Transfusion Review Committee

[GilTphoto]

Who presents the statistics at the Transfusion Review committee?

After being promoted to BB Supervisor, it was 6 months before getting caught up with Transfusion review. There were 47 pages of reports. I was given 5 minutes to discuss them.

Because I objected and continued to talk, the COO told the Lab Manager, he only wanted him to present the statistics and not me, from now on. I have tried talking to the COO, but he insists he only wants department managers at that meeting. I'm not even allowed to attend.

This is not a separate Transfusion Review Committee, only a part of the Medical Executive Committee. I recommended a separate committee for transfusion, but no one is interested.

[tbostock]

Check your state regs to see if a separate Transfusion Committee is required (it is here in NY State). It's not easy, getting proper attendance is always a challenge, but if you can get a few docs that are interested it can be very beneficial to have the separate meeting. I've only presented at the Medical Executive Committee a couple times here, and you're right, they don't want you there if you don't have COO or MD at the end of your name. We can get a lot more done at our separate Transfusion Committee.

[Eagle Eye]

BB supervisor and QA presents STATs and if there is any new information, usually BB director presents it. But we have transfusion Committee.

I think once a year we present @ med exe comm. meeting...which is very short and only few graphs and <10 min.

YOu can achieve or improve process if you have separate comm. You can start with two meeting every year. We meet every quarter.

[krichards]

Our Transfusion Committee was disbanded about 5 years ago due to lack of interest and participation. Every time the issue comes up, our pathologist chooses not to re-create the committee for the same reason.

Our stats are currently presented in our Quality Council and Patient Quality & Safety Council...the former is physician-only, the latter being primarily dept. administrators. Because the BB stats are only a small fraction of what is covered each month, our medical director and lab director present these stats in the meetings, not me. When I have all my reports completed each month, I simply email them to the lab and med directors with my comments. These comments are then repeated almost verbatim when they are presented. For us, this arrangement has worked well for everyone involved.

[kslaforce]

The Joint Commission is on the verge of adding quite a few metrics surrounding transfusion practice. This may impact how your tranfusion review is handled. Our transfusion committee is a subcommittee of P & T, reporting there once per year but meeting quarterly. Our Lab Medical Director is the Chair and we have representation from the major service lines and nursing on the committee as well. We are using it as a springboard to bring our transfusion practices in line with the latest available liturature. In the two years we have been activiely pursuing this, our red cell usage has decreased almost 10%. You might get more buy in from administration if they realize that monitoring and actively working to bring physician practice in line with the latest research regarding blood usage will bring down costs.

[David Saikin]

Our "utilization" review is done at infection control meeting. This is supposed to be peer review, not mine as BB Mgr. With the retirement of our full time pathologist, the docs have set back transfusion practice 30 yrs . . . I am absolving myself of any participation except providing stats. The docs don't want good transfusion practice . . . they want to do whatever they want. Very disappointing.

[GilTphoto]

... With the retirement of our full time pathologist, the docs have set back transfusion practice 30 yrs . . . I am absolving myself of any participation except providing stats. The docs don't want good transfusion practice . . . they want to do whatever they want. Very disappointing.

Sounds like my hospital. I work in a third world country (Miami, FL). Most of the doctors did not go to med school in the USA. No one speaks English here. They do whatever they want and waste many FFP and PLT's.

We had 477 inappropriate transfusions last year (about 11%). Inappropriate FFP transfusions in February was 56%. They transfuse 1-2 units prior to procedures if the PT ot PTT is 0.1 out of normal range. PLT's are transfused if < 100. They have no idea how many units to order either and always over order. They do not follow up with post transfusion testing (20%). 165 patients received RBC's with Hgb >9. We also discarded 51 units of FFP thawed but not used.

Our Pathologist does nothing to stop it. The last Medical Exec Comm, our Lab Manager was given 30 seconds to discuss 40 pages of reports. I'm wasting my time creating these reports, but can't get out of them.

[tbostock]

You might get more buy in from administration if they realize that monitoring and actively working to bring physician practice in line with the latest research regarding blood usage will bring down costs.

