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To Penny: the only solvent reason to get rid of the blood bank armband is if you can rely on all of your phlebotomists and transfusionists to accurately identify the patient and the sample and the blood product using only the hospital armband (preferably 100% of the time...). Our nurses have proven that they respect the blood bank armband slightly more than the hospital armband (which is to say not much), but with the blood bank band we have a somewhat better chance of catching them at it when they don't. We are going to 100% use of the blood bank armband because it helps us to catch more errors. We used to require that they hand write the medical record number on the tube from the hospital bracelet (the only place they could get it from in the room), but JC killed that process by announcing that we were causing them to make errors. In truth, we were catching WBIT by seeing the wrong medical record number on the label. This is not to say that they could not obtain the medical record number by returning to the nursing station and looking it up in the medical record or on the computer... Jehovah's Witnesses are members of a Christian group that does not allow blood transfusion. It is a general practice for adult Witnesses to carry on their person a wallet-sized advance directive card refusing blood. The blood refusal card directs that no blood is to be given to the owner under any circumstance, even if physicians believe transfusion will be lifesaving. Although the card claims to refuse blood on a religious basis, it also states that there are various dangers associated with blood. The possibility that in an emergency the dangers of blood may be relatively small, as compared with the likelihood of death due to exsanguination without blood, is not noted on the card. Emergency physicians should look for evidence of an informed refusal when evaluating these documents. Advance directives regarding life and death decisions should be subject to scrutiny and not be automatically accepted at face value. A goodfaith decision to transfuse the unconscious adult Jehovah's Witness, in emergent need of blood, is justified if the patient does not have a blood refusal advance directive that is informed and otherwise survives a high level of scrutiny. The ethical and medicolegal considerations upon which this thesis is based are discussed. Gyamfi C, Berkowitz RL (September 2004). “Responses by pregnant Jehovah’s Witnesses on health care proxies”. Obstet Gynecol 104 (3): 541–4. doi:10.1097/01.AOG.0000135276.25886.8e. PMID 15339766. “This review refutes the commonly held belief that all Jehovah’s Witnesses refuse to accept blood or any of its products. In this population of pregnant women, the majority were willing to accept some form of blood or blood products.”
Under the new arrangement announced in 2004, the elders would only have to make one thorough sweep of the congregation members to insure their permanent compliance and eliminate this hugely embarrassing situation. Acts 15:20 clearly states “abstain from … blood.” There are numerous scriptures in the Bible that support the idea that blood is sacret and should be avoided. Whether whole or fractional, one’s own or someone else’s, transfused or injected, it is wrong.”– The Watchtower 09/15/1961 p. 559 Your hospital has invested time and resources to perfect its blood transfusion protocols to deliver superior patient care. However, a single patient or blood misidentification error can have serious or even fatal results. According to the FDA, there is an average of 414 transfusion errors in the U.S. each year. One of the top National Patient Safety Goals established by the Joint Commission is to eliminate transfusion errors related to patient identification. The PDC line of blood bands and systems can help. Halabi, W. J., Jafari, M. D., Nguyen, V. Q., Carmichael, J. C., Mills, S., Pigazzi, A., Stamos, M. J. (2013). Blood transfusion in colorectal cancer surgery: incidence, outcomes, and predictive factors: an american college of surgeons national surgical quality improvement program analysis. The American Journal of Surgery, 206(6), 1024-1033. doi: http://dx.doi.org/10.1016/j.amjsurg.2013.10.001This new policy eliminated the annual service meeting part and distribution of new blood cards that were completed and signed each year to demonstrate the individual’s continuing commitment and belief in the policy. This marked a dramatic departure from the established policy – one that medical professionals relied upon in assessing the actual wishes of an unconscious Jehovah’s Witness who showed up at the emergency room. Why was this done? Note the following: Nursing is also inserviced by yours truly. The inservice includes some legal facts and scenarios whereby they come to understand that a untoward patient event due to mislabeling will result in a non-defenseable legal issue that will most likely result in the loss of their license and possible personal lawsuit for gross negligence. I created a special bright yellow label for nursing to use just for BBK samples: all information prompts are on the label along with the statement that only information from the armband is used. Nurses sign an affadavit that they understand the policy. Bennett-Guerrero, E., Zhao, Y., O’Brien, S., Ferguson, T. B., Peterson, E., Gammie, J., Song. H. (2010). Variation in use of blood transfusion in coronary artery bypass graft surgery. The Journal of the American Medical Association, 304(14), 1568-1575. doi:10.1001/jama.2010.1406. We seldom hear Jehovah’s Witnesses talk in terms of blood transfusions being a “feeding” on blood. This is because they now know that a transfusion is not a feeding on blood, but rather an organ transplant. The old view was based upon outdated medical views that were discarded nearly a hundred years ago. Today, Watchtower writers are forced to speak in terms of how it is wrong to “sustain one’s life” by means of blood. As we have shown, however, the Bible no where talks about blood in this way. Phlebotomists are Lab Trained AND must take a short special "Meet the Old Smiling Blonde in BBK" who will give you a friendly inservice and quiz (inter-active so it's not too threatening). She will be attentive to your questions, will show you exactly what is expected and will be your mentor as you encounter situations that are gray area. Hint: You do not want to screw up..you do not want to go there...it's not pretty.
The other interesting thing about the wording in this older card is that it would clearly prohibit a Witness from taking any of the multitude of blood products that have worked their way into the Watchtower’s approved list. It accurately reflects the position taken by the Society in the following quote:
Whenever the Bible speaks of the misuse of blood it is always in the context of eating it as food and more specifically when the life of an animal has been taken. Transfusion of blood or blood components cannot be demonstrated to be the the equivalent of eating blood. Additionally, no life is taken to provide the blood or blood components that are transfused. Simply stated, the Bible has nothing to say about the modern medical use of blood products which are liquid tissue transplants and the equivalent of organ transplants. The obvious paradox Watchtower policy creates for Jehovah’s Witnesses is that all blood products are in fact permitted if sufficiently fractionated. Ferraris, V. A., Davenport, D. L., Saha, S. P., Austin, P. C., Zwischenberger, J. B. (2012) Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Archives of Surgery, 147(1), 49-55. Retrieved from http://www.uthsc.edu/Internal/syllabus-consult/transfusion_minimal_blood.pdf Williams, S. C. P. (2013, Spring) Against the flow – what’s behind the decline in blood transfusions? Stanford Medicine. Retrieved from http://stanmed.stanford.edu/2013spring/article5.html#hdr Reply
Findley LJ, Redstone PM (March 1982). “Blood transfusion in adult Jehovah’s Witnesses. A case study of one congregation”. Arch Intern Med. 142(3): 606–607. doi:10.1001/archinte. te.142.3.606. For these reasons, we believe that it is incumbent upon emergency room physicians to verbally verify the level of commitment to the current Watchtower policy. Especially in view of the fact that it is well-known a significant percentage of Jehovah’s Witness secretly oppose the policy and feel coerced into carrying the blood card or risk exposure as apostates with subsequent shunning.1,2,3,4
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Merrit. R, Banerjee, A., Granger, C., Newby, K., Califf, R., Harrington, R. (2005, November 23). U. S. heart patients receive more transfusions than international patients. Duke Clinical Research Institute. Retrieved from https://www.dcri.org/research/news/2005-news-archives/u.s.-heart-patients-receive-more-transfusions-than-international-patients
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