introduction

[nsfirm]

Hi,

I'm Nova Hippy from Indonesia. I work for a blood bank hospital in Jakarta.

At this moment, my hospital is trying to get the JCI accreditation, and it's a kind of giant leap, since transfusion is a kind of ignored before.

I really need a lot of help from others, since some time I feel blank about what to do.

For example, would you please share your point of view about transfusion for out / ambulatory patient. We usually let the patient go after being transfused, but:

1. as far as I know, WHO asked to check the vital signs 4 hours after the transfusion ends.

2. some of the patients that I know had transfusion reaction after they was outside the transfusion room.

do you think that we still have to ask the patient for 4 hours (which will bring a lot of trouuuuuubbbllllleeeeee) or ask the patient to be hospitalized at least one day (which also bring a lot of troubleeeee from financial point of view) or just let them go, and hope that they will not get the transfusion reaction (which means underdiagnosed and underreported of the cases)?

I also would like all the help regarding the forms.... For a start, I've already made the forms for:

1. informed consent

2. forms to take the blood from the blood bank

3. forms for blood administration

4. reporting transfusion reaction

I know that it's still too few, but I don't want to give too many forms at one time (before the clinician only fill in the blood request form).

is there any possibility for me to share the forms, and ask for your suggestion and opinion about the forms that I made?

thanks a lot before.

Nova

[Malcolm Needs ☆]

Welcome to this wonderful site Nova Hippy.

[Liz]

Welcome Nova!

[Deny Morlino]

Welcome Nova! This group is very helpful on any topic. Opinions on forms are frequent here (most likely you will have a huge amount of information to choose from). I am not familiar with the WHO recommendations regarding transfusion vitals and time frames, but whatever the time frames given happen to be I would say that is your best practice to follow. Good luck in your pursuit of JCI certification.

[bmarotto]

Welcome Nova Hippy. Our outpatients are discharged a short time after the transfusion is ended but they are given an information sheet with signs and symptoms of a reaction and instructions on how to proceed should they experience a reaction.

[nmartin]

[ATTACH]584[/ATTACH]

Welcome Nova,

We also do a lot of out patient transfusions and send them home after 1 hour with an instruction sheet. I attached an example of the instruction sheet we use.. You should develop one that matches your procedures. Good Luck

Nancy

[ATTACH]584[/ATTACH]

[nsfirm]

Welcome to this wonderful site Nova