"In-Service" on Transfusion Reactions

[Bob M]

Hello everyone. I have been lurking for some time in here, and have to say that the information from this community is extremely helpful.

We recently had a CAP inspection, and were cited for TRM.41650. It reads:

"Are criteria for the recognition of transfusion reactions documentented, and is there documentation of periodic in-service education on the recognition of such reactions? NOTE: These must be readily available to clinical personnel in areas where patients are transfused."

I am unsure how to proceed here. Is this in reference to in-service training and yearly competency checks of the transfusionists (who are nurses in our hospital)? The lab personnel would not be the front line individuals who would need to "recognize" a transfusion reaction, so it must be some type of competency assessment of the nursing staff. If so, how are you doing this in your institutions? I am a clinical lab scientist, and I am not certain my skill set would recognize a reaction event at the patient's bedside. As such, I do not feel qualified to deliver an in-service of this nature. Are there on-line materials that might be used in these instances?

Secondly, I am uncertain as to the definition of the word, "These", in the supplemental note. What materials are in reference here that "must be readily available where patients are transfused"? Again, this must be some type of information that the transfusionists/nurses would need access to. If so, do they need to be in the actual patient's room, or just available in the nursing stations. And what would it actually be?

Hope I do not sound too clueless here. It's just that, well, I am. But I do thank you for any advice and pathways to information that you can provide.

Bob

[bmarotto]

Our hospital's transfusion reaction policy, which was approved by the Transfusion Committee and the Medical Practice and Utilization Committee, is in the Clinical & Administrative Policies and Procedures Manual. This manual is posted on our intranet and is available from any PC on our network. The signs and symptoms of reactions are also on the cover sheet of the transfusion reaction investigation form, which is stocked in all areas that transfuse blood products. The signs and symptoms of reactions will be included in our next revision of the Transfusion Medicine pocket card which is given to all staff physicians, residents, and fellows.

Recognition of tranfusion reactions is covered in new nurse orientation. Annually thereafter, it is one of the topics covered in the mandatory nursing skills fair. Our nursing education department coordinates and maintains records of initial training and annual skills fair attendance. Our medical director speaks to all medical and surgical residents and fellows each year.

This system has satisfied all our inspectors so far.

[Mary]

The reaction procedure is part of the nursing manual. They include it in the new nurse orientation. All other nurses are required to review the symptoms annually. The education coordinators oversee this and send me a copy of a form that I designed that has all the names of the nurses who have done this.This has satisfied the inspectors so far.

[caj1018]

At our facility (and most I suspect) each unit issued is accompanied with a transfusion form or transfusion tag that has a place to record vitals and also includes a list of transfusion reaction symptoms and for us the back of the card has the instructions to follow if symptoms occur. That complies with the documentation of symptoms part. Nursing inservice at our facility occurs yearly as part of a competency review and consists of a posterboard with signs and symptoms and a miniquiz which quarantees that the staff must read the posterboard.

[Eagle Eye]

Our nurses go through a lecture on transfusion medicine during their orientation(transfusion reaction is included there). They have to take competency after that and yearly competency on transfusion reaction is in their file.

[Lcsmrz]

One facility produced inexpensive "webinars" for nurses as part of their annual Skills Fair, with an online post-test to make sure everyone listened to it. Nurses can view them whenever they have time or review them as needed.

They used their monthly "transfusion practice" audits to ask a few questions about reactions as a training assessment.

The facility uses the same system for annual lab training ...

The word "these" refers to the reaction criteria. We print them on the back of our transfusion forms. Our EMR software has pop-ups available, should we go to on-line documentation.

[Geriann]

We have the instructions for possible transfusion reaction on the Transfusion Record Form. It list specific instructions for the RNs to look for and monitor and when to stop the transfusion and call the MD.

The Nursing manual also addresses this issue.

The instructions on the Transfusion Record Form are gone over during the annual Skill Faire for Nursing.

Geri

[babsglab]

Hello everyone,

Right now I am dealing with the issue of educating nurses on the topic of transfusion reactions, so this topic has great interest to me.

I will be present at the nursing skills seminar with a small handout and short test. Signs and symptoms of a transfusion rxn are posted on top of the transfusion flow sheet but everyone seems to miss reading them.

