IBTS new system for dornating blood. UNBELIEVABLY DANGEROUS!!!

haemfire

I have been dornating blood for about three years now, since I became old enough. I also have experience with the IBTS via the course of study I am doing, and I have done a week on work placement/talks on procedures used in the IBTS building on the grounds of st. james hospital last year.

Last year for one week I listened to the teachnology of the NAT(Nucleic acid amplification) lab, reduction of window periods, validation of new virology systems, transfusion error cases, leukocyte reduction systems, import of clotting factor proteins from the US( products cannot be made from irish blood because of the potential risk of vCJD:eek:) and the list go on. To quote from Peter O' Donnell the training Chief Medical Scientist ' if we can take a step to reduce risk, however slight that risk is we take it'

As anyone with laboratory/ward experience of blood transfusion will tell you the potential of a error occuring, is mainly due to clerical errors, its doesnt matter how big and fancy your BTS lab is, if the doc in A&E, mislabels the tube a person will die, not being a scaremonger thats just a fact. BTS laboratories cannot function if their are not fully accredited to several standards, unlike getting a FBC/smac a blood sample for transfusion has to be labelled manually by the requesting doc and 3 unique identifiers have to be present on the tube and requesting form. I know of a case where a sample was refused because the fodda for i on 'sinead' wasn't present the requesting form, yet present on the blood sample. Any major hospital will usually have two haemoviligance officer, these are auditors basically who follow the papertrail of BTS, a porter has approximately 15 minutes to collect a unit of red cells from the blood bank and bring it to the fridge on the patients ward, if he takes 20 minutes that 450ml unit of red cells(€230) will be disposed of.

Until recently I was quite happy to dornateblood as i felt the procedure carried out the the IBTS staff was very professional and safe, when you went to dornate blood you name would be called your file left on a dornating bed , a donar attendant would then ask you to confirm you name and DOB and the dornation would begin, one donar attendant would be present thoughout your dornation who would fill your sample tubes ect. The last time I dornated blood I was horrifies by the practice that now exist whereby blood can be dornated from either arm(previously always left) and the donar attendants now have to tend to two patients at the same time. The samples for each patient are too close to each other and the potential for errors is shocking, giving that a busy IBTS clinic can have 120+ throught in a night, the IBTS now wants to save a bit of cash on donor attendant who can be working till 12 at night. I have now personally made the decision to cease dornating blood if this current protocol is to be continued, to repeat a quote that was given a few years ago about the garda reserve 'if it wasnt so dangerous it would be funny'

ergo

haemfire wrote: »

The last time I dornated blood I was horrifies by the practice that now exist whereby blood can be dornated from either arm(previously always left) and the donar attendants now have to tend to two patients at the same time. The samples for each patient are too close to each other and the potential for errors is shocking, giving that a busy IBTS clinic can have 120+ throught in a night, the IBTS now wants to save a bit of cash on donor attendant who can be working till 12 at night. I have now personally made the decision to cease dornating blood if this current protocol is to be continued, to repeat a quote that was given a few years ago about the garda reserve 'if it wasnt so dangerous it would be funny'

I only have time for a quick reply but as someone who has taken blood hundreds of times I'd suggest using the same arm the whole time will just use up (as in cause scarring/collapse/basically make it difficult to take blood from them in future - not doing any real harm to the donor as such in the greater scheme of things) all the veins in that arm, best to alternate imho

as for your other concerns, have you addressed these to anyone at the IBTS, and did you ask the attendants there about the apparent change in their conditions?

have you seen how close to each other patients are sometimes in A+E (not saying it's right but it is a reality)?

Captain Ahab

haemfire wrote: »

I have been dornating blood for about three years now, since I became old enough. I also have experience with the IBTS via the course of study I am doing, and I have done a week on work placement/talks on procedures used in the IBTS building on the grounds of st. james hospital last year.

