Lookback processes - who notifies the patient?

[jshepherd]

At our facility, when a lookback notification is received and the transfusion recipient/patient must be notified, the blood bank supervisor (me) will reach out to the attending physician to have them contact the patient for testing of HCV or HIV. These happen so rarely, and sometimes the lookback is from so long ago, that we are getting pushback from the attending physicians. How is this notification of need for testing done at other hospitals? Do the clinical pathologists or transfusion service medical director own this process? Our clin paths feel it is not in their scope to be contacting patients directly, as they don't have any sort of relationship with the patient in place. Does your Risk Management team do this? We are exploring all options to make this smoother for the few times per year we need to contact patients! Thanks!

[Gkloc]

Here the Medical Director or designee is the one responsible for contacting the patient's physician. If the patient's physician refuses to contact the patient, our Medical Director or designee will end up having to do it. 

[jayinsat]

21 hours ago, jshepherd said:

At our facility, when a lookback notification is received and the transfusion recipient/patient must be notified, the blood bank supervisor (me) will reach out to the attending physician to have them contact the patient for testing of HCV or HIV. These happen so rarely, and sometimes the lookback is from so long ago, that we are getting pushback from the attending physicians. How is this notification of need for testing done at other hospitals? Do the clinical pathologists or transfusion service medical director own this process? Our clin paths feel it is not in their scope to be contacting patients directly, as they don't have any sort of relationship with the patient in place. Does your Risk Management team do this? We are exploring all options to make this smoother for the few times per year we need to contact patients! Thanks!

This is one of the biggest frustrations of my job, exactly as you have described it. Our Medical Director does not want to direct contact patients/family members. Some treating physicians do not want to take responsibility for this. I would meet with your director of quality and facility chief medical officer and get them involved by first helping them understand the FDA requirements. They can help educate treating physicians on their responsibility when they order transfusions. A lot of these physicians do not understand that this is a real risk. Perhaps that will tighten up some of their maverick blood ordering practices. 

I recently had one where the donor tested repeated positive for HIV. The patient is now deceased but did spend time with his family between the time of transfusion and his expiration. 2 years later, we are battling how to contact his spouse and mother, both of whom cared for him in the interim. We do not even know what primary care physician to contact in this case. If we did, I guarantee they will not want to cause that kind of alarm in the surviving family, possibly risking a law suit.

[jshepherd]

49 minutes ago, jayinsat said:

 I recently had one where the donor tested repeated positive for HIV. The patient is now deceased but did spend time with his family between the time of transfusion and his expiration. 2 years later, we are battling how to contact his spouse and mother, both of whom cared for him in the interim. We do not even know what primary care physician to contact in this case. If we did, I guarantee they will not want to cause that kind of alarm in the surviving family, possibly risking a law suit.

Precisely! Our current conundrum is a snarky Ortho attending who is insinuating that our blood supplier and my blood bank gave the patient "contaminated blood" and he shouldn't have to be the person to notify the patient. Snarkiest of the snark, and its clear there is little understanding of the risks of transfusion. 

My medical director wants to involve our Patient Safety and Quality folks or Risk/Legal, since this is an FDA requirement, and I think we'll have to take that route, if for nothing more than educating the physicians. 

[mcgouc]

The BB supervisor sent a certified packet to the physician on record. We included a letter documenting the transfusion, a copy of the current FDA requirements for notification, and a form for them to complete and return by a certain date with the notification information. The Medical Director’s name and phone number were in the letter as the contact person for the physician. The Medical Director was copied on this info in case he was called.  If the completed form were not returned, the Medical Director called the physician.  Every phone call, etc, was documented.   There were problems, as mentioned above. We had hospitalists who only treated the patients in the hospital who might not work there anymore or did not feel responsible for follow-up.  What if the patient went to rehab and never went home?  If we could not reach an end point, we sent to risk management for resolution. 

[Cliff]

When I worked in a hospital, we notified the patient directly on all lookbacks, and we also sent the patients PCP a courtesy letter.  We found that the PCP rarely notified the patient, so we chose to make our lives easier and notify the patient ourselves.