I would like to discuss criteria for "calling" a transfusion reaction.

Does everyone use a 1 degree C rise in temp from baseline temp as an automatic call for a transfusion reaction workup? Babs

[bbkdiane]

We do the following:

1. Nursing SOP for Transfusion is readily available on a common computer drive available to all personnel. I helped write the SOP for nursing.

2. Each year I make up a short 5 question quiz for my BBK staff based on the latest information on Transfusion Reactions for their continuing ed.

3. We have a Lab Newsletter for physicians called Under the Scope which is a great vehicle to educate physicians to new items and review of problematic issues. Each lab section contributes. We also actively participate in the orientation process for new nurses: we have a Lab Powerpoint Presentation that different techs take turns presenting to the orientees. Transfusion Reaction information is part of this.

4. As BBK supervisor, I offer quick 20 minute reviews annually to the nursing units at their convenience: I e-mail a series of dates and times that I'm available and go to the lounge of the nursing unit...with a basket of chocolate candies and some hand outs of the topic. I make sure to include anything that the unit has had issues with in a friendly non threatening way. The nurses do not receive CEUs because the reviews are short; but the Nursing VP gets a list of who attended and it does count for something for them. They are very receptive...I think the candy is key.

5. Nurses can e-mail me directly with questions regarding BBK policy. The answers are shared with others. The questions can indicate a target need for a particular topic inservice.

6. I am getting ready to redo my transfusion unit tag for our upcoming switch from Misys to Meditech. We already have instructions printed on the back of the tag that instruct the nurse on what action to take if there is a reaction, but I am going to add some symptoms to the instructions.

You can make this a win win situation. Reactions are rare. Nurses will tend to forget what to do unless you have some system of reminders in place. I know, you're busy and short staffed; so am I. Like Nike, just do it!!

[babsglab]

Thank you so much bbkdiane, I will follow a similar format! Babs

[rcurrie]

One of the best "quick and easy" sources for signs and symptoms of transfusion reactions is the Circular of Information (see page 5, Side Effects and Hazards). The COI should be given to each nursing unit that transfuses blood (or available on line).

I give a transfusion inservice at all of our general nursing orientations, and I give inservices on special request. I also make my PowerPoint presentations available to all nursing QI reps, and they in turn give inservices. I will share my presentations with anyone here who requests them. Just drop me a line at rcurrie@swmail.sw.org . You can modify them anyway you wish.

I recommend that someone in the blood bank establish a working relationship with the nurse QI reps. Each nursing unit most likely has one. These are your frontline contacts, and they can help you meet the standards.

BC

[Victoria T.]

I am a little late jumping into this discussion, however, this caught my eye as we also were inspected by the CAP in June, and were cited for this as well (TRM.41650). A section giving the signs and symptoms of a transfusion reaction and how to proceed should one occur is (and has always been) part of the transfusion form which accompanies each unit signed out of the blood bank. Also, these signs and symptoms are included in nursing orientation and are part of the nursing patient care policy for blood transfusion. However, our surveyor said that this did not satisfy the intent of the question. There must be a routine periodic inservice for all nurses. Our response to this citation was to immediately re-inservice nursing staff for signs and symptoms of a transfusion reaction, and to add the requirement for periodic inservice to the nursing patient care policy. We sent agendas for inservices given at that time and a copy of the modified nursing policy to CAP.

[bernvil]

In our setting we decided with the hospital adm. that blood administration including watch for transfusion reactions requires specific periodic training of nursing staff. We are in the process of adopting an e-learning course that takes staff through the different scenarios with links to relevant background info. Nurses must pass the test prior to handling blood transfusions. The test must be repeated every 24 months. A management system reminds staff to renew the competency test.

Kind regards,

MD, Denmnark

[babsglab]

Thank you so much for all your input. Last Friday I participated in the nursing staff "skills fair" which is held every 6 months. It is mandatory for all nurses to attend 1 a year. I presented handouts on blood administration and transfusion reactions along with a little quiz. I've put all this in a binder to keep at the nurses station for new staff.

It's important the nursing staff knows how important they are to transfusion medicine and that they feel supported with any questions. Thank you again for all your help! Babs