Blood Grouping and Blood Transfusion Protocol

This was a procedural protocol and instructions, leading to blood Grouping and Blood Transfusion, I made while (to ensure Quality Control) working in a private medical institution.
I detected many systemic errors and finally recruited a medical graduate to supervise the procedure.
Most of the young guys and girls were poorly trained and ultimately computer typists were wrongly  incriminated when something goes radically wrong.
The medical  graduate was under my direct supervision, luckily for me she had worked briefly at the Colombo Blood Transfusion Center.
Happy to say, the short period of Quality Management Guidance, I did, nothing untoward happened.

Purpose
              1. Eliminate errors at all levels
              2. Streamline Procedure

Requirements and Objectives
Request Form, Report and the Computer Database should tally 100%.
Duplicate should be recorded separately for checking with the in ward entries.

01. Design customized Request Form for Blood Grouping and Blood Transfusion.

02. Only Blood Grouping and Transfusion needs should be entered in the form and nothing else.

03. It is necessary to develop a dedicated computer program for this purpose at the end of the initial observation period.

04. Any other investigation ( eg. Antenatal, VDRL, HIV status and Hb should be requested in different forms)

05. Person who does the ordering should be clearly stated.
Ideally he/she should fill and sign the request form.

06. Naming and labelling should be done by the same person.
Ideally the person who ordered the request should sample but if delegated to another person that person should cross check with the person who ordered the original request and sign appropriately.

07. At the reception and at the cashier's point, patient identification should be 100% accurate.
Full name should be entered and speckling should be correct.
For some such as medical examination and visa purposes National ID and Passport Number were required before payment and sampling.

08. When Grouping blood related donors the relationship to each other and to the patient should be clearly stated (father, mother, son, daughter etc).

09. A patient dedicated identification code should be designed and retained in the computer memory.

10. Identification details should be double checked  before payment is obtained.

11. Whether testing is routine or urgent should be clearly stated.

12. Samples properly labelled and checked should be sent to the laboratory as soon as possible.
There should not be any delay.

13.  Duplicate computer request form should be obtained as soon as possible.

14. The original and duplicate computer request form should be stapled together and not with clips or pins.

15. The seal should be eliminated.
What' the point.
Rubber stamping errors?

16. The computer request form and the original request form should have appropriate printed caging for entering results in detail

17. Testing should be done by the most experienced MLT.
If for any reason delegated to a junior MLT  he/she should be supervised appropriately by the senior MLT.

18 As far as possible individual samples should be tested.

19. The report should go as a simple dedicated report and not grouped with other reports.

20. Unlike other reports when report is handed over it should be documented with a signature to avoid producing duplicate reports for misplaced of lost reports by the requested patient.

Now you wonder why this was posted.

I know nobody will read this.

One who is a care giver only should read from beyond this point.

With Coronavirus pandemic lot of errors of  omissions and commission are committed in the intensive care units often affecting the first responders and care givers.
I used to say with 10 items (it is posted elsewhere) I could manage a rural hospital, which I did during Pan Polling days of Sirima and NM.

Saline
Pain killers IM
Diuretic Frusemide IV
Hydrocortisone then but potent dexamethasone derivative now

Nebulizer with Controlled Oxygen supply (28%) not avaible then but only a face mask

Plasma
Blood I never had

Broad spectrum antibiotics rarely used.

Good old days we realized some patients needed intensive care, often for post surgical patients.

Surgical Intensive Care was born.

Blood Transfusion Unit was the major supply unit.

I was a link man between the laboratory and blood bank and had lot of time to spare unlike other guys.

Girls were very few then in intensive care barring of course nurses.

I / we often lost lot of patients but saved a few important guys like retired old Prime Ministers and Venerable monks.

Lost was due to initial delay in recognising the very sick from the sick.

The patients in SHOCK or end organ failure.

Then we developed medical intensive care units.

Lastly the renal unit.

No liver transplantation units then.

I used to love teaching metabolic shock and organ failures.

1. Heart Failure
2. Respiratory Failure
3. Renal Failure
4. Liver Failure
5. No brain failure but management of the unconscious patient

The Shock or End Organ Failure was my favourite in later years as a pathologist, which I used to see under the microscope often in babies and infants without a diagnosis at hand.

Lately of course I migrated to interleukins in disarray.

In the private sector never had proper intensive care units now and then.

If they had they were poorly equipped with trained staff.

The medical institution I did my above observations did not have any.

The entry to the proposed emergency unit was permanently blocked by service lorries and it never functioned.

All the despairately sick we lumped together in a unit with absolutely no organisational principles.

Nobody wanted to take the responsibility and were shunted to the general hospital at the gate itself.

I took some interest and saved a young guy with Gillian Barre Syndrome or ascending encephaliomyelitis.

Three solid months of supervision and the duplicates of all his reports were with me.

I duly handed the duplicate file to the parents on discharge.

The hospital records were in tatters.

Incidentally university guy I befriends later had his surname and he told me that was his elder brother's son.

Life have many surprises!

NO MORE on this BLOG POST.
I go into hibernation!