Nursing Home Transfusions

[DMR]

We are looking into the possibilities of providing pre-transfusion testing and blood products for Nursing Homes. At this time, it appears that the plan is have specimens collected and labeled at the Nursing Home using a BBID Labeling system. We would then perform compatibility testing blood products. These units would be sent via a courier system in monitored cooler to the Nursing Home.

If you are providing this service, I would appreciate any information that you would be willing to share about your process.

Thank you,

DeLilah Rosecrans, CLS(NCA), MT(ASCP)SBB

Laboratory Manager Transfusion and Quality

MeritCare Medical Center

P.O. Box MC-0041, 737 Broadway

Fargo, ND 58122

Phone: 701-234-2493

Fax: 701-234-7316

e-mail: delilah.rosecrans@meritcare.com

[Karen Olsen]

We used to provide this service exactly as you described above. We would have them go by our P&P and have to prove competency which was tricky at times. Now there are some new regulations in place that do not allow nursing to perform transfusions without a physician accessible so we no longer provide this service. Our blood centers can no longer perform therapeutic phlebotomies for this same reason. They are all performed in a hospital setting now.

[L106]

Karen - Do you know any more specifics about the new regulations that do not allow transfusions without a physician accessible? The reason I'm asking is because our Out Patient Transfusions are now done in a building separate from the hospital (but on the hospital grounds.) Any idea of what they specifically mean by "accessible?")

I do know that 3 or 4 years ago the local Hemodialysis Centers (not affiliated with our hospital) stopped doing transfusion during dialysis because of changes in Medicare reimbursements. (I do not know the details.) But you might check into this, DeLilah, before you do much work to set this up.

[RR1]

We are looking into the possibilities of providing pre-transfusion testing and blood products for Nursing Homes. At this time, it appears that the plan is have specimens collected and labeled at the Nursing Home using a BBID Labeling system. We would then perform compatibility testing blood products. These units would be sent via a courier system in monitored cooler to the Nursing Home.

If you are providing this service, I would appreciate any information that you would be willing to share about your process.

Hi DeLilah,

You would first need to set up a technical / service level agreement with the nursing home that states how you require the following aspects of the complete process to be handled :

1. Collection and transportation of samples- which includes labelling criteria.

2. Transporting and handling blood components at both ends (lab and nursing home) and by couriers.

3. How any adverse reactions to components would be handled and communicated to the lab/ medical staff

4.Training of all staff in the correct blood component handling/ transfusing/ traceability recording etc practices.

5.Communication with the lab.

6. Ability to perform quarantine / recall any units immediately once they have left the laboratory.

7. Storage of units within the validated coolers and return of unused units and documentation to the lab.

Place these on a matrix and write which 'side' is responsible for the various aspects.

Edited August 6, 2009 by RR1