Rhogam

[sarahk]

Does your facility require that a pharmacist review all Rhogam orders?

Our pharmacy is insisting that Rhogam is a medication and that the order must be reviewed by a pharmacist before administration. I'm not at all thrilled with this idea.

[jhaig]

Rhogam should fall under the transfusion service simply because it is a transfusion issue, not pharmacological, when deciding to give Rhogam. What advantage does the pharmacy expect to gain from reviewing all Rhogam orders? The blood bank's job is to determine which patients need it or not. Rhogam is a concentrate of predominantly IgG anti-D derived from pools of human plasma, so their thinking may be that it is the same as giving something like IGIV. But it's definitely not the same as giving an antibiotic. I wonder, has your blood bank given Rhogam in the past and for how long have you done it? Why is the pharmacy suddenly insisting on this action?

Our pharmacy used to handle albumin, but they couldn't keep track of it and didn't keep up the paperwork, so we took it into the blood bank. No problems since then.

Most places I know of leave the issue of Rhogam to the blood bank. If it's not broke, don't fix it. I'd keep the pharmacy out of it altogether.

[rcurrie]

Blood is a medication under FDA regs. Ask them if they want to review those orders, too.

BC

[sarahk]

Bob, I thought about that! I want to bring it up...though I'm a little afraid they'll say yes.

It is my understanding that Joint Commission is behind this. Another blood bank supervisor near us has been approached about the same thing. I find it ridiculous--what do pharmacists know about blood bank? There are very few contraindications for Rhogam and blood bank are the ones likely to know about patients who shouldn't get it, not pharmacy.

We have dispensed Rhogam for as long as anyone can remember and have a nice computer system that handles inventory and dispensing. We have a simple, straightforward, computerized process that they want to replace with a mess of phone calls, faxes, and paper. Despite the Joint Commission thing, this was mostly precipitated by a billing problem they can't find a way around in a new computer system.

I'm concerned about meeting the CAP requirements for keeping track of Rhogam administration if it's not in our hands. We deliver more than 3,000 babies a year, so that's a lot of Rhogam.

[JMunden]

Last year Pharmacy took control of our Rhogam (after dispensing > 20 years from Blood Bank) to be compliant to Joint Commissions requirement that the pharmacist have prior review for appropriateness of order: As Joint Commissions deems Rhogam a medicine, not a product...Funny doesn't have an NDC #. Anyway, conversion was easy we added a prompt "Rhogam indicated yes or no" to "help pharmacy out with their interpretation".

Actually, it is convenient to have them deal with any "look back" issues in case of recall, and they can deal with the RN's requests for the product...oops, I mean medication.

[rcurrie]

When you hand this over to Pharmacy, be sure to thank them for accepting all liability for violating FDA regulations.

BC

[Lcsmrz]

I've been trying for years to get rid of RhIg and all of its headaches -- Pharmacy refuses to take it! I thought the JCAHO requirement would allow me to finally rid myself of it, but I was wrong.

We don't do ABO/Rh on all OB admits, and we only see the cord bloods when testing is ordered. It's an administrative nightmare to try to track things.

[Mabel Adams]

When you hand this over to Pharmacy, be sure to thank them for accepting all liability for violating FDA regulations.

BC

OK, tell me what liability you speak of. Our pharmacy has handled RhIG for close to 15 years.