Transfusion Audits

[bmarotto]

Is anyone still doing audits of transfusions, or is it left to each nursing unit to perform audits if desired? We currently have a tech follow a unit of blood from the Blood Bank and observe the initiation of the transfusion. They look for things like verification of the order to transfuse, patient and patient/iunit identification verified by two nurses, verifying unit is not expired, and that nothing other than saline is hanging with the blood. We do this four times a month (twice on first shift and once each on 2nd and 3rd shift). We have not found any problems so I am wondering if we should discontinue this audit. We can certainly find more productive things to do.

[vam3401]

We also used to do this audit more often, but found no problems, so discontinued the continuous type of audit. Now we just perform this type of audit once or twice per year to continue to monitor the process.

[adiescast]

My opinion is that if you do several audits and don't find anything, you probably don't have a problem in that area and you could profitably move on to something else. You could do spot checks periodically to see if you had no problem because you were watching or if you really had no problem. Look at areas that are most likely to have problems (areas that transfuse under stress or don't transfuse often enough to maintain competency) if you decide to spot check.

Find something to audit that may need improvement. One thing we have found is that nursing documentation of transfusion is terrible, but their administration isn't bad.

Just my two cents...

[bmarotto]

One thing we have found is that nursing documentation of transfusion is terrible, but their administration isn't bad.

Just my two cents...

Isn't that the truth!. I am so looking forward to the electronic documentation of blood products.

Anyway, thanks for the replies. I agree there is not much to gain continuing with regular transfusion audits.

[AMcCord]

We have electronic documentation of blood product transfusion. We went from near perfect paper documentation to a documentation error rate of about 25% electronically. A recent CAP Q-Probe points out their failings. When their electronic documentation form was in the design process, they (nursing service) asked for my opinion. I told them they were setting themselves up for a high error rate by not having required entry fields (like so many of our lab report forms have) and by designing a form that required lots of scrolling up/down and left/right in order to fill out or review entries. Guess the new error rate supports my point of view. So, my advice is...don't regard the electronic form as the answer to all your problems. It's going to take some careful form design, excellent training for users (another problem our system has), and ongoing review to police it. I would sure like to convince nursing service to do their own policing. Wish me luck there!

[adiescast]

Good luck with that!

Often electronic methods just allow people to make more mistakes faster unless there is careful design consideration up front.

[tbostock]

We still perform an audit once per month.

[BankerGirl]

So for those of you who discover problems, how do you proceed with audits? Do you perform them more often, concentrate on the "offending" person/unit... I have recently begun performing the audits, since it "takes too much time" for our Care Management department (like I have the time!) and we have horrible documentation, especially in the critical care units. Looking at the documentation in the past, we seemed better because Care Management did not count the ones where the documentation was incomplete. Yikes!!!!!!

[adiescast]

Usually when we start something new (or re-start as you seem to be doing), we do broadcast education for awhile. Then we go to individual education after we have made sure the message was out there for all. It helps if you can get the WIIFM (what's in it for me?) message out clearly. With documentation, that is usually the threat of citation by an outside agency that they care about (which means JC for nursing in the US. Sometimes FDA or State will also work. AABB and CAP don't have clout with nursing as far as I can tell).