Department
Blood Bank / Transfusion
A blood bank is a licensed establishment that happens to sit inside a hospital. Every unit it issues has to be traceable from the donor to the patient, and every step in between has to carry the name of the person who took it.
The licence
What a blood bank is legally required to hold.
A blood centre in India operates under the Drugs and Cosmetics Rules, with a licence, a designated medical officer and a record set that has to be producible on demand.
- Donor selection, deferral and consent, kept as signed and versioned forms rather than as a register somebody has to find.
- Testing for transfusion transmissible infection on every unit, with the result tied to the unit and to the donor.
- Component preparation, storage temperature and the disposal of what was discarded, each with a named person and a time.
- Issue records that name the patient, the unit, the crossmatch result and the person who released it.
- Adverse reaction reporting under national haemovigilance, from report through investigation to resolution.
Each of those already happens. The question the licence really asks is whether they can be produced as one chain for one unit, months later, and that is a record problem rather than a laboratory problem.
Impact and action
Identity breaks in three places.
- The sample is drawn against a handwritten form, the crossmatch is booked in a register, and the unit is issued against a slip. Each of the three is a fresh chance to attach the wrong name.Forge carries the crossmatch and the issue as one order against one visit, so the request, the sample and the unit are states of the same object.Forge
- The unit is checked at the bedside against a form the ward filled in, which is the last place an identification error can be caught and the least instrumented.The bedside check is a structured, signed step on the record, so the check is evidence rather than a tick on a sheet.GlyphQuest
The reaction is reported into a folder.
- A transfusion reaction is written up, sent to the blood bank, and disappears into a file that is opened when an assessor asks.Vigil tracks the reaction from report through investigation to resolution, as the same evidence the accreditation file needs.Vigil
- A look-back after a positive donor test means reconstructing which patients received which components from paper.The donor, the unit and the recipient are one chain on the record, so the look-back is a query.Atlas
Stock is a whiteboard and a phone call.
- Group availability is asked for by telephone, reserved verbally for a theatre case, and released by whoever remembers.Pensieve stops short of a component stock ledger. It integrates with the blood bank system the hospital already runs, over Westron, so availability and reservation are read from the system that actually holds them.Westron
- A hospital with no such system keeps the stock position in a book, and every request is a walk to the counter.An application for it can be built in Durin, either by hospital staff themselves or by a Pensieve forward deployed engineer without taking staff off the floor, and used across the hospital.Durin
Vein to vein
The chain a unit has to carry.
Request
A clinician orders group and screen, crossmatch or a specific component against the patient's visit, with the indication attached.
Sample
The sample is collected as a task against the order and labelled at the bedside, which is where the identification either holds or fails.
Crossmatch
The bench works the order. The result, the technologist and the time are recorded against it, and the unit is reserved against the patient rather than against a name on a slip.
Issue
The unit is released by a named person to a named patient. The issue record, the charge and the traceability entry are the same movement.
Transfusion and after
The bedside check, the observations during transfusion and any reaction are recorded against the same order, so the chain closes where it started.
The chain above is what the licence asks for. Producing it should be reading the record rather than assembling one.
The tools this department lives in.
Read top to bottom. Each tag is a tool inside Pensieve, and the line beside it is what that tool does in a blood bank specifically.
| Tool | What it does in this department |
|---|---|
| Forge | Group and screen, crossmatch, component request and issue, as one order against one visit. |
| Glyph | Donor consent and deferral, the bedside check, the transfusion observation chart and the reaction report. |
| Vigil | Transfusion reactions from report to resolution, haemovigilance returns and the licence evidence file. |
| Atlas | The patient record the transfusion history sits on, and the chain that ties donor, unit and recipient. |
| Quest | Sample collection, the timed observations during a transfusion, and the post-transfusion check as due tasks. |
| Sentinel | Incompatible result, expiring reservation and unacknowledged reaction alerts, with an escalation chain. |
| Vault | The charge for the component and the processing fee, at the price that applied on the day of issue. |
| Westron | The connection to the blood bank system and any analyser the centre already runs, with a forensic trail. |
| Falcon | Issue against request, wastage, crossmatch to transfusion ratio, and demand by department. |
Published research
What the literature already measured.
Findings about transfusion practice, each with its study and a link. None of it is a Pensieve result.
- The United Kingdom's haemovigilance scheme reports that most transfusion incidents are errors in the process rather than reactions to the component, concentrated at the points where the patient is identified.Bolton-Maggs PHB, Cohen H. British Journal of Haematology, 2013. Sample collection, laboratory handling and bedside administration are the three points named.
- In a prospective study of errors in a hospital stat laboratory, 68.2 percent arose before the sample reached the analyser.Plebani M, Carraro P. Clinical Chemistry, 1997. Identification and container error dominate that share.
- India's national auditor found 749,820 scheme beneficiaries registered against one mobile number, and 78,396 instances of a single patient recorded as admitted to more than one hospital at the same time.Comptroller and Auditor General of India, Report No. 11 of 2023. Identity is the substrate a transfusion chain rests on.
Who draws on the blood bank, and when.
The theatre
A listed case reserves units in advance and returns what it leaves unused. Reservation, issue and return are three states of the same order, so the count is right at the end of the list.
The casualty
A massive transfusion protocol issues components faster than any paper chain can follow. The order carries the protocol, so the record catches up without anybody stopping to write.
The laboratory
Group, screen and antibody work is laboratory work with a transfusion consequence, and it belongs to the same visit as the issue record.
Maternity
Obstetric haemorrhage is the reason a labour room needs an answer about availability in under a minute, and the answer has to be the same one the blood bank would give.
A unit of blood should be able to describe its own journey. Donor, test, component, crossmatch, patient, and what happened afterwards, as one chain with a name at every step.