Sorry, but if you are studing in the area of medicine then surely you should be able to spell donating. When donating in D'olier Street they have a bar code system & always look in control of the process, even if busy.

haemfire

ergo wrote: »

I only have time for a quick reply but as someone who has taken blood hundreds of times I'd suggest using the same arm the whole time will just use up (as in cause scarring/collapse/basically make it difficult to take blood from them in future - not doing any real harm to the donor as such in the greater scheme of things) all the veins in that arm, best to alternate imho

ergo wrote: »

i agree with you about their being no probelm with switching arms, but the IBTS is now taking blood from BOTH arms so that at a donor can be at either side of an attendant have you seen how close to each other patients are sometimes in A+E (not saying it's right but it is a reality)?

oh i can totally understand a labelling error in a hospital, but this situation in a dornation setting is totally unacceptable, its a reality in A&E, but that doesnt mean it should be a reality for the IBTS

Vorsprung

haemfire wrote: »

The last time I dornated blood I was horrifies by the practice that now exist whereby blood can be dornated from either arm(previously always left)

I didn't know this was a policy, but does it actually make sense? I mean, what if you can't use your left arm? What if you've had an axillary node clearance? Or even if you have no left arm?! Lots of other more plausible reasons too.

As mentioned above, the bar code system does seem pretty thorough. DO you have any information on best practice internationally?

rainbowtrout

To be honest, you're just describing how blood has always been donated in my experience. I've donated for the past 12 years and I've had blood taken from both my arms with no adverse effects.

I've answered a million questions at each stage, and on nights where it's been busy and there is a nurse between 2 beds, the sample is attached to the tube hanging out of my arm and the nurse puts the bar code on it immediately, it would be quite hard for her to mix up my blood sample with another donor's sample when their details are on a form on their bed, not mine.

And as for nurses working until 12 at night, it's called an evening shift, they only started at 4. It's not like they've been working since 8 that morning.


This is how blood donation operates in all of the mobile clinics i've been to over the years and I've found staff to be efficient, competent and professional.

haemfire

look we're getting off-point the reason why I am horrified with taking blood from both arms is that this allows and MEANS that the IBTS now have one donar attendant taking blood and filling sample tube from two patients, if the IBTS was concerned about scars being caused to donors arms they could just switch to the left arms for say 5 years. I am new to dornating blood I dontknow if this is the case, another point to beconsidered, alot of family members ateend IBTS clinics together, what happens if John Murphy Snr(GpO RhDPos) sample gets mixed up with his son John Murphy Jnr(Gpa RhDPos)

rainbowtrout

haemfire wrote: »

I am new to dornating blood I dontknow if this is the case, another point to beconsidered, alot of family members ateend IBTS clinics together, what happens if John Murphy Snr(GpO RhDPos) sample gets mixed up with his son John Murphy Jnr(Gpa RhDPos)

isn't this why every attendant, nurse and doctor gets every donor to confirm their details at every stage? it eliminates this happening

dustbabe

I am unsure what your issue is mate!
you think that one nurse standing with each patient is still going to write the right thing on the label? the nurse checks and double checks. The haemovigilence officers follow every blood product used on a patient. I have stood in theatre and checked 100 units and more for one patient, and we have all of that blood checked twice before giving it. The procedures are in place. if we do not sign a form, they are after us the follwoing daybut let me assure you that its checked. a blood reaction will occur within a few minutes, so we know and we monitor our patients as they get the blood.
We theatre nurses do a good job, considering there is so much else going on, ie the patient needs drugs to keep them alive etc, or they crash. So you relax tehre and learn how to spell donate. you are freaking out about a minor thing, but say it, and i am sure you will be given a satisfactory answer.
Being busy is not a reason to make a mistake, being careless is.

