Quality Indicators Monitoring in Blood Bank

[VACASE]

I'm writing to ask what other Blood Banks do for quality monitors in Blood Bank (e.g. STAT Turn-Around-Times). We currently do some but are looking for some more ideas. Any help would be appreciated. Thanks.

[kriti]

For our pre-analytic, we measure if they answer the PAT questions correctly (ie, no PAT samples answered as not pregnant for scheduled c-sections), rejected samples collected by pt care areas, rejected samples collected by lab, and TAT for plasma prepared to made ready for ER. For analytic, we measure ER plasma from time of order to transfusion time and wasted/expired products. For post-analytic we measure uncrossmatched/trauma forms being returned and completed with corerct info, transfusion reactions, transfusion reaction completed consults, verbal orders/readbacks and giving units a final dispositon. I hope that is helpful. I am curious to see what others are doing as well.

[David Saikin]

A good one is tracking the ability of your blood supplier to meet your requests for products.

[Eoin]

We look at TAT, and always include any stat or urgent XMs. We also monitor wastage and C/T ratio and adherence to Maximum Surgical Blood Ordering Schedule. The C/T ratios we take to speciality and then to individual clinician level. If they are consistently high, they will get a letter from the Blood Transfusion Consultant. A bit of work - but well worth the effort. We also monitor completeness of forms/specimens as part of form/specimen error monitoring.

Cheers

Eoin

[Likewine99]

We monitor transfusions when hgb is >8.0, inr <1.5, plt >50,000. We pick one random day of the month, run the canned report from our hospital EMR and audit the transfusions in the chart.

Also C:T ratio, Stat TAT for T&S, preanalytical labeling errors, availability of blood from supplier, product waste.

[RR1]

How about:

number of recorded incidents/complaints.

Equipment breakdowns.

% staff trained/ re-assessed within your defined periods.

Length of time to clear audit non-conformances.

% Patients wearing correctly labelled wristbands.

% traceability figures (or time taken to obtain full traceability)

[Dr. Pepper]

One could add to the fine monitors already listed:

1. Transfusion process audit: follow a unit from issue in the lab to start of transfusion to ensure nursing and BB are following proper procedure. This should include any off-site locations as well (like blood supplied to private dialysis centers).

2. Review of transfusion reaction investigations: again, ensure that nursing and lab did and documented everything they needed to do: post-rxn check of donor and patient ID - performed by nursing in our hospital - did they document it on our form? Did the lab accept the blood bank without the documentation? Was a blood culture on the bag performed if indicated? Reactions get reported on our Record of Blood Transfusion Form, so this also serves as an audit of nursing completing other documentation on the form (date, time, nurse discontinuing the transfusion, etc).

3. For the cases where your appropriateness review gets to chart review of transfusions not meeting audit criteria, you can also check documentation of informed consent on the chart.

4. Some non-automated blood banks will separate serm/plasma from clot/cells for processing and storage. You could periodically check that the aliquots have the same label as the original tube and that there was phlebotomist ID on the tube.

5. Have a QA database (I built one in Access), establish whatever problem types you wish, and pull up summaries periodically to look for trends (i.e. 3 of the same problem in a quarter = a trend, which needs written followup).

6. Reagent supplier issues and incidents.

7. Customer satisfaction surveys.

[Malcolm Needs ☆]

Beware of number 7.

We do this and have had experience of individuals who have made a complaint about us, only to find later that the error lay at their own feet. That notwithstanding, when the next satisfaction survey went out, they marked us as bl**dy awful, becaus ehtey still held a grudge! Unprofessional, but true.

[Dr. Pepper]

Yes, #7 can lead to some interesting responses. So long as they don't end up on the front page of the Croydon Daily Times, though, they still give you another point of view to consider (however twisted and unprofessional it may be!).

[Malcolm Needs ☆]

Yes, #7 can lead to some interesting responses. So long as they don't end up on the front page of the Croydon Daily Times, though, they still give you another point of view to consider (however twisted and unprofessional it may be!).

True Phil, but it is not the Croydon Daily Times I'm worried about (nobody really reads local newspapers in England - in fact, few people read national newspapers in England, apart from the headlines and the football [soccer]) - it's the NHSBT Board Members reading this that worries me!!!!!!!!!!!!!!! They, too, only ever read the headlines of a report!

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