Re: Pre hospital blood draws and T&C/ Recall on blood tubes.

[Guest guest]

,

Please take this in the spirit of a lively debate and not a " pissing contest. "

In regards to the " arm-banding turf " and the comments regarding helping the patient first. The patient arm-banding ritual has come into being to actually help and protect the patient. Blood products are foreign substances which have the potential to kill, cripple, or seriously compromise the current and future health of the patient. It is mandated by the FDA and other governmental agencies that some form of consistent documentable procedure is followed in an institution for the administration of blood and blood products. The hospital can be fined, sued, decertified, and in worst case scenarios, the lab shut down for not following accepted guidelines. This is why some hospital labs even refuse E.D. nursing-staff drawn blood for T & C. To circumvent this, the following scenario and procedure has been developed. The lab is notified in advance of a potential blood product recipient-the pre-hospital report from the paramedics, and a lab tech is in the room waiting for the patient. Usually a nurse will start the 2nd, 3rd, or 4th IV and draw more lab specimens and give the blood to the tech who is observing and labeling the blood specimens. The lab will then do their thing with the blood. To get the blood products, the nursing staff nurse has to go to the lab, properly identify the patient and the request, the lab tech and the nursing staff member check the bag number, blood type, expiration date and then they both sign off. The blood administration nurse then checks the patient's identification at bedside with another nurse and they review the same information again and sign off. The blood is then given. In emergent situations the lab tech will bring the blood to the bedside and the nurses will sign off on it then or later-when the smoke clears. This is not as cumbersome as it sounds and it offers the maximal protection for the patient-which is what we are about-aren't we?

The administration of blood products in most circumstances also requires a permit for the administration of the products. Even in major trauma cases, usually someone from the family is asked to sign a blood permit. Obviously, this may occur after the fact and puts the hospital and the staff at risk in certain circumstances.

I for one prefer not to do the patient any harm, which is what can very likely happen if correct patient identification procedures are not carried out. Also, are you prepared to take the responsibility of a blood transfusion reaction because the wrong blood was given to the wrong patient. Who ever identifies the patient can be responsible for some of the damages. Who is best served-the patient who may be on dialysis for the rest of his life because he was mis-identified, or the paramedic who may have his feelings hurt because his blood specimen wasn't utilized? If the condition of the patient is that critical, uncross-matched or type specific blood can be given. Type specific blood can be made available in 10 minutes. If uncross-matched blood is given, the brunt of responsibility is on the physician, the lab, and the hospital. A quick lab draw in the ED takes about 30 seconds, so the expediency of pre-hospital drawn blood and saving the patient a single stick is basically a moot point. Besides, one more or less needlestick on a major trauma patient is essentially minor in comparison to what else the poor victim is going to receive.

The ambulance crew may be transporting only one critically injured patient to the E.D. That does not mean there are no other critically injured patients at that same E.D. I have worked in situations where we have had a couple of shootings, an MVA with 2 critically injured, and a patient with AMI who is receiving tPA all at the same time. All five patients were potential blood recipients. At this point, patient identification is of paramount importance.

In case you are wondering about my experience level, I am a charter member of the National Registry of Emergency Medical Technicians, have 7 years experience in the field as a paramedic, and have been an E.R. Nurse and ICU/SICU/NICU nurse for 20 years. I have been the Major Trauma Preceptor responsible for the training and education of all nursing staff members in major trauma for 9 years for a Level II E.D. which averages 100-125 patients per day-some of which actually need to be there.

That was my volley, -your turn.

Sincerely

Easley

President

UHCS, Inc.

[Guest guest]

,

Thank you for replying to my post regarding the pre-hospital blood draws.

I Never intended to make this a contest, but rather an inquiry on the way

you seemed to present your case regarding the T & C. The fact is that I

am not fully aware of the all the potential legal implications that

accompany T & C. I appreciate your insight to the subject; however, it

just seemed to me that you were saying that Paramedics are not capable of

doing a blood draw for the " sacred " infusion. I really don't think any

Paramedics are getting their feelings hurt, so I didn't see your point

with that statement. No one was attacking your post about with hurt

feelings for not having their blood used, or anything so what's up with

the remarks? As far as your experience, BRAVO!!! I guess we can all

sleep better knowing you have 7 years experience. I have 8 in EMS and 4

in Respiratory, so that should make everyone feel that much better too.