haemfire

to quote from my training in the IBTS 'if we can take a step to reduce risk, however slight that risk is we take it' yet why are the IBTS in my opinion taking a step to increase the occurence of clerical errors, which is by far the biggest window of potential error in BTS, yet are pumping millions into virology testing' this is the first time in donating blood 9/10 times in several locations that I have seen this practice, I spoke to the donor attendants who whole heartedly agrees with me on this topic

dustbabe

Ok, john junior never gets onto a label! how many patients can have the same name? many!! ?U have never been to theatre, you get checked and double checked and checked again, by every nurse you meet, to ensure that you are the right patient for surgery, and that your consent form is right. if we pick up that there is an issue with your blood not being compatible with the donor unit, its not given.
As for the porter, thats trash, they carry the blood in cool boxes or igloos. in theatre we have blood fridges, for blood alone.
the label will be:
john smith
m.r.n: 989008
DAte of birth:
Address:
Dr
Rh group
each patient has a unique identifier number, address, dob etc and each unit can be traced back to you! so if you developed hiv and they needed to trace who got it, it can be done!

haemfire

dustbabe wrote: »

I am unsure what your issue is mate!
you think that one nurse standing with each patient is still going to write the right thing on the label?

Being busy is not a reason to make a mistake, being careless is.

not a nurse, but a donor attendant, the most diligent person will make a mistake, taking steps to increase the occurence of these mistakes is stupid

a case where 2 units of GpO RhDNeg blood is issued in an emergency sitaution without crossmatching, with segments retained to allow crossmatchong to subsequently occur, could result in a error, if the unit was mislabeled in the dornation clinic with the samples from a GpORhDNeg patient

dustbabe

ps yhou shoul not have named the trainer, thats not a good idea.
did they tell you that before blood is given it has to be crossmatched?
That means if they take a sample from the patient, they mix a drop of their blood with a drop from the donor unit, to ensure there is no reaction, if the unit was labelled incorrecly, it would show a reaction and would be discarded.

Still think you are worrying bout storm in a teacup

haemfire

well what about other platelet dornation that can be crossmatched, taking steps to increase the chance of clerical erros is a lose-lose situation for these products

Mrs OBumble

I from overseas (country of similar size to Ireland). I've been giving blood there for 20 years, did it here for the first time the other week.

Was very surprised to have a donor attendant (am pretty sure they're not registered nurses) hovering over me the whole time: even when she was doing the samples for the other person, she was anxiously looking at me every twenty seconds. TBH, I couldn't see what she was so worried about, and I can kind of see that she would have done a better job with the other person if she'd focussed on them. Not sure I'd call it "unbelievably dangerous" though. And I thought it was odd that the attendant couldn't actually insert or remove the needle herself, someone else had to do that for her.

I'm used to having someone (ie one person) insert the needle and take the samples into tubes that are labelled immediately and check that the donation has started - uninterrupted. Then they move on to do other work. Every few minutes, someone (one of the team who are managing about 20 donor chairs) casts an eye in my direction, but only comes near me if something is actually wrong. When the donation is finished, whoever is free removes the needle and ends the process (takes the donation away, directs me to go).

Perhaps fewer, better skilled and more focussed, staff would be better.

Re the arm thing: I have difficult-to-find veins. In my experience, medical people don't like me telling 'em which arm to use. So I let the nurse poke about at my left arm for a while, and come up with the idea "maybe the right arm" would be better all by herself. But I know that if she'd had to use the left, the donation probably wouldn't have happened.

littlebug

Like justMary my "good" vein is in my right arm. The last time I gave blood the attendent just asked me to turn around the other way on the bed ie head where everyone else's feet would be. That's quite a few years ago.. can't donate anymore because I lived in the UK:(

Alun

JustMary wrote: »

I from overseas (country of similar size to Ireland). I've been giving blood there for 20 years, did it here for the first time the other week.

Was very surprised to have a donor attendant (am pretty sure they're not registered nurses) hovering over me the whole time: ...

Me too. I gave blood in the Netherlands for ages too, not a country known for it's lax standards. There, you could have a room with 10 or 12 donors, with only 4 or 5 people covering the whole room, each doing multiple jobs, and certainly no-one hovering over you all the time. Needle in, check it's flowing and then off to do something else like packing bags into plastic crates, or other administrative work. When the buzzer goes, someone free comes and does the rest. They also ask which arm you want to donate from each time.

