1. Blood Components Independent Double Checks Chris Downey RN CPN(C) MSc RNFA

2. Blood Components Independent Double Checks  What are classed as blood components? Autologous whole blood (lifespan of 35 days) Red blood cells (RBCs or packed cells) Frozen plasma (FFPs) Cryoprecipitate (Factor VIII) Platelets

3. Blood Components Independent Double Checks  Blood products are never stored in a regular fridge Brought into the room in a cooler with cool paks Bacterial proliferation &/or loss of function in blood components  2 blood fridges in the OR, one in Connell anesthesia room and one in Kidd core Where there is a definite need, Type and Cross Where there is a potential need, Type and Hold (KGH Blood Schedule)

4. Blood Components Independent Double Checks  Why Independent Double Checks? Literature on blood administration states:  Errors of commission 1 in 1000  Errors of ommission 1 in 100  Errors in high stress environments with rapidly occuring events 1 in 4 Serious Hazards of Transfusion reports (SHOT) demonstrate cases of incorrect transfusion often result from a sequence of errors involving failure to detect the incorrect identity of the patient &/or the blood component.

5. Blood Components Independent Double Checks  Policies controlling Blood Administration (Adult & Peds, not Neonates) Intranet > KGH Community > Admin Policy Manual  06-040 Consent for Blood Administration  13-010 Patient Identification  20-020 Administration of Blood Products  20-025 Administration of Plasma Derivatives

6. Blood Components Independent Double Checks  According to Policy Prior to infusing RBC’s 2 practitioners (RN, RT, Docs, Perfusionists) will perform independent double checks - Exception: In an emergency situation where the practitioner is of the opinion that the time to do a double check would put the patient at risk of serious harm.

7. Blood Components Independent Double Checks  Documentation All blood products have a removable label that may be attached to the “Blood Components/Products Transfusion Record” (pink sheet-SAP # 278 ) In the OR, when blood has been checked, Nurses will put initials on the removal label Do not put initials on the bag or the CBS label (bag cannot be reused by blood services)

8. Blood Components Independent Double Checks B79269

9. Blood Components Independent Double Checks Blood band # Patient Name Blood Unit #Compatibility

10. Blood Components Independent Double Checks Blood band #Patient Name B79269

11. Blood Components Independent Double Checks B79269 Blood Unit # Blood band # Compatibility ABO Rh

12. Blood Components Independent Double Checks If any part of the check is not correct: DO NOT TRANSFUSE Determine if the case should proceed if the appropriate amount of blood is not available; Identify to team members that there is a discrepancy, repeat the check; and If discrepancy still exists give unit(s) to the Perioperative RN and call Blood Bank (4188) stating the discrepancy. (…You may want to ask Blood Bank if they require more serum or are they able to retype and cross with what they have)