OR Refrigerator Overview

     The patient is in bad shape with primary health threats of lung failure, diabetes, gangrene, sepsis, and cardiac failure. While in the operating room undergoing amputation of his gangrenous right leg, he experiences brisk blood loss. At this time, he is risky and unstable and starts to bleed out. In response, the OR orders two units of blood. Despite standard OR set-up, appropriate blood for this patient is unavailable in the OR because the refrigerator is not working. Ideally, prescanned blood is available in the OR when it is probable that the patient will need it.

     This particular refrigerator unit is approximately three years old. During this time, it has had problems maintaining temperature due to unreliable current, the evaporation function failed, a faulty sensor board was replaced, recalibration was necessary, another new board was installed, the digital readout failed and inadequate gaskets prevented complete and thorough door closing; signs posted on the unit remind lab workers to shut the door firmly. Over the past two months, the false alarms from the refrigerator have been occurring with greater frequency. Every time this happens, the device needs to be recalibrated. The unit is not the standard brand generally in use in blood banks. A new refrigerator has been ordered and should arrive in two to three weeks. A contingency plan to use a cooler if necessary was developed but not communicated.

     Because the surgery occurs after hours, there are no blood bank transporters available to send so the circulating nurse goes to the blood bank to pick up the blood. Although the usual procedure is to call the NOD, this often takes too long. The blood loss is life threatening. Due to the urgency of the situation, the circulating nurse decides it would be fastest for her to go to the lab herself. Because of the "emergent release of blood policy" the lab is authorized to release only one uncrossed unit at a time unless both units can be started within 30 minutes. The nurse delivers the blood to the OR. Once the blood arrives, it takes the OR nurse 5 to 7 minutes to get the scanner to work. Patient X is now down to a critically low blood count. Accordingly, anesthesia wants the blood transfused without scanning. The situation is grave. The nurse, however, wants to follow the standard scanning procedure. This is complicated by the uncertainty in scanning due to the fact that the blood has three bar codes.

     In response to anesthesia's request for the lab work on patient, the OR nurse needs to go into the computer and move several screens out of the surgery package to get the information. After 4 to 5 attempts the OR nurse successfully scans the blood. She completes the order for the blood test and gives it to the lab tech who is now in the OR. She gets ice for the blood gas, fills out the requisition to put with the specimen according to procedure and then the tech takes the specimen back to the lab. By this time, blood loss is life threatening without transfusion. The OR does the usual blood unit check, part of the standard procedure designed to insure the right patient gets the right blood. The match is satisfactory and OR proceeds with the infusion. The nurse calls the NOD to pick up the second unit, and then props open the usually locked door so the NOD has a timesaving shortcut to the OR. The second unit scans and is infused. Eventually, the patient receives 4 units.