinic
FMC ER Unmatched O Negative units only

GWHC PARR
HRC OR
PLC OR
PLC PCU 18-Specialty Clinic Units must be returned at the end of the day

RGH Day Medicine Units must be returned by the end of the day

ACH OR