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Prospective review for all blood components


Jane

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My facility (300 beds) is considering implementing prospective review for all components. We currently do a prospective review for everything but red cells (thought it might be easier to break them in slowly). Part of the reasoning for starting this is it is hard to perform the review adequately retrospectively. Doctors do not typically write in the chart. " I gave this patient blood because . . . "

If anyone else has this process in place, help!

Thanks!

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We are rather large 700+, and only do a retrospective audit. Our current LIS, homegrown, does not support prospective auditing. We hope our new system, Mediware, will be able to do this. We will have it implemented by next September and are working with Mediware to tie to our LIS and possibly do prospective auditing.

Good luck.

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I work at a 700 bed University Hospital. We have been performing prospective review of all blood products (RBC, Plt, FFP, Cryo) for several years now. Unfortunately our HIS does not support the ordering of blood products directly and we use a manual requisition for blood products. The requisition requires the physician to check the appropriate indication. The technologists look up and verify the appropriate lab values and ensures they match the indication marked. If no indication is marked and the lab values alone do not qualify the order, we page the physician for clarification. Any order that does not meet the indication is given to the resident, fellow or attending to contact the physician for further explanation. We document the need for Transfusion Medicine physician approval and the reason for approval or denial. Every order that requires Transfusion Medicine physican review is reported to Transfusion Committee. We have set guidelines for any physician with three or more orders in a quarter requiring TM review is reported to our Hospital Credentialing department. I am willing to share our experience and process.

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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.

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We too have been having Nursing fill in the reason for the transfusion but this is often done by the unit secretary who writes things like- anemia or hgb 9.3. This leaves the blood utilization committee to wonder if this patient couldn't have just received iron or procrit. But maybe the patient had symptoms of anemia. The chart reviews become long and drawn out trying to figure out what the doctor was thinking. So were hoping by having the doctor indicate the reason we might get a better grasp on this. And have improved utilization.

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  • 2 months later...

We, like "sgoertzen" have Meditech and do the prospective review at the time we issue the blood.

However, we don't have a form that the nurses fill out. If we see something that appears inappropriate, the blood bankers turn it over to a Pathologist who in turns calls the attending physician right then and gets the reason for the transfusion.

We also run a report every morning of all those patients with a Hgb. of 7 or below (O.B.'s below 6)from the previous day. If any weren't transfused, we give the name to a Pathologist who calls the attending and finds out why. Many times, its a patient refusal or a "DNR" but once in awhile, the attending didn't know and really does want to transfuse the patient.

At our quarterly Blood Utilization Review meetings, there are very few charts that have to be reviewed for appropriateness, usually less than 3.

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  • 7 years later...
Yes. You can e-mail me at lmcclann@unch.unc.edu. I can either send it electronically or by fax.

Dear Laura,

I am writing this many years after your post.

Can you please share your process & Form, maybe SOP too. We wish to start the process of prospective review of all blood products, but are not very clear about it. Your experience & shared inputs will be of great value.:confused:

Thanks in advance.

Regards,

aafrin

adil.elavia@jehangirhospital.com

PS: I forgot to add that my mail to your above e-mail id bounced back.

Edited by aafrin
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