It's also a lot more efficiently run .. none of this every 3 months lark whether they need it or not. It's all done on a pull-demand system, and you're only called up when necessary. I (boring O+) could go over a year without being called up sometimes, whereas my wife (O- universal donor) would get called up much more frequently.

Alun

littlebug wrote: »

That's quite a few years ago.. can't donate anymore because I lived in the UK:(

Me neither. It's a bummer.

dustbabe

Haem fire have you not heard of the cut backs in hospitals fo the last few years. you should come and stand in theatre when you get one of the shootings or stabbings in, then you will see the story about safety.
you are working in some area with blood alone, you cannot spell donate yet despite being told a few times. Are you some one with a little knowledge that makes you dangerous?
Have you put your concerns in writing to the BTSB yet?
Just because you have someone standing over you to watch means nothing mate, you need registered professionals. patients have better outcomes when nurses look after them, its a fact, internationally proven.
The elections are coming up, ask your td why this is?

Jeapy

"UNBELIEVABLY DANGEROUS!!!"??? more like unbelievably over-exaggerated.

I'm still not sure what your big issue is OP. So you don't want an attendant to look after two donors at once?
Most blood banks check the ABO and Rh groups on each unit when they arrive in the lab, so in your example, where GpO RhD neg is issued in an emergency (and you're saying it could possibly be a name mix up, and is truely a GpA RhD neg unit), it would be picked up as wrong before it ever left the lab.

Where are you studying btw? Im guessing you're a 3rd Medical Scientist (GMIT) or 3rd Biomed (DIT)???
Anyway, isn't his surname McD, not O'D?!

Tree

seeing as donor units are typed in every hospital before they are issued, esp the o-neg emergeny units (they are typed before they get set aside for emergencies), i really dont see what the issue is.

also, using both arms is a good thing, being regulary used for a pincushion getting blood tests, i understand that somedays one are is better than the other. given a choice of both equally, i would be inclined to offer my non writing arm, but other than that, the phlebotomist/nurse/etc has all the choice they want

leeroybrown

I won't comment on the safety or otherwise of the protocol but I do think that the OP should be addressing the issue directly with the BTSB then coming here with their response rather than scare-mongering. Moaning on the internet solves very little.

eth0_

haemfire wrote: »

The last time I dornated blood I was horrifies by the practice that now exist whereby blood can be dornated from either arm(previously always left) and the donar attendants now have to tend to two patients at the same time.

You're so full of rubbish! There has never been any rule to say the IBTS should always take blood from the left arm!

What if the donor (yes it's spelled d-o-n-o-r not 'donar' - that's a kebab - but then as a biomed student you'd know that...right? :rolleyes:) can't give blood from their left arm? I personally can't even have my BP taken from my left arm.

And if someone is giving blood every 3 months it would be bad practice to take blood from the same arm each time as it runs the risk of collapsing veins.

Vorsprung

eth0_ wrote: »

You're so full of rubbish!
And if someone is giving blood every 3 months it would be bad practice to take blood from the same arm each time as it runs the risk of collapsing veins.

I should use this line at 3am when I'm struggling to get red cells out of a patient!

Me: (After attempt #4) Man, your veins are terrible.
Patient: Really? The blood bank have no problems getting blood off me.
Me: Selfless ****

Marianne S

Mad to see all the medical scientists and potential medical scientists on boards, I wonder if there's many of us! Daft post really, Surely haemfire you should be more concerned about the shortage of blood donations and realise how important it is to continue donating regularly instead of scaremongering. Hardly fair either to come on bad mouthing the IBTS procedures here, why not make an official complaint.

eth0_

Many of the blood boards in the UK (especially Scotland) have to chuck blood out before its use by date because they have so MUCH of it!

I guess the reason for this is there is so much more advertising on TV, magazines etc for blood donors, and also the fact we don't have the same ridiculous donor prohibitions on large sections of the community that you have in Ireland.

Tree

Chucking blood often involves just the rarer types, as they arent in as much demand as teh o's and a's of this world.

I thought there was equally stringent rules in the UK, i believe it can be difficult to source blood for certain groups due to the relevant migrants not being allowed to donate.