Look the point is, I didn't want to start a pissing contest, I just

wanted a little more explanation, which you provided, Thank you very

much, so lets move on.

,NREMT-P

On Sat, 24 Oct 1998 11:31:06 -0500 " Easley "

writes:

>,

>

>Please take this in the spirit of a lively debate and not a " pissing

>contest. "

>

>In regards to the " arm-banding turf " and the comments regarding

>helping thepatient first. The patient arm-banding ritual has come

>into being to actually help and protect the patient. Blood products

>are foreign substanceswhich have the potential to kill, cripple, or

>seriously compromise the current and future health of the patient. It

>is mandated by the FDA and othergovernmental agencies that some form

>of consistent documentable procedure is followed in an institution for

>the administration of blood and blood products. The hospital can be

>fined, sued, decertified, and in worst case scenarios, the lab shut

>down for not following accepted guidelines. This is why some hospital

>labs even refuse E.D. nursing-staff drawn blood for T & C. To

>circumvent this, the following scenario and procedure has been

>developed. The lab is notified in advance of a potential blood

>product recipient-the pre-hospital report from the paramedics, and a

>lab tech is in the room waiting for the patient. Usually a nurse will

>start the 2nd, 3rd, or 4th IV and draw more lab specimens and give the

>blood to the tech who is observing and labeling the blood specimens.

>The lab will then do their thing withthe blood. To get the blood

>products, the nursing staff nurse has to go to the lab, properly

>identify the patient and the request, the lab tech and the nursing

>staff member check the bag number, blood type, expiration date and

>then they both sign off. The blood administration nurse then checks

>the patient's identification at bedside with another nurse and they

>review the same information again and sign off. The blood is then

>given. In emergent situations the lab tech will bring the blood to

>the bedside and the nurses will sign off on it then or later-when the

>smoke clears. This is not ascumbersome as it sounds and it offers the

>maximal protection for the patient-which is what we are about-aren't

>we?

>

>The administration of blood products in most circumstances also

>requires a permit for the administration of the products. Even in

>major trauma cases,usually someone from the family is asked to sign a

>blood permit. Obviously, this may occur after the fact and puts the

>hospital and the staff at risk in certain circumstances.

>

> I for one prefer not to do the patient any harm, which is what can

>very likely happen if correct patient identification procedures are

>not carried out. Also, are you prepared to take the responsibility of

>a blood transfusion reaction because the wrong blood was given to the

>wrong patient. Who ever identifies the patient can be responsible for

>some of the damages. Who is best served-the patient who may be on

>dialysis for the rest of his life because he was mis-identified, or

>the paramedic who may have his feelings hurt because his blood

>specimen wasn't utilized? If the condition of the patient is that

>critical, uncross-matched or type specific blood can be given.Type

>specific blood can be made available in 10 minutes. If

>uncross-matched blood is given, the brunt of responsibility is on the

>physician, the lab, and the hospital. A quick lab draw in the ED

>takes about 30 seconds, sothe expediency of pre-hospital drawn blood

>and saving the patient a singlestick is basically a moot point.

>Besides, one more or less needlestick ona major trauma patient is

>essentially minor in comparison to what else thepoor victim is going

>to receive.

>

>The ambulance crew may be transporting only one critically injured

>patient to the E.D. That does not mean there are no other critically

>injured patients at that same E.D. I have worked in situations where

>we have had a couple of shootings, an MVA with 2 critically injured,

>and a patient with AMI who is receiving tPA all at the same time.

>All five patients were potential blood recipients. At this point,

>patient identification is of paramount importance.

>

>In case you are wondering about my experience level, I am a charter

>member of the National Registry of Emergency Medical Technicians, have

>7 years experience in the field as a paramedic, and have been an E.R.

>Nurse and ICU/SICU/NICU nurse for 20 years. I have been the Major

>Trauma Preceptor responsible for the training and education of all

>nursing staff members in major trauma for 9 years for a Level II E.D.

>which averages 100-125 patients per day-some of which actually need to

>be there.

>

>That was my volley, -your turn.

>

>Sincerely

>

> Easley

>President UHCS, Inc.

>

>------------------------------------------------------------------------

ZZZXXXZZZ

>

[Guest guest]

,

No offense taken. Sorry about the comment regarding " paramedics getting

their feelings hurt. " The first beer (out of uniform) is on me---

Easley

------------------------------------------------------------------------