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Patient Identification and Pre-transfusion Sample Labelling - Observational Audit

May 30, 2021

Aim

To evaluate how staff in the SHED perform patient identification and pretransfusion specimen labelling, and identify areas where practice can be improved.

Process

Direct observation of patient identification and pretransfusion specimen labelling procedures was undertaken by the SHED educators using the audit tool developed by the Blood Management CNCs.

Results

21 direct observation audits were undertaken December 2020 and January 2021.

Patient Identification

  • Overall, only 15% (3/21) patients were identified in accordance with hospital policy prior to having blood drawn for pretransfusion testing.
  • 52% (11/21) patients had NO Identification checked prior to having blood drawn for pretransfusion testing.
  • 33% (7/21) patients had incomplete identification checked prior to having blood drawn for pretransfusion testing;
    • 2 patients had only their wristband ID checked. Neither was asked their FULL name and DOB. Neither had a Dorevitch Blood Product request form prior to blood being drawn.
    • 2 patients who were unable to identify themselves had their ID checked with their significant other. Neither patient had their wristband ID checked. Neither patient had a Dorevitch Blood Product request prior to blood being drawn.
    • 2 patients were asked their FULL name and DOB, had their wristband checked but did not have their ID checked against a Dorevitch Blood Product request form because one was not available
    • 1 patient did not have their wristband ID checked, all other ID checks were performed
      33% (7/21) patients had a Dorevitch Blood Product request form prior to blood being drawn for pre-transfusion testing. This means that 67% of patients had a sample drawn in advance of a medical order for pre-transfusion testing.

Sample Labelling

  • No sample was labelled before blood was drawn from the patient.
  • 90% (19/21) of samples were labelled immediately following collection.
  • 52% (11/21) samples were labelled at the patient’s bedside/chairside
  • 10 samples were labelled at the nurses desk, 1 was recorded as being labelled by a nurse who did not draw the blood

Strengths Identified
No sample tube was labelled before the blood was drawn from the patient.

Issues Identified:

  • Over half the patients who had a pre-transfusion sample drawn did not have any form of positive patient identification performed to ensure that the sample was drawn from the right patient. Although the primary focus of this audit was to evaluate how staff undertake patient identification and label pre-transfusion samples, the results may be applicable to how staff practice when drawing general pathology samples.
  • Over two thirds of the patients had a pre-transfusion sample drawn in advance of a medical order-a completed Dorevitch Blood Product Request Form.
  • Half of the pre-transfusion samples were labelled away from the patient and at the nurse’s desk.

Final Comment:

We ask staff from each ED to reflect on the results of the audit and check in with the education teams should they need support or clarification