After a transfusion we don't get anything back, do you?

[John C. Staley]

We are trying to standardize our bagtags corporate wide due to a new computer system coming online. One of the problems is the "bagtags". To make a long story short the best system for us would be a single copy form that gets posted in the chart and nothing is returned to the Transfusion Service after the transfusion is completed.

A few of the supervisors are concerned that if they don't get anything back how can they monitor the transfusions like they have been doing for years and years and years and years.

I have not had anything sent back for over 5 years. I currently do a one month audit of every product transfused during that month, twice a year. What are those of you who don't get anything back do, if anything in the way of audits so I can provide these folks with suggestions. They think my system is tooooo much work.

[C Lumbert]

We are trying to standardize our bagtags corporate wide due to a new computer system coming online. One of the problems is the "bagtags". To make a long story short the best system for us would be a single copy form that gets posted in the chart and nothing is returned to the Transfusion Service after the transfusion is completed.

A few of the supervisors are concerned that if they don't get anything back how can they monitor the transfusions like they have been doing for years and years and years and years.

I have not had anything sent back for over 5 years. I currently do a one month audit of every product transfused during that month, twice a year. What are those of you who don't get anything back do, if anything in the way of audits so I can provide these folks with suggestions. They think my system is tooooo much work.

John,

We also do not get copies of transfusion records back in blood bank. Our hospital Quality Assurance Department monitors transfusions for appropriate documentation and compliance with procedure.

This may be an unusual arrangement, but we are a free standing laboratory (half-owned by the hospital). We provide transfusion services, but the hospital does all their own quality assurance.

Hope this is helpful.

Chuck Lumbert

[Franklyn]

We do not receive a copy of the transfusion report form (bag tag) back either. The record of the transfusion is in the computer system and easily accessible and as our nurses do not document the transfusions in a standard manner (surgery is on a flow sheet, Heme-Onc is on a special sticker they apply, Nursery is in the computer, etc). Return form serves no purpose. However, we use a multi-ply form. The floor gets the top and second copy, we keep the third. The top copy goes into the charts. The second ply goes to the nursing manager for their audit. The bottom copy stays in the blood bank as a temporary record in case we get the unit back (as in from surgery).

Transfusion audits are a tricky thing. The nurses have their audit (which is really just a documentation audit). Random spot audits are done periodically to check practice. We do not, have not and have no plans to audit every transfusion as you do. We transfuse about 5,000 blood products a month so such a detailed audit would be impractical.

[Eagle Eye]

It all depends on your state requirment too. I know for a fact that NJ STATE requires that a copy of transfusion tag return to blood bank after tranfusion. STATE requires blood bank to audit them and take corrective action. Eg. if transfusion lasted for >4 hrs, >2F temp rise form the baseline etc.

[Lcsmrz]

We are rapidly heading to online documentation via the EMR. Once verified that everything is working, we won't be asking for anything back. A report of the information will be audited by the nurses, and we will make sure that everything issued is documented. But it will all be done online.

[Karen Olsen]

We have not received a copy of the transfusion record back from the floor for probably 20 years now. We do spot checks on the floors and our PI department has retro access via the electronic medical record -this data is included in our QA report each month. One of our sister facilities is very disappointed in this untimely data reporting and would like to go back to sending a copy to the BB for immediate review and resolution. I like Franklyn's procedure of the Nursing manager getting the second copy for review and resolution. Put it back on them! We do keep a copy in BB which gives us the issue record documentation - this has been invaluable to us! Eventually we are going to migrate to an electronic record such as Carefusion where all of the desired information will be available in the computer-real time! Can't wait!!

[Mabel Adams]

We not only don't get any paper back from nursing, we don't provide the record for the chart in the first place. Our units have only a compatibility tag. (Less chance for mix-ups.)

Nursing was using a transfusion flow sheet even when we still got papers back so they didn't need a transfusion slip for thier documentation. They used to put the slips in the chart but then they were in the Labs section and the flowsheet was in Graphs. Now the ID check etc. are part of the flow sheet and everything is in one place. (Well, the computer record of BB is still part of the Labs section.)

They do their own auditing.

[rcurrie]

Back when I was Blood bank QA instead of running high speed passenger and freight trains, our compatibility tag was 2-part. The nurses documented start and stop times, vital signs, whether a warmer was used, and how much blood was transfused. They were filled out correctly about 33.275 % of the time (rough estimate). My blood audits were 10 RBC units a quarter, 5 SDP units a quarter, and random audits of cryo and plasma. The FDA was happy with that.

BC

[LAS]

We get nothing back either. Our units have only a compatibililty tag attached and it is placed on the chart after the transfusion is completed. Nursing documents the transfusion using their form. Monthly chart audits are done by Blood Bank. We only transfuse around 300 units/month, so we are able to audit about 10%.

Good luck with your plans; change is hard!

[John C. Staley]

Thanks everyone. I appreciate the input. I now have suggestions to help ease the change forward.

[Eoin]

John

Just FYI. I know this is not your law or requirement, but stemming from an EU Directive here in Europe, the issuing laboratory must fate the blood, and requires us to store Traceability Labels, which are returned at completion of crossmatch. This directive is enforced in European Member States by statutes from the contry in which you operate.

Eoin

[garnerk]

A single copy transfusion tag is placed in the patient chart. An audit of the transfusion process is performed once every two years. In addition, an audit from receipt to final disposition is performed utilizing one example of each type of product twice a year.

[huntilla]

We are trying to standardize our bagtags corporate wide due to a new computer system coming online. One of the problems is the "bagtags". To make a long story short the best system for us would be a single copy form that gets posted in the chart and nothing is returned to the Transfusion Service after the transfusion is completed.

Well, I think it is wonderful to have only one copy of the bagtag floating around, we currently have three. We do not have a Blood bank software module and we use a sign-out tag printed to nursing, a "bagtag", and nursing faxes the original upon completion of transfusion. I am thinking of doing away with the faxing since we now have the choice to review online the medical record for transfusion discrepancies. In the near future we are going to implement Horizon Blood Bank and I am hopeful that this diminishes our hard copy filing to near zero.

Barr Antilla, MT(ASCP)

Blood Bank coordinator