Transfusion Reactions - Timeliness

[dmpollock]

Our nursing people have switched to a computer based reporting of transfusion reactions. Since it is a rare event for each nurse to ever have to fill out a report, they are not proficient at it.

In auditing records, I find it takes them >5 HOURS to get the report to the blood bank. They get confused by the computer and end up re-reporting on paper. In 1/3 cases the report never even gets to the blood bank!

I know it is a bit much to ask, but I am setting a standard of 15 minutes max to get the report to us. If we are to identify an ABO-incompatible error, time is important in order to start treatment. Does anyone else have a standard, or have you looked at your data?

I plan to change our procedure to have the blood bank initiate the blood bank part of the investigation and test ordering based on a phone call from nursing, rather than wait for a report. Does anyone use this approach?

[RR1]

We use the approach of the clinical staff calling us as soon as a T.R is suspected. Currently we take details of the reaction/ symptoms over the phone, but next year will be sending a form out once the initial call has been received for the ward staf to complete.

[Lcsmrz]

We also require a call, since our pathologist needs to OK further transfusions.

[LAS]

We do not yet have electonic recording of transfusion reaction workups for nurses. They are required to notify the laboratory immediately upon suspicion of a reaction, and the paper form that they complete indicates what time the transfusion was stopped and what time the laboratory was notified. After we received notification, if appropriate paperwork is not received in a relatively short period of time, we request it. We audit every chart that has a suspected reaction and fortunately have not detected any problems with excessive delays in notifications. We consider this a STAT procedure, so in my opinion it would be absolutely appropriate to set some type of standard.

[eric1980]

For my hospital, the clinical staff got to call the BB to inform us of the reaction, and then we will get some information and then get the nurse to fill up a TR form. The form will state exactly what specimens to send, as well as some of the patient's vital signs that we need to know.

And then we wait for them to send everything down.

[CYGI]

Once the nursing unit notify the blood bank of a possible transfusion reaction, we normally begin the process of sending the phlebotomist to the unit for post-transfusion specimen, with the form for the nurse to fill out. Notify the nursing unit that the form must be filled out immediately so workup can begin, also inquire if additional units are needed. The pathologist is notified with all information after workup is completed.

cygi:o

[Mary**]

Does the pathologist review them 24/7 even if the work up was negative?

[Malcolm Needs ☆]

I'm not sure, but I believe what is being discussed in this thread is a rise in temperature and other minor symptoms.

I am worried, though, that there are some places where the report of a suspected transfusion reaction takes so long to get to the Blood Bank.

In the case of a more acute transfusion reaction, the symptoms of a red cell antibody reaction can mimic the symptoms of the transfusion of a bacterially infected unit of blood or blood component. If the unit or the blood component is bacterially infected, your Blood Supplier needs to know as soon as possible, because other components made from the same unit may be out there at another hospital (or even in the same hospital) and these need to be quarantined with immediate effect.

I'm not entirely sure how well the ward staff understand this, and the need for any suspected transfusion reaction to be reported to the Hospital Blood Bank, and then on to the Blood Supplier as a matter of urgency, and we need to get this information across in words of one syllable.

:eek::eek:

[L106]

I'm not sure, but I believe what is being discussed in this thread is a rise in temperature and other minor symptoms./QUOTE]

No, Malcolm, I don't think dmpollock made any distinction regarding the severity of transfusion reaction, just in the time delay to get the event documented/reported to Blood Bank.

What CYGI described (in a couple posts above) is what happens with transfusion reactions at our institution. No, our pathologist does not review reaction reports 24/7. Our Blood Bank reaction workup procedure explains very clearly what test results and patient's clinical symptoms indicate the possibility of a "serious" transfusion reaction (ie: hemolytic, anaphylactic shock, bacterial septis, TRALI, DIC, etc.) In those cases our pathologist must be notified immediately.

[CYGI]

:)To answer the question regarding pathologist review for all possible transfusion reactions, the senior tech reviews the workup and it is their responsibility to inform the pathologist. The thread is regarding timeline, how did we get on temperature and other transfusion reactions?

This may be a suggestion to help with the time line, talk with the techs in your department and see what they can handle as far as communication with the nursing units, just to make waves you can ask that any transfusion reactions, report to blood bank and than document how longs it takes to start the workup, with the information that was gathered, get with the nursing director and reach an agreement on how to make the process more effective for the patient. I have learned without documentation that it is hard to get any resolution to a problem. Everyone wants to pass the buck, no one wants to pick it up.

Good Luck

[LAS]

Yes, someone in our pathology group is advised 24/7 of transfusion reaction workup results, even if negative.

[adiescast]

We still use paper reports for transfusion reaction workup requests. We get a phone call when they detect the reaction. We begin the workup when we receive the paperwork, the post transfusion sample and the blood bag. Nursing has instructions to stop the transfusion when they detect a reaction. They must also call the doctor to obtain instructions as soon as they have informed blood bank. I have not audited to see how long it takes for them to get us the paperwork after they report the reaction.