CAP Question TRM.42315 Therapeutic Phlebotomy

[Michaele]

Hi all, I am struggling with the new therapeutic phlebotomy CAP question:

Are the indications for therapeutic phlebotomy reviewed by the physician responsible for performance of therapeutic phlebotomy prior to initiation and not less frequently than every 12 months thereafter?

Here, our technologists perform therapeutic phlebotomies and they review the patient files just before the procedure. The pathologist does not review the phlebotomies at all. (In fact, my pathologist really doesn't want to have responsibility for them at all--if she could get out of that she would)

What are your policies concerning therapeutic phlebotomy reviews? Would a QA study suffice? Or---can my pathologist delegate this responsibility to the technologists who are performing the procedure, since we are doing it anyway? Some guidance would be appreciated.

Thanks!

[LaraT23]

My view is that if the pathologist reviews the criteria every 12 months, then he can delegate the day to day review to the techs. But, there should probably be a statement to that effect in the policy.

I am lucky here, Nursing does the therapeutic phlebotomies here, I don't even know they are going on most of the time!

[adiescast]

The pathologist has to be involved in establishing and maintaining the criteria if the lab is responsible for therapeutic phlebotomy. Most places I've inspected have the pathologist review each patient before the first time they receive the procedure to ensure that they are candidates and then annually after, if the patient continues to require the procedure.

Have you checked with CAP to see what their intent is with this new requirement?

[SMW]

This was listed as one of the most common deficiencies during a recent AABB teleconference. A question was asked concerning this specific item and the CAP spokesperson responded the intent/expectation is the physician overseeing the staff performing the therapeutic procedure reviews the specific patient information and indications before the initial procedure is performed.......(and of course if it's not documented, it wasn't done.)

[L106]

I agree with adiescast and SMW. If the Lab/Blood Bank perform the therapeutic phlebotomies, the Pathologist must review the patient's information before the first phlebotomy (and at least once every 12 months thereafter) to ensure he/she is an appropriate candidate for the procedure. That review cannot be delegated to a non-physician.

[AMcCord]

When we did them (nursing does now...Yahoo!), the pathologist reviewed the patient's diagnosis and labs with the first visit and then I took the cases back to him yearly when the standing orders were renewed. We also had parameters set for temp, BP, HR, and H&H. If the patient's numbers fell out of those parameters or if there was something new going on with their health (new diagnosis, not feeling well that day, etc), then the pathologist had to aprrove that day's phlebotomy. It took about 1 minute of his time for most cases, maybe a phone call to the patient's attending in a few cases per year. It really wasn't a major burden. The documentation always passed inspection with flying colors.

Edited June 4, 2010 by AMcCord

[Eagle Eye]

our nurses perform TP. blood bank is involved in development of policy and we also keep statistics. and do audit of pt's chart.

[Michaele]

Thank you all for your replies, they were very helpful. I'm still up in the air as to how I'm going to address this. My pathologist resists having any responsibility for TP anyway, this may send her over the edge..............

[L106]

My goodness......If reviewing therapeutic pheresis is such a daunting challenge, it must involve a very short edge!!

[Michaele]

ya...I agree.

[tbostock]

:cries:If your pathologist thinks she has it bad, tell her never to move to New York!