OldBloodBanker

The Joint Commission may move from the realm of being a "big stick" to that of a cudgel, mostly to the benefit of those of us in the field of transfusion medicine. TJC (which is what they want us to call it these days) has taken a deep and abiding interest in our domains and has been working for several years on new Blood Management Performance Measures. I'm essentially retired these days so I don't have my ear to the keyhole as I used to, so I don't know when they will publish these performance measures, but my recollections are that they are greatly interested in the subjects of blood conservation, the appropriateness of transfusion, and, of course, patient safety. With the TJC's spotlight on the blood bank, our Blood Usage committees are likely to become more energized, and hospital administration may be beating a path to your door. Perhaps some of these performance measures will assist us in getting compliance with those who interface with the blood bank, over whom we seem to have little or no control, but at the very least there will have to be new lines of communication, and, hopefully, an era of greater cooperation. We work so hard to ensure that the services we offer are of the highest quality, and that the blood products we process and issue are "safe, pure, and efficacious." Thus we would want our clinical partners at the bedside to be just as dutiful in their processes.

Just a point of information... After calling it "The Joint Commission for the Accreditation of Healthcare Organizations " for years, or fondly and phonetically, "JAYCO," they went and changed their name! Now it would appear that they want us to call them "TJC," for they have become, simply "The Joint Commission." Don't know why. Perhaps it is because the original title wouldn't fit on their building (which is not far from where I live)?

Ah! Brenda! I am deeply grateful for this thread. I have been preaching this for so many years and I do dearly hope that it has sunk in to those Medical Laboratory Scientist candidates and the pathology residents who have been in my care. It sounds as if you are succeeding in your efforts. Probably the most difficult history problems arise among sickle cell disease or Thal Major patients in a large urban area. As their rate of isoimmunization is higher than "normal" patients, you are not likely to encounter such a patient without one or more antibodies. The trouble is that they tend to move among hospitals, either because they are searching for better treatment options or because their pain control isn't adequately addressed. And of course they don't tell anyone upon admission what kind of antibodies they may have, should they know, and before long, through no fault of your own, you are staring down the barrel of a DHTR. A while ago, what was then known as the Chicagoland Blood Bank Society was looking into the possibility of keeping a database of such patients, with their various and sundry antibody problems, (and their phenotypes) and to share them among the area hospitals. While it never came to fruition, and perhaps these days we might have to run into some interference with HIPAA guidelines and regulations, it is certainly a good idea. I envy the network hospitals that share this data. With respect patient cards that identify their problems: For a number of years, for those patients who suffered from DHTRs caused by the usual evanescent antibody specificities, we used to provide MedicAlert bracelet/necklace applications to the attending physician along with the transfusion reaction report. It was an idea I had hoped would assist other blood bankers in the metropolitan Chicago area. I finally gave up after a pending surgical patient phoned me from our intensive care unit, and told me that she was wearing such a bracelet. She had told several residents that she had a "compatibility problem" but they told her not to worry about it because "the transfusion service at our hospital was so good" that we would figure it out. So she read off "anti-Jka" from her bracelet. It was our bracelet, and the antibody problem was in our computer system, but her antibody screen was, indeed, negative. If she had been admitted elsewhere would the other physicians have been equally cavalier and dismissed this information?

There is nothing more I would want to add except to reiterate: anything out of the ordinary, as in these examples, should be referred to the medical director. It may not be within our purview to be diagnosticians, but we do serve as the eyes and ears of the director. We tend to forget that this individual is a donor/patient, and that the medical director is his/her physician. During my active career we discovered several donors suffering from polycythemia or hemochromatosis who, ironically, (that word is NOT a pun) became our patients, as therapeutic "donors." It was good to see the FDA's change of stance on the issue of some of these donors. For years we drew an R2R2 donor whose RBCs went into frozen stock. His Hemoglobin was only tested via the old-fashioned copper sulfate method. When modern technology became available, it became obvious that his hemoglobin level was perilously high, and he became a patient. And of course he went from donating for free to paying for therapeutic phlebotomy. He was not a happy man.