Incomplete Forms

[DOGLOVER]

Does anyone monitor transfusion forms (whether paper or EMR) for completeness? If so, why? We have done it at my institution since long before I cam here and it was done when I worked in Mass. However, I have not seen an actual requirement to do so. It has come up as we are preparing to make the switch away from paper to the EMR. Logistically it seems kind of hard to look up 1800 products a month to see if they are complete. Relatively simple just to go through returned tags. I can't find where AABB or CAP require this. What about JCAHO? We are thinking it really should belong to clinical effectiveness, anyway. Thanks for any info.

[Malcolm Needs ☆]

In the UK, the filing of the form is part of the Pre-transfusion Guidelines, and we do monitor them.

The underlying pathological condition (quite apart from the patiuent's details - that's a given) is really useful, particularly where an MSBOS is in use, to guage whether or not there has been an over-order of blood components, or, more seriously, an under-order of blood components for, for example, a particular surgical procedure. It is also really useful to knoe the EDD of a lady with an antibody, as this allows for more pertinent clinical advice to be given, with regard to how the pregnancy should be treated.

Similarly, in Reference Laboratories, it can save an awful lot of work (and rare reagents) if we are given the ethnic origin of the patient, particularly when there is a possible antibody directed against a high-incidence antigen present in the plasma.

I fully understand that this monitoring can be one heck of a chore, but it can also be extremely useful.

[DOGLOVER]

Thanks, the part of the form I was referring to was the transfusionist and witness signatures, vital signs pre and post and volume infused. The other points you refer are on a separate computerized order form. That part is monitored by Clinical Effectiveness. Have a great day.

[David Saikin]

We monitor the forms . . . Nursing seems to have sporadic episodes of compliance/non-compliance in completing them. We monitor ~50%/month. Most places I inpsect also monitor these for completeness.

[jlphunn]

In our institution we issue blood using an electronic form which is also used by nursing to enter vital signs, volume infused, and beside signatures of of the nurses involved in the administraion of the product. Our policy - which indirectly follows 5.27.1 of Standards - require us to review the forms for completeness. But to answer your question, no it is not required as far as I know. Standards only indicates that the patient's medical record contain this information. It could be located on five different sets of paperwork in the patient's chart, but the requirement would still be satisfied. This is why, personally, I like all of this information being in one place - i.e. an electronic form or returned tag. The difference between the two of us is that I only have to review about 200 forms a month, not 1800. Big difference. Hope this helps.

[bduff]

We review the forms at my hospital as well. I believe that we do it to make sure the vitals are documented and blood warmer temperatures if applicable and stuff like that. We almost went with an electronic issue process and all of this would be entered into the computer. If the information was not entered it would not let you go passed it. It was a great product but unfortunately the almighty dollar kept us from purchasing it. If we had that there would have been little to no review.

[Deny Morlino]

We review the forms at my hospital as well. I believe that we do it to make sure the vitals are documented and blood warmer temperatures if applicable and stuff like that. We almost went with an electronic issue process and all of this would be entered into the computer. If the information was not entered it would not let you go passed it. It was a great product but unfortunately the almighty dollar kept us from purchasing it. If we had that there would have been little to no review.

This is the direction we are heading in the long run. The review here is focused on making sure signs and symptoms of a transfusion reaction were not missed by nursing, and appropriateness of product usage. Completeness is transitioning to the chart review folks since they are already deeply into the chart.

[John C. Staley]

This would be the perfect opportunity to review the info you are concerned about and determine things like, are we duplicating and the info is located elswhere in the chart, if not could it be and would that be a better place for it. Specifically, things like patient vitals. Odds are that is or will be documented else where so do away with it in your area. Is some one else, such as risk management, nursing QA, etc, reviewing the same info, if so let them have it, you have better things to spend your time on.

This really is your best opportunity to stream line the system. I've said this a million times and my wife will probably put it on my grave stone, "no one ever imprpoved a system by making it more complicated, always simplify!!!"

[KKidd]

We started review all of the forms about 10 years ago after a Joint Commission inspection. A number of the forms they reviewed were incomplete. Our compliance rate is about 88% with a goal of 85%. When we first started, one nursing unit had a compliance rate of 65-70%. I would be thrilled to raise our goal to 90%. I report to the nurse manager for the unit and she reviews with the nurse. Conversely, if they do an exceptional job with documentation (including other important info), I try to let them know. After all, I'm not trying to be the "Wicked Witch of the BB"!

:whew::whew::whew:

[hunb]

Does anyone monitor transfusion forms (whether paper or EMR) for completeness? If so, why? We have done it at my institution since long before I cam here and it was done when I worked in Mass. However, I have not seen an actual requirement to do so. It has come up as we are preparing to make the switch away from paper to the EMR. Logistically it seems kind of hard to look up 1800 products a month to see if they are complete. Relatively simple just to go through returned tags. I can't find where AABB or CAP require this. What about JCAHO? We are thinking it really should belong to clinical effectiveness, anyway. Thanks for any info.

Yes, there is a requirement through JCAHO and our facility must perform at a minimum of 50 audits per month to satisfy the regulatory requirement. If you transfuse over 500 units a month this requirement is a minimum of 100 audits. Our risk manager has confirmed this information and I do monthly reporting through our corporate RM software. Are you doing 100% audits right now?

[Kip Kuttner]

In addition how you document a transfusion could come up at an AABB assessment when they review transfusion paperwork. If the paperwork is intended to document the proper patient was identified, the vitals were taken at the proper times and so on, Standard 5.21 probably applies: " At the time a unit is issued, there shall be a final check of transfusion service records and each unit of blood or blood componenet. Verification shall include: etc

The Standards are written fairly broadly and take a bit to get used to in comparison with the checklist regs of CAP and JCHO.

[Barbarakym]

There are lots of possible audits. Is JOint commission specific? Vitals and completion of nursing sounds like it should be nursing mgr that audit. Preferably on the transfusion floor. Only way to use it for pi. Nursing at our hospital does 1 in 5 and that was ok.

Also Qa audits reasons for transfusion. We set parameters in measurable pt stats (h&h,plt,inr). And we pull all those outside of range and send to Qa. They pull 1 out of 5 to review chart

What other audits would meet JC requirement? I did not see where they demanded anything specific. Just that some audits were being done.