Need help with non-compliance in ER

[Jane]

I feel sure that I'm not the only one in this situation. We sign out blood to the ER with a form that all other floors use (including OR). It comes back and they haven't filled out any info on it. No signatures by the nurses that transfused it, no vitals, no nothing (except what it left here with). Their answer is "we don't have time" Maybe they don't- but to not even check that they've verified any info??

Do any of you use a different form for "trauma situations?" And how is your compliance with the form use?

Thanks for any help!

[John C. Staley]

Are you referring to the release of uncrossmatched type O RBCs to an unknown trauma patient or to a fully ID'd and crossmatched patient. These are 2 very different scenarios. In the first, the normal routine is of little value, in the second I would get the hospital risk management folks involved.

[emeraldquest]

In our hospital Blood Bank, we expect completed transfusion unit tags. If they are not completed, it is up to blood bank to follow up with the information from the transfusionist. Our SOPs note complete compliance for documentation of the transfusion.

We have some non-compliance with filling out the unit tag to be returned from a few areas (ER and OR) in the hospital, since we usually know where the transfusion takes place we send the nurse educator or director for that area a copy of the tag and a note to the problem. Our Nursing council has been helpful in backing up the completion of the unit tags. Nurses who have not filled out the unit tags properly are reeducated about what is expected & needed. The copy I have sent them, usually comes back to blood bank for filing.

At this time we have paper trails until our Wyndgate Blood Bank system goes live (Jan 05)...then we will find our paper trail, computerized and more efficient in our tracking of tags. Since we have aggressively taken a stand that documentation is essential, we have had a decrease in lack of documentation being noted. We also can track how long till they hang the blood and how long they transfused.

[GSD2SABSAL]

We have found that nursing administration has helped us a great deal. I now send these incompleted forms to our VP of nursing. It seems that receiving a note from her is a re-education that works. We too, have the SafeTrace system. I am not sure you will be able to track any better when you go live.

Good Luck,

Ray

[kate murphy]

We had the same issue some years ago. We streamlined the form - all the FDA/AABB/CAP want is an acknoledgment that the transfusion physician knows the units are uncrossmatched or incomplete in some way. Our form only requires a pt identifier stamp and a physician (or designee) signature.

We made the forms bright red, we stock them in the ER. We do not release any red cells without a presenting form (though that took a while of chasing after the fact). The BB techs complete the unit numbers and what testing is incomplete in the BB.

I'd be happy to share our form and procedure with you.

One large help in implementing this form was our medical director who met with the ER docs to train/explain. We presented it as a way to save them time and expedite release of product. We did not present it as a regulation or helpful to the BB.

[luhubert]

We need computer documentation and when it isn't there, I send the patient name, date and unit number(s) to the Nurse Manager of the floor where the transfusion was done,- in your case ER. They have to get the chart and see if the documentation is written anywhere and then report back. Most of them sit on the Blood Utilization Review Committee and they don't like to have their number of undocumented transfusions reported out loud to the Committee. Usually they get the documentation completed as soon as it's brought to their attention.