BBTS Standard 5.19.8????

[Skinrash]

Would anyone be willing to share their organization's policy that covers this AABB Standard.

" Specific written instructions concerning possible adverse events shall be provided to the patient or a responsible caregiver when direct medical observation or monitoring of the patient will not be available after transfusion."

My question to everyone is... What is a good time frame for after a transfusion...12 hours, 24 hours, 48 hours???????

My next question is how do you handle your inpatient population with this standard?

Thank you for your help!

[David Saikin]

Nursing is the responsible caregiver while the patient is in house. We provide a written instruction form for the patient to take home . . . either in or out patient. It describes symptoms to look for after transfusion. I believe we say to observe for up to 1 week. 6 months for any TTD complication.

[tbostock]

For inpatients, they are being directly monitored by nursing. So I believe this standard only applies to outpatient transfusions, where they are going to be discharged after the transfusion to go home. We give each outpatient a discharge instruction sheet which covers information about possible signs of transfusion reaction, and instructions to call their physician immediately for anything unusual.

[Skinrash]

Thanks, tbostock, so you don't think that this standard applies to those inpatients that may be discharged within a short time following a transfusion? We see this often on our oncology unit. A patient may be here for a day or two and the Doctor wants to discharge them following a transfusion. Or our Open Heart patients typically stay between 4-7 days and have received transfusions post-operatively the day befor they go home. I would think they should be sent home with instructions and what to look for. In these cases, what would sound like a good time to you for them to be considered unmonitored and would be required a discharged instruction sheet? Thank you for your help!

[tbostock]

Skinrash: We don't have inpatients who are immediately discharged after a transfusion. But your original question included times of 12, 24, or 48 hours...seems a little long to me. The standard reads "after transfusion", which is up for interpretation. Of course all of our patients will be discharged sometime after a transfusion, so I guess we would have to incorporate something into our hospital discharge instructions about transfusion reaction symptoms if a patient has received a transfusion at any point during their admission. Because we don't see inpatients here in the Blood Bank, and if we handed out instructions to nursing, they would never make it to the patient.

How does everyone else interpret this standard, and how do you ensure that inpatients get the information?

[Eagle Eye]

Our policy nursing policy require patient monitoring up to 6 hrs after transfusion (because of TRALI).This is inpatient.

Our out patient can go home 1 hour after transfusion but we have a discharge instruction.

[ANORRIS]

Could you email me a copy of your discharge instructions?

Thanks! Alicia anorris@georgetownhospitalsystem.org

[adiescast]

Outpatient transfusion areas have discharge instructions for patients who come in only for their transfusion and then go home. We do not currently provide discharge instructions for inpatients who have been transfused. It would be very rare for a patient to receive a transfusion the day they are discharged. If they did, it really should be treated like an outpatient transfusion, but I don't have anything in place to make sure that happens...Yet another project!