Transfusion medicine handbook

3. Guide to Good Transfusion Practice

3.6 Collecting Blood Samples for Pre-transfusion Testing

Correct identification of the patient, directly prior to collecting the pre-transfusion sample, is critical to avoid ‘wrong blood in tube’ (WBIT) episodes, a significant cause of patient morbidity and mortality. Only when the patient’s identity is positively confirmed can the blood sample be taken. Once collected, the sample must have the patient identifiers handwritten onto the tube label, before leaving the patient’s side.

Check Twice. Label Once.

Sample collection must be performed in accordance with hospital policy and must meet blood bank strict sample criteria requirements, adhering to the following:

• The completed request form, with legible patient identifiers and the testing requirements specified, must be taken to the bedside to verify the correct patient is approached.
• Prior to taking the sample, ask the patient to state their full legal name (family name, first names) and date of birth. Some patients may know their national health index number (NHI) and can state this on request.
  • If the patient is unable to tell you their name (e.g. unconscious, babies/infants, language barriers, patients with dysphasia, expressive disabilities or diminished mental capacity) an alternative means of identification must occur in accordance with the local hospital identification policy.
• Check the patient’s verbal response against their ID band and the patient identifiers on the request form to verify that the details are identical.
• Verify the NHI on the ID band and request form match exactly.
  • In the absence of an ID band, for example, primary care settings/community phlebotomy services, ensure the NHI on the request form is verified.
• Do not proceed until positive patient identification has been secured.
• Collect the blood sample into the correct EDTA (pink top) sample tube.
• Before leaving the patient’s side, hand write the following patient identifiers, from the ID band (or request form in primary care settings), directly onto the blood tube label:
  • Patient’s family name.
  • Patient’s first name.
  • Patient’s national health index (NHI) number.
  • Patient’s date of birth (DOB).
• The collector of the sample must then:
  • sign the tube label, verifying the ID details
  • hand write the date and time the sample collected.

• Check all details written on the tube label match the ID band and request form exactly. In primary care settings, asking the patient to check the identification details on the label may be a local policy or requirement.
• The collector of the sample must then sign the mandatory declaration on the request form, hand-writing the date and time the sample was collected. The sample cannot be processed in the absence of a signed, and correct, declaration.
• Please note: The information on the request form will be checked against that on the sample tube and both must be identical. NZBS Blood Bank does not accept pretransfusion samples labelled with pre-printed labels.
• Sample tubes must be hand labelled in the presence of the patient, directly after the blood is collected, by the person who obtained the sample.
  • Sample tubes must not be prelabelled before the sample is obtained because of the risk of bleeding the patient’s blood into the wrong tubes.
  • Sample labelling should not be delegated to a third party.

In specific circumstances, where there is variation from the above, then it is recommended that a risk assessment is undertaken, and endorsement given by the local hospital transfusion committee after consultation of NZBS.

The sample acceptance criteria used by NZBS are informed by ANZSBT 2020 Guidelines for Transfusion, Immunohaematology Laboratory Practice. ANZSBT Guidelines - ANZSBT : ANZSBT Blood Bank staff are not authorised to accept samples which do not meet labelling requirements. If the criteria are not met, the sample will be rejected and a new sample requested.

In the rare cases, where a dispute arises in relation to a sample, the final decision on suitability for testing will lie with an NZBS Transfusion Medicine Specialist/Medical Officer who must undertake a risk assessment to establish and guarantee no patient harm (morbidity and mortality) can arise by proceeding.