sgoertzen

We are a pediatric hospital and we have a 2 tier matching protocol for all chronically transfused patients: (e.g. sickle cell, thal, hgbopathies, etc.) We initially match for Cc,D,Ee,K. If the patient makes an antibody in spite of this basic matching, we then move them into the 2nd tier where we also match for Kidd, Duffy, and S.

We use the regular hospital ID band (which is bar coded), but currently only medications are being given using the hand-held bar code readers at the bedside. We will be converting to this bar code system for printing specimen labels and administering blood products over the next couple of years.

We are also a 300 bed hospital and our chart reviewers perform the routine 30 chart retro-transfusion reviews each month (rotating month from month through the various components to audit). We do, however, perform an additional ongoing prospective audit at the time of issue for every transfusion by linking the most recent Hgb/Hct result with all red cell products, PLT count with all platelet products, and PT/PTT results to plasma and cryo products. We have the Meditech system which allows those most recent lab results to pop up and display to the BBK Tech at the time of issue. Anything that looks suspicious for appropriateness is brought to my attention and I request my pathologist and QA to audit that specific transfusion for appropriateness. We also have boxes and fill-in the blank fields on the issue form for the nurse to complete as she/he is doing the pre-transfusion ID check as to the reason for transfusion. We have very good compliance and rarely do audits fall out becuase there is no indication for transfusion documented.

We are a pediatric hospital, so we send the family a simple letter and an antibody card for their wallet explaining that it is important that if their child is ever treated at a different hospital than ours, they need to show this card to the physician and nurse taking care of their child and ask them to make sure they relay this information to the laboratory blood bank at the new hospital.

Our informed consent form does not list the reasons for or the current risk statistics of blood transfusion. It just states that the physician has had a discussion with the patient/family and has explained both of those things to them, that the patient/family understands the risks and benefits of receiving the possible transfusion, that they have had all of their questions answered to their satisfaction, and that they agree to this course of treatment. Coming from California, we also need to cover the Paul Gann requirement and so there are boxes to check on the form about having had the discussion about donor options (Directed Donor or Autologous) and that they are either deciding to utilize those options or they are not. Our hospital transfusion committee has developed a Transfusion Brochure that the physician is encouraged to use during the informed consent discussion which details the risks, benefits, and the various transfusion options (directed, autologous, associated additional costs for special donated products, the phone # to call at the local donor center should they be interested, use of alternative methods such as cell saver, hemodilution, and possible enrollment into our "Bloodless Program" should they decide they want to try to avoid transfusion altogether.) This seems to work well. I update the Transfusion Brochure annually as part of my document review to make sure information remains current.

We have the Meditech system which is not yet approved by FDA to perform electronic crossmatch. We do, however, already use the system to perform a variation of the electronic crossmatch (ABO/Rh compatibility check with subsequent assignment) for those products which technically do not require crossmatching (i.e. RBC aliquots for infants < 4 mo. and autologous units.) 07/14/04

Our donor center has purchased the BacTAlert system. :|