Recording Results

Test results need to be recorded immediately in order to avoid clerical errors. To allow for proper interpretations and thus protect the patient, results must be recorded legibly, in pen, with corrections being initialled. Pen-recorded results are not to be erased or obliterated: a single stroke is made through the incorrect result and the proper result is recorded above and initialed. This protocol maintains a chain of responsibility aimed at protecting the patient and is also important for legal reasons. Paying careful attention to all clerical details is essential since clerical errors are much more common than technical errors and can result in serious consequences to recipients of blood transfusions.

Enrichment activity #1

It is always interesting to learn about standard practices in other transfusion services. E-mail information about local practices in your place of employment or geographical area to the class mailing list. Practices to discuss include these:

1. Approximate number of antibody screens done per day (or per month); including how often antibody identifications are needed

2. Method(s) used for antibody screening and antibody identification

3. Number of screen cells used for antibody screening

4. Method used for routine crossmatching of patients with negative antibody screens

5. Type of antiglobulin serum used for pretransfusion indirect antiglobulin tests (polyspecific or monospecific anti-IgG?)

6. Microscopic reading: are negative antiglobulin tests routinely read microscopically?

7. Are pretransfusion test results recorded on paper or directly into a computer?

Recording