1. Error Management in Blood Collection
Dr. Ravneet Kaur
Professor & Head
Department of Transfusion Medicine
GMCH, Chandigarh

2. Regulated and technically specific blood collection process is vital
Provide safe blood
Preparation of high quality blood component

3. Multi-tier process Donor Education/ Pre donation counseling
Detail history of prospective donor
Physical examination
Phlebotomy
Post donation care and counseling
Error …… Harmful to donor as well as recipient

4. Errors…….

5. Error – Donor counseling/ Physical examination
Ne photograph
Error – Donor counseling/ Physical examination

6. Error – Preparation of blood bag ( wrong expiry date)
New photograph
Error – Preparation of blood bag ( wrong expiry date)

7. Registration no. 110670 Blood bag marked O positive Blood bag group A positive
Blood bag marked A positive
Blood bag group O positive
Error – Improper identification of pilot tubes

8. Blood bag & pilot tube prepared
Donor registration no
Blood bag & pilot tube prepared
Donor deferred - Poor vein
Next day – First donor – same registration no.
Pilot tubes missing from Donor complex
Pilot tubes with blood sample traced in laboratory area
Error – Wrong identification of Pilot Tubes

9. Error – Over collection / Under collection

10. Error – Inadequate mixing / Inadequate flow
Clot
Error – Inadequate mixing / Inadequate flow

11. Error – Improper sealing of tubal segment after blood collection

12. Errors in blood collection
Technical errors
Improper preparation of venipuncture site
Faulty technique
Inadequate mixing of blood with anticoagulant/ volume collected
Sampling error
Sample collected in wrong pilot tube
Non collection of blood sample
Improper sealing
Inappropriate discarding of needle
Clerical errors
Improper donor identification
Improper preparation of blood bag
Wrong identification number on the blood bag
Wrong collection/expiry date on the blood bag
Mislabeling of pilot tubes

13. Error Management
Error prevention
Error analysis

14. Error Prevention Appropriate Standard Operating Procedure
Training of staff & continuous motivation/education
Validated and functioning equipment

15. Standard Operating Procedure - Donor blood collection

16. Pre donation information /Counseling
Conducted
By trained staff with counseling skill
In a separate room
Should include
Information regarding eligibility criteria, blood donation process, TTI and various test performed
Pre donation risk assessment for TTI
Informed written consent

17. Physical examination Donor should be in good health
Detailed history…….High risk behavior
Meet the standard criteria for donor selection
Donor weight, blood pressure, hemoglobin

18. Donor identification
Critical to the safety of both donor and recipient
Numeric or alphanumeric system to identify the donor
Segment no. of the blood bag
Photograph of segment no and registration sticker to be added

19. Preparation of blood bag
Correct identification number
Blood bag
Satellite bag
Donor record (registration card)
Pilot tubes
Appropriate date of collection and expiry
New photograph to be added

20. Phlebotomy Carry out hand cleaning before and after each procedure
Should wear well fitting gloves

21. Preparation of venipuncture site
Inspection of both anticubital fossae
Skin preparation by aseptic technique
70% isopropyl alcohol
& tincture of iodine
Concentric spiral manner (centre to periphery)
Area – 3 inches ; contact time – 30 seconds
NO TOUCH - Venipuncture technique
Prepared site must not be touched again. Do not repalpate the vein at the intended venipuncture site

22. Single clean venipuncture Performed by trained phlebotomist
Phlebotomy
Single clean venipuncture
Adequate flow
Performed by trained phlebotomist

23. Phlebotomy Ensure proper mixing with anticoagulant
Collect adequate volume

24. Desired volume X Sp.gravity + Weight of empty bag with anticoagulant
Weight of blood bag
Desired volume X Sp.gravity Weight of empty
bag with anticoagulant =
350 x = 448gms ± 10%

25. 350 ml Blood Bag
450 ml Blood bag
Normal
ml / gm
ml / gm
Low volume PRBC
ml / gm
ml / gm
Under collection
< 233 ml / 325 gm
< 300 ml / 409 gm
Over collection
> 385ml / 485 gm
> 495 ml / 614 gm
Blood bag should be appropriately labeled – Low volume, Under collection, over collection

26. Never leave the donor alone Sample collection at bedside
New photograph to be added
Never leave the donor alone
Re check the registration no.
Sample collection at bedside

27. Appropriate discarding of needle
Phlebotomy
Proper sealing
Appropriate discarding of needle

28. Proper storage
Adequate temperature
Up right position

29. Post donation care Guide donor to refreshment room
Give post donation instructions
Provide contact information of the transfusion centre

30. Training
Must to ensure that all staff members are undertaking critical processes are competent to perform task
Should include
Induction training for new staff
Refresher training
Intimation of any change
Training program
Principles, procedures – SOP
Principles of good manufacturing practice
Safety requirement for staff
Training programme should be conducted for new staff and refresher training especially for the tasks that may not be performed on a regular process. When ever any change is made in any of the procedure it should be intimated to all . The training programme should be based on Standard operating procedure and should through light on principles of good manufacturing practice so that staff understands the potential consequences of not following SOP. Stress should also be laid the safety requirement to be followed by the staff members.

31. Equipment
Periodic maintenance and calibration should be carried and documented according to established procedures

32. Blood collection in blood donation camps

33. Camp site Organized in a way
Ensures safety of blood donors, staff & donated units
Avoids errors in blood collection

34. Camp site Waiting area Screening / Physical examination area
Phlebotomy area
Refreshment area
Close watch on the donors

38. Transport of blood
Maintain temperature not more than 10°C during storage and transport
Secure the lid tight shut
Not to exceed the capacity of boxes

39. Automation in blood collection
Unique set of bar coded identification number for identifying blood bags, samples and records
Helps to avoid manual/clerical errors

40. Medical event reporting system for Transfusion Medicine
Capture threats, hazards, near misses, injuries, and deaths systematically
Can identify error where action is required
Raises staff awareness about error management
Blood centers can benefit from identifying and tracking their events and errors and near misses. It helps to identify system attributes and factors that may per dispose to error. One such reporting system that can be used is MERS- TM ;Can identify error where action is required

41. Root Cause Analysis of Error

42. Documentation Record information Pertaining to donor
Adverse donor reaction
Any deviation from Standard Operating Procedure
Errors reported and corrective action taken

44. Conclusion Strictly adhere to Standard Operating Procedures
Errors should be analyzed and documented
Helps to identify areas where resources need to be targeted
Improves over all safety of transfusion

45. Thank you