blood utilization committee

[armymt2002]

Hello,

The blood utilization committee is not operating at full speed yet. The chairman of the committee is a doctor who has no real interest in chairing the committee. For those who have an official committee how are the chart reviews done and what type of agenda do you follow for the meetings. We seem to talk about the same things every month and nothing gets done. Thanks for your responses.

[donellda]

I just took over my new position a few months ago and our utilization review meeting is scheduled in a few weeks. My part in the committee is to go through our utilization reports and submit patients who do not meet our transfusion criteria. From what I understand is that not too much gets accomplished at our meeting either. Our meetings are done quarterly though as opposed to monthly. I will soon find out how it is run and what is put on the agenda. I can let you know.

[bevydawn]

My facility is the same, I review all of the transfusion committee reports to find any transfusions that don't meet criteria and then submit those to the BB Medical Director. He then reviews them and 99.9999% of the time he ok's them. (He is very non-confrontational!!) On the rare occasion one gets past him, it goes to the committee, but there they have thus far been 100% ok'd by the committee. I feel that the committee is more for show than to actually accomplish anything. At the meetings, they just review the crossmatch/transfusion ratio, how much blood we have utilized over the past quarter (ours are done quarterly), any wastage of products, stuff like that, just throw numbers around but never get anything real done.

[adiescast]

Our group meets quarterly and the membership is half physician and half non-physician (nursing, lab, and blood center). The physicians (except for the BB medical director) rarely show up.

We report on blood wastage, C:T ratio, transfusion reactions, audit results, and FDA reportable errors. We used to report on transfusions falling outside of the criteria, but I ran into trouble getting the data. I am working on data capture methods that require less manual chart handling. We spent a great deal of time recently re-vamping our criteria (which were way too loose). Now we have to find a way to track them and enforce them. In the past, we designed the transfusion consent form, launched a blood conservation effort, improved our tracking of blood products through to transfusion, discussed the use of autologous and donor directed blood, approved a blood pick up form, redesigned the transfusion tag, and created a physician order sheet for transfusion. The problem, as always, is that the committee has no teeth (and we can't get physician participation). The BB medical director chairs the committee because we can't get any other physician interested in it. :disbelief

[Liz]

Being the Medical Director of the Blood Bank I can give you the following info briefly which I hope is helpful.

The chair of the committee must not be the BB Medical Director, it is usually chaired by a surgeon.

The BB medical director must serve on the committee and can be the secretary.

We meet monthly and we are not an executive committee but we recommend to the Chief of Staff and through him things get done.

On our agenda:

C/T ratio

Monthly blood utilization reviews, the indications are very strict. : these are performed by our residents and cover 20% of transfusions in a new dept. each month

Transfuaion reactions.

Increasing donation awareness

Blood drives and campaigns

Assuring In-service training to the housestaff annually

Perioperative autologous blood usage

any new problem that comes up,

and many other activities.

It is a very active committee with many accomplishments.

Finally, we have chosen indicators and these are reported to the bOT.

Then there is the yearly report that is read and distributed to all by the COS.

[kate murphy]

We are at the point where we review about 10% of our transfusions. We look at all transfusions done on Mondays and Thursdays. The techs (it is assigned to our QA bench) check pre H/H, plt cnt, INR, etc against preset cut-offs. Any that do not pass lab value cutoffs, go to chart review. This used to be done by Utilization Review RN's - due to many factors, it is now done by pheresis RN's or the residents. There are clearly defined cutoffs for this chart review - bleeding >10% blood volume, symptomatic cardiac, etc. Those that fail the second round go to the BB Med Dir. She asks (via letter) ordering MD or attending the reason for the transfusion. Sometimes it takes a couple of letters. If no reply, it goes to their chief. If still no reply, it goes to chair of dept. If still no reply, it goes to CMO. (never gotten to that point). All of this is reviewed at Trans Comm, which reports to Med Exec Comm. Sounds like a lot, but at this point, we only need to write a couple of letters a quarter.

[armymt2002]

Thanks everyone for your help so far. Does anyone have a chart review form they use and could send it to me as I am trying to come up with one to use here.

[kelliott]

I can remember a meeting 8 years ago when only the medical director, myself and one other person being in attendance. Currently as co-chair with a med onc physician we have in attendance at each quarterly meeting at least 6-10 physicians, 1-4 nurse representatives and a Quality department representative. During these years we have revised the informed consent form,implemented a transfusion order form, implemented a system of prospective review where 90% of the orders to transfuse are reviewed prior to transfusion, implemented the surgical blood order schedule, elevated the surgical blood order schedule to a standing order to reduce the number of patients with T&S the day of surgery, implemented a massive transfusion protocol where the blood bank controls the transfuion of blood products based on documented transfusion triggers, implemented a system where non group O patients with historical blood type require a 2nd blood type from a 2nd sample prior to transfusion, arranged for a blood conservation specialist, Dr. Tim Hannon to speak to entire medical staff prior to implementation of our transfusion order form, revised the transfusion guidelines 2-3 times during the 8 year period, the quality department tracks and trends transfusion related events - events level are discussed and an action plan generated to improve processes. In general our transfusion committee has been instrumental in providing support needed to ensure justified and safe transfusions in our institution and at the same time conserve blood products.

There are many good articles out there related to how to resurrect the transfusion committee. Saxena, et al, Shulman, et al have published multiple times in Transfusion.

[Sandy Jo]

We actually use a blood pick-up form that serves as the first step of the utilization review. Blood Bank staff and myself (supervisor) review records first, then outliers go to medical director. Could fax form if anyone is interested. I may also have it on computer to email, but I would have to check at work.

[FHFM]

hi Sandy - could you please send me a copy of this form? We are starting to review blood utilization and would greatly appreciate any and all help to get started. Thanks, Kathleen

email: kathleen.okane@FHFM.org

We actually use a blood pick-up form that serves as the first step of the utilization review. Blood Bank staff and myself (supervisor) review records first, then outliers go to medical director. Could fax form if anyone is interested. I may also have it on computer to email, but I would have to check at work.

[AMcCord]

I would also appreciate a copy of the form. Perhaps you could post an attachment in this thread.

thanks!

[Eoin]

We can pick stats on indivual medicos. We look at triggers, compliance with MSBOS, and C/T ratios for them. They know we are looking at these and compliance thus lower blood outdating has occurred.

[labrat10102]

Hello! Does anyone have a blood utilization review form that they can post to this thread or email? My email address is chosea@seymourtexas.net.

Thanks so much!

Catherine

[reidhospbb]

We had trouble with attendance at the Transfusion Committee. Now, our "Transfusion Committee" consists of the blood bank manager and the BB medical director. We review charts that fall out from our QA department (we also only review approx. 10%) together and any that don't meet the established criteria are forwarded to the chief of the section of which the ordering physician is associated. A report is made to the medical executive committee as part of that section's QA function. This way we don't have to worry about getting physicians, et al. to the meetings. It has gone through several AABB, JCAHO, HFAP, and CAP inspections and meets their regulations.