Error Management in Blood Collection Dr. Ravneet Kaur Professor & Head Department of Transfusion Medicine GMCH, Chandigarh

Regulated and technically specific blood collection process is vital Provide safe blood Preparation of high quality blood component

Multi-tier process Donor Education/ Pre donation counseling Detail history of prospective donor Physical examination Phlebotomy Post donation care and counseling Error …… Harmful to donor as well as recipient

Errors…….

Error – Donor counseling/ Physical examination Ne photograph Error – Donor counseling/ Physical examination

Error – Preparation of blood bag ( wrong expiry date) New photograph Error – Preparation of blood bag ( wrong expiry date)

Registration no. 110670 Blood bag marked O positive Blood bag group A positive Blood bag marked A positive Blood bag group O positive Error – Improper identification of pilot tubes

Blood bag & pilot tube prepared Donor registration no.111427 Blood bag & pilot tube prepared Donor deferred - Poor vein Next day – First donor – same registration no. Pilot tubes missing from Donor complex Pilot tubes with blood sample traced in laboratory area Error – Wrong identification of Pilot Tubes

Error – Over collection / Under collection

Error – Inadequate mixing / Inadequate flow Clot Error – Inadequate mixing / Inadequate flow

Error – Improper sealing of tubal segment after blood collection

Errors in blood collection Technical errors Improper preparation of venipuncture site Faulty technique Inadequate mixing of blood with anticoagulant/ volume collected Sampling error Sample collected in wrong pilot tube Non collection of blood sample Improper sealing Inappropriate discarding of needle Clerical errors Improper donor identification Improper preparation of blood bag Wrong identification number on the blood bag Wrong collection/expiry date on the blood bag Mislabeling of pilot tubes

Error Management Error prevention Error analysis

Error Prevention Appropriate Standard Operating Procedure Training of staff & continuous motivation/education Validated and functioning equipment

Standard Operating Procedure - Donor blood collection

Pre donation information /Counseling Conducted By trained staff with counseling skill In a separate room Should include Information regarding eligibility criteria, blood donation process, TTI and various test performed Pre donation risk assessment for TTI Informed written consent

Physical examination Donor should be in good health Detailed history…….High risk behavior Meet the standard criteria for donor selection Donor weight, blood pressure, hemoglobin

Donor identification Critical to the safety of both donor and recipient Numeric or alphanumeric system to identify the donor Segment no. of the blood bag Photograph of segment no and registration sticker to be added

Preparation of blood bag Correct identification number Blood bag Satellite bag Donor record (registration card) Pilot tubes Appropriate date of collection and expiry New photograph to be added

Phlebotomy Carry out hand cleaning before and after each procedure Should wear well fitting gloves

Preparation of venipuncture site Inspection of both anticubital fossae Skin preparation by aseptic technique 70% isopropyl alcohol & tincture of iodine Concentric spiral manner (centre to periphery) Area – 3 inches ; contact time – 30 seconds NO TOUCH - Venipuncture technique Prepared site must not be touched again. Do not repalpate the vein at the intended venipuncture site

Single clean venipuncture Performed by trained phlebotomist Phlebotomy Single clean venipuncture Adequate flow Performed by trained phlebotomist

Phlebotomy Ensure proper mixing with anticoagulant Collect adequate volume

Desired volume X Sp.gravity + Weight of empty bag with anticoagulant Weight of blood bag Desired volume X Sp.gravity + Weight of empty bag with anticoagulant = 350 x 1.053 + 80 = 448gms ± 10%

350 ml Blood Bag 450 ml Blood bag Normal 315-385 ml / 412-485 gm 405-495 ml / 520-614 gm Low volume PRBC 233-314 ml / 325-410 gm 300-404 ml / 409-518 gm Under collection < 233 ml / 325 gm < 300 ml / 409 gm Over collection > 385ml / 485 gm > 495 ml / 614 gm Blood bag should be appropriately labeled – Low volume, Under collection, over collection

Never leave the donor alone Sample collection at bedside New photograph to be added Never leave the donor alone Re check the registration no. Sample collection at bedside

Appropriate discarding of needle Phlebotomy Proper sealing Appropriate discarding of needle

Proper storage Adequate temperature Up right position

Post donation care Guide donor to refreshment room Give post donation instructions Provide contact information of the transfusion centre

Training Must to ensure that all staff members are undertaking critical processes are competent to perform task Should include Induction training for new staff Refresher training Intimation of any change Training program Principles, procedures – SOP Principles of good manufacturing practice Safety requirement for staff Training programme should be conducted for new staff and refresher training especially for the tasks that may not be performed on a regular process. When ever any change is made in any of the procedure it should be intimated to all . The training programme should be based on Standard operating procedure and should through light on principles of good manufacturing practice so that staff understands the potential consequences of not following SOP. Stress should also be laid the safety requirement to be followed by the staff members.

Equipment Periodic maintenance and calibration should be carried and documented according to established procedures

Blood collection in blood donation camps

Camp site Organized in a way Ensures safety of blood donors, staff & donated units Avoids errors in blood collection

Camp site Waiting area Screening / Physical examination area Phlebotomy area Refreshment area Close watch on the donors

Transport of blood Maintain temperature not more than 10°C during storage and transport Secure the lid tight shut Not to exceed the capacity of boxes

Automation in blood collection Unique set of bar coded identification number for identifying blood bags, samples and records Helps to avoid manual/clerical errors

Medical event reporting system for Transfusion Medicine Capture threats, hazards, near misses, injuries, and deaths systematically Can identify error where action is required Raises staff awareness about error management Blood centers can benefit from identifying and tracking their events and errors and near misses. It helps to identify system attributes and factors that may per dispose to error. One such reporting system that can be used is MERS- TM ;Can identify error where action is required

Root Cause Analysis of Error

Documentation Record information Pertaining to donor Adverse donor reaction Any deviation from Standard Operating Procedure Errors reported and corrective action taken

Conclusion Strictly adhere to Standard Operating Procedures Errors should be analyzed and documented Helps to identify areas where resources need to be targeted Improves over all safety of transfusion

Thank you