Nursing verifications done at bedside before transfusion

[tms8313]

I was wondering how other facilities are meeting the requirements for CAP TRM.41300 and AABB BBTS 5.28.3 regarding the bedside verification performed by nursing staff before transfusion.  We were recently cited for no documentation that nursing staff was reviewing the interpretation of crossmatch testing and if special transfusion requirements are met (CMV, Irradiated, etc).  We have that information included on the transfusion report that goes with the product to the nursing unit.  We use the Bridge administration system and it records all of the other required information by scanning the patient armband and the blood product.  Also the nurses have to answer questions in Bridge before they start the transfusion, such as  1. consent form signed? 2. physician order reviewed?  along with some other information.  

I am wondering how other facilities document what information the nurses are checking.  I can add an additional question in Bridge to document that the nurse has checked for special transfusion requirements ordered by the physician but I am not sure how to proceed with the crossmatch interpretation.  Nearly all of our crosssmatches are compatible and the RN could document that in Bridge, however what do you all do if you have to give least incompatible units as in the cases of warm autos?  It is marked that way on our transfusion reports but I am imagining some of the nurses not understanding the situation and not wanting to take responsibility for giving the unit.

Any suggestions, advice or how you handle these situations is greatly appreciated!

[Mabel Adams]

Oh my!!!  We used to have a flowsheet row in the Epic transfusion module that the nurses were to mark that they checked the blood bank band number and it matched (then we dropped using a BB band).  It wasn't a required field, but I suppose you could make it so.  How is Lab supposed to police the work of nurses who are overworked, short staffed, often travelers and over whom we have zero power to change their behavior!

[Gkloc]

Here we have a list of requirements that the tranfusionist completes by checking off that they performed the task. This is on the transfusion tag that is attached to the unit. 2 of the items are Verify Interpretation of Crossmatch Tests if Performed and Verify Special Transfusion Requirements. Inspectors have been ok with these.

[SbbPerson ☆]

There are hospitals now that has switched their verbiage from "least incompatible" to "most compatible". Which is true! This blood is the BEST blood possible considering the patient's situation. There is nothing you can do about the patient's auto, but you can make sure to provide the "best" compatible unit to the patient.  Of course you do this by making sure there are no underlying clinically significant alloantibodies in the patient's plasma.

 

Some places just straight out say "incompatible" on the transfusion report/tag.  The physician is then notified and made aware of this.  Some places make the doctor sign a form acknowledging the "incompatible" units and the risks involved, but where I work, a verbal "ok" would suffice.   We are all on the same team, working towards the same goal, the welfare of the patient.  We are not trying to "pin the blame" on anyone for possible hemolytic transfusion reactions.  We all want the same thing. 

 

Here is a really good podcast on the subject from the Blood Bank guy. It is really interesting and goes deeper into the subject and "what to do when everything is incompatible".  Good day. 

https://www.bbguy.org/2020/06/17/085/

 

 

 

 

 

 

 

[BankerGirl]

We have the compatibility question on the pre-transfusion checklist in Meditech TAR.  We were also cited for this several years ago and have not had a problem with this since.  Whether the RN understands is another question though.

[Ensis01]

We vertically audit ten transfusions a month, reflecting different departments and floors. We ticked each criteria box as it was done correctly. If missed or done incorrectly another box was ticked and we educated the RN. The form was signed by us and RN. The BB kept a copy and original went to the RN supervisor. Not sure what they did with it. Not ideal system but showed us willing.