Update for nurses and phlebotomists taking blood samples for Transfusion in General Practice The Hospital Transfusion Team rde-tr.HTT@nhs.net.

Welcome to Blood Transfusion training The aim of this training is to support you to take blood for transfusion in a safe and correct way There is a national mandatory requirement for all involved in the process of blood transfusion to have regular 3 yearly training, which this training will fulfil

The Request Form Before taking a sample for transfusion make sure you have a completed request form available The clinical information regarding how many units of blood, where and when the transfusion will take place and the reason for the transfusion should be completed by a doctor A maximum of 2 units will be cross matched for each transfusion

Use patient sticker or hand write: Hospital or NHS number Surname Fore name Date of birth Requesting Doctor to print name Sample taker should print/sign name/grade and date/ time sample Doctor to complete special requirements box Doctor to complete time and place Of transfusion Doctor to complete reason for transfusion (if possible not low Hb but symptoms etc) May use PAS label on form only. Remember SBAR Most samples come in either low Hb or bleeding. Must tick yes/no in the irradiated. WE USE MONOVETTE sample tubes. 4 4

Taking the Blood Sample The most common reason for blood samples to be rejected is that there is a discrepancy between the patient identification details on the form and the sample The lab staff have a zero tolerance policy over any discrepancy, this has been shown to improve patient safety The sample label must be hand written but a sticker can be used on the form

Patient Identification Errors In the RD&E we detect about 6 samples per year where the blood in the sample is not the blood of the patient whose details are on the sample label. There are 2 main reasons for this: Failure to identify the patient correctly, so blood is taken from the wrong patient but labelled with correct patient details Failure to label the sample at the bedside so right patient bled, but sample then labelled with wrong patient’s details.

Taking the blood…… Ask the patient for their name and date of birth, let them tell you. Always write details on the tube straight away and AT the bedside Only take blood and label samples for one patient at a time

Patient Identification details 4 forms of ID are needed: Forename Surname Date of Birth Hospital or NHS number If you use a sticker on the request form you can decide on whether you use the NHS number or the RD&E number on the sample bottle label as both numbers are on the sticker. If you hand write the request form using only one of the numbers, you must use the same number on the sample Patient address is not required

Taking the sample.. How many do you need to take? We need confirmation of a patient’s ABO group from 2 separate samples before cross matching blood, to reduce the risk from mislabelled samples Over 90% of patients already have a group recorded on our computer system and so just 1 sample is needed If you are unsure of how many samples to take please ring the Transfusion Laboratory If taking 2 samples they should be taken from 2 venepunctures with 2 SEPARATE attempts at patient identity, please use 2 forms with time difference on samples

Taking the sample.. How far in advance of the transfusion can it be taken? The standard sample validity time is 72 hours between sampling and transfusion If no pregnancy or transfusion within previous 3 months then the sample validity time extends to 7 days In transfusion dependent haematology patients it may be possible to waive the 72 hr rule after discussion with their consultant

Time to blood transfusion from taking blood sample……. Day 1: Blood sample taken in Community, arriving in lab on transport at 3pm when the blood sample will be cross matched but not in time for community transport that leaves RD&E at 4pm each day Day 2: Blood transported to Community Hospital, leaving RD&E at 4 pm Day 3: Blood Transfusion

Key Points….. Identify patients correctly and label the specimen immediately by hand at the patient/ bedside Ensure the patient ID details are identical on the request form and the sample bottles, if not they will be rejected The sample generally lasts 72 hours from being taken to transfusion being completed, check the time for transfusion on the form The lab need 48 hrs from the sample being taken to the time of transfusion

The Hospital Transfusion Team rde-tr.HTT@nhs.net. Thank You! The Hospital Transfusion Team rde-tr.HTT@nhs.net.