In implementing our Blood Conservation Program, it was Administration that was on board, NOT the physicians. They still aren't. But we decreased usage by 50%. It's worth the effort for patient care, but is a tremendous amount of work and fighting. The Joint Commission's new proposed performance measures should help bring some hospitals up to speed with the latest recommendations. With the blood shortage, the increasing cost, and the studies coming out just about daily about transfusion risk, we have to keep plugging.:shakefist

[TStec]

We have a Transfusion Practice/Blood Utilization Review Committee that meets every other month. It is chaired by the Transfusion Medicine Service (TMS) Medical Director and consists of representation from nursing practice, quality & PI department, infection control and physicians from ER, OR, Anesthesiology, Cardiac Care, Pediatrics & Hematology Oncology. From TMS, the manager presents news and update of activities, the QI tech presents various statistics according to self assessment/ quality monitoring schedule and the blood utilization review nurse presents interested cases. I present perioperative, tissue issues and transfusion reactions. There is a standing agenda and minutes are kept by TMS secretary. These are e-mail to members before the meeting. Others are invited when issues occur in their department. This meeting is held during lunch which is provided and CMEs given to encourage physicians to attend.

[martha]

I am aso from Miami , Florida and I have to disagree with David Saikin , Miami is not a third world country. In the Hospital were I work everyone speaks English and the physicians obtained their medical degree in the USA .The committee meets Quarterly and it's chair by one of our Hematology/oncology physicians. We have representation from nursing, infection control, anesthesioly , PI, transfusion services and our Medical Director. We present monthly statics, waste,appropriateness, transfusion reactions and any incident report related to blood products. The committee also reviews and recommends on any issue that has to do with blood products. This year our goal is to reduce our waste by 50 %.

Martha Delgado, BS MT (ASCP)

[allahbaksh]

Well, I may be lucky here in India to be a Pathologist who is Director Blood Bank, in a teaching hospital. We have 3 monthly transfusion committee meetings attended by our COO, Heads of Surgical and Medical Dept.s that use blood, the Pathology Head, and interested participants (we ask for agenda points ahead of the meeting). I present the statistcis and any important transfusion-related events, put acroos our take and any requests we have - this is then brieflly debated on and decisions taken after discussion. Though the thoughts and interests of the people who take part differ, I think such meetings are important cos they keep communication between dept/s alive... that COO in the 1st post doesn't really appreciate the importance.

[RR1]

You could try submitting the information as ' this is how much poor practices is costing our hospital'.

Blood wasted = $$$

FFP wasted = $$$$$$

Platelets wasted = $$$$$

one powerpoint slide might do the trick......try asking the director of finance to attend the meeting.

Edited April 7, 2009 by RR1
.

[GilTphoto]

You could try submitting the information as ' this is how much poor practices is costing our hospital'.

Blood wasted = $$$

FFP wasted = $$$$$$

Platelets wasted = $$$$$

one powerpoint slide might do the trick......try asking the director of finance to attend the meeting.

We already do. Last year total was $61,000 for a total of 477 inappropriate and wasted units.

[Eoin]

Hi Folks,

One thing the EU Blood Directives have given us is impetus to our Transfusion Committee. Has been runing about 3 years now and is very beneficial. I agree, it is difficult to get medico interest, but one or two movers and shakers are handy. The Committee is chaired by the Consultant Haematologist, Blood Transfusion. Members are Lab Services Manager, Senior Bloodbanker, Lab Quality Manager, Haemovigilance Officer, Director of Nursing (or Deputy), Hospital Best Practice Manager and Nurse Practice Development coordinator, Medical Physician, Surgeon and Anaesthetist (last often hard to get because of work patterns) It is a lively committee and the chair gives feedback to the Medical Advisory Committee. He also (very politely) pulls over-orderers back into line (we do individual C/Ts). We review Non-conformances; Any Adverse events or reactions; Blood Wastage and any complaints, staffing issues etc. It does work well and is VERY useful and here is required by law. (At least one sensible law that helps patient safety and improves practice)- Cheers & good luck.

[RR1]

Thanks Eoin,

i'm going to show the chair of my HTC this message, and see if we can also get these other key people more actively involved in our meetings- which need a bit of interest and enthusiasm injected into them.

[bbbirder]

This is an interesting discussion. At our hospital, there is no transfusion committee, these functions are addressed in a peer reviewed Medical Excutive committe or subcommittee. I don't do anything except provide statistics. However, I also communicate directly with the quality care department and will suggest, 'can you review this chart?'. We aren't a large institution, so it works pretty well for some inappropriate use.

However, if you are really going to impact use, you need administration at the top on board. In my experience, most pathologists are not willing to question orders and physician education about blood use is falling behind. They may try to keep up with the literature, but mostly remember what the were taught, 5, 10 or more years ago.

This is a challenge.

Linda Frederick