Blood Forgotten in Coolers After Case Completion

[NurseBots]

I have been a nurse for five year on the General Team. One thing I have learned is that mistakes will happen.  When they do, you won’t make them again personally! (Hopefully they are not ones that cause patient harm or death, but in my experience, I haven’t seen it where I work). Many issues that I have seen, are usually a result of rushing, bending policies, not using closed-loop communication, having a shaky routine, etc., but could have potentiataed patient harm if not caught. Honestly, the mistakes just make you just feel really stupid in front of your coworkers. The routine, for me, is key. BUT… Every solid routine takes time to develop. In which time, that’s where the mistakes often happen. 

Since I have worked here, every few months, various blood products get left behind in coolers under melted ice in the OR after a case is completed, which necessitates disposal. It’s always the same scenario; The coolers sit on the ground near the door and are often forgotten, because they are not at eye level. Also, they don’t get wiped out daily and have dust or swimming/melted ice bags left inside. *gross.* We have signs that we post on the door to remind the team to send back unused products, but that too, is forgotten. There are plastic slots that have multiple signs (latex allergy, contact precaution, etc) stuffed inside and don’t make it easy to find the right one.. that is, if it’s not missing. Once located, the person has to stuff it back in the clear slot, often causing it to just rip. This is just too much time wasted; Especially in trauma situations. The system doesn’t work… clearly. It is not time efficient, sanitary, checked or managed, and hasn’t changed after multiple failures and system breakdowns. 

So… My question is, how does your OR team transport, handle, and remember to send back unused blood after a case is done? 

Thank you for your suggestions and knowledge! Keep yah chin up! It’s hard out there! #support

-NurseBots

[RickyRescueRN, BSN, RN]

Where I work, you need to check in blood to the room on Epic and then as part of your Debrief as surgery ends you need to document what happens with the unused blood products. Typically just before the case ends , we will ask the anesthesia providers whether they still need blood , particularly if none of it has been used. If they say no, I send it back to the blood bank immediately and call them once it gets sent in the tube system to make sure they know its on the way. There are serious repercussions to the RN who leaves the blood in the room as that is someones tissue donation (its like leaving an organ in a room) so I think we all appreciate that donors sacrifice and make it our duty to protect and conserve this scarce resource . Our blood bank sends us blood via the tube system and calls the room when it is on its way to us so that we can have a blood cooler ready and waiting and then can be at the tube station when it arrives. We check it in on Epic and let the anesthesia provider know it is  in the room. If we are going to use. it, we check it with the anesthesia provider and sign the form. When the case is over/ at the end we send it back and document this on Epic as well.  Its all about personal accountability .

[NurseBots]

9 hours ago, RickyRescueRN said:

Where I work, you need to check in blood to the room on Epic and then as part of your Debrief as surgery ends you need to document what happens with the unused blood products. Typically just before the case ends , we will ask the anesthesia providers whether they still need blood , particularly if none of it has been used. If they say no, I send it back to the blood bank immediately and call them once it gets sent in the tube system to make sure they know its on the way. There are serious repercussions to the RN who leaves the blood in the room as that is someones tissue donation (its like leaving an organ in a room) so I think we all appreciate that donors sacrifice and make it our duty to protect and conserve this scarce resource . Our blood bank sends us blood via the tube system and calls the room when it is on its way to us so that we can have a blood cooler ready and waiting and then can be at the tube station when it arrives. We check it in on Epic and let the anesthesia provider know it is  in the room. If we are going to use. it, we check it with the anesthesia provider and sign the form. When the case is over/ at the end we send it back and document this on Epic as well.  Its all about personal accountability .

Thank you for the suggestion! I like that idea. I think that I will also suggest that we could punch a hole in the corners of the signs, so that they stay together and don’t get taken. That way, someone can just flip to the one that applies. 

[Rose_Queen, BSN, MSN, RN]

We don't use coolers. We have refrigerators for each group of 8 ORs, and there's a mini refrigerator in the cardiac OR. Temperatures are monitored remotely. Staff are supposed to make sure products go back as soon as the case is over, but if there is a delay at least the blood products being out of temperature range isn't a concern.

[amoLucia]

RickyRescue - TY for your comment re blood comparing it to an organ donation.

I'm ready to cry as I read OP's post re wasted blood. I  responded to another post re my emergent need of 2 units PRBCs just 2 yrs ago. Am still borderline anemic - just don't regenerate blood quickly.

To waste blood is abhorrent. I DO understand forgetting, but a better system is needed. 

[OR_RN]

We have our service coordinator pick up a blood slip with the patient info from the circulating RN in the room and our request form completed with the number of units of blood we want in the room. We can order several units and only request 2 RBCs to be brought down, but have other units prepared in blood bank for our patient in the event of an emergency.

The service coordinator goes to the blood bank and picks up our coolers and brings them back to the OR for us. We had a few instances of wasted blood, so now we have timers on the coolers that go off 1 hour before they are to expire. The blood bank also keeps track of the coolers, so if the timer is running out of time, they will contact us. We always share the cooler information on a white board with expiration times and EBL, given units, what is left in the coolers, and what is available in the blood bank. We also discuss blood available and in the room in our intra op handoffs, timeouts, and debriefs with all members of the team (surgeon, anesthesia, etc.). 

The circulating RN and the service coordinator communicate about when the blood is no longer needed in the room and they return it to the blood bank. Our service coordinators have made this a top priority to bring back any unused blood as soon as the case is finished or when the RN asks them too. It's a team effort!

[NedRN]

On 4/8/2022 at 5:06 AM, Rose_Queen said:

We have refrigerators for each group of 8 ORs, and there's a mini refrigerator in the cardiac OR.

We had a similar system in my hospital and at least twice, the wrong blood was infused into patients in the 3 years I was there. No harm believe it or not to the patients and I wasn't involved but it was mind blowing (for both reasons).