CAP TRM 42310-42315 Therapeutic Phlebotomies on In Patients

[Mary**]

We do not perform phlebotomies on out patients. We are asked to do a few inpatients annually. These inpatients probably do not have a diagnosis that would warrant needing a phlebotomy, nor will they need a therapeutic plan as is described in these regulations. Any suggestions on how to handle tese regs?

[David Saikin]

I do very few in pt TPs . . . as you intimate, they do not readily comply with the CAP standards. I just perform them as per the MD requests. There is no real treatment plan like you have for a hemochromatosis pt . . . it is usually short term to get hct lower. If/when they need more after discharge, then I would have the MD complete one of our protocol requests. Actually, all the info required by CAP is usually in the chart if you dig deep enough.

[rcollins]

Hi David and Mary,

I'm having trouble understanding what a "therapeutic plan" is for our outpatient hemochromatosis pts. Does it include just a "goal hct." or is it much more involved. I'm working on this CAP checklist and realizing our ther. phleb. program needs a little beefing up after these regs came out. Will you give me some guidance??

Thanks,

Becky

[bmarotto]

Beside some basic medical history, our request form for for serial therapeutic phlebotomy requires the following information (this is "the plan"):

1. Indication for phlebotomy, with diagnosis code

2. Frequency of phelbotomy

3. Hold for hematocrit <____%

4. Labs to be drawn (e.g.: iron profile every 3 months)

5. Special requests

We draw a standard unit of 450 + 45 mL unless otherwise specified. The order is good for up to one year or until any of the parameters change, whichever comes first.

[David Saikin]

Mine is similar to bmarotto's . . .

[ANORRIS]

I have attached our policy. It is in compliance with AABB.

Therapuetic Phlebotomy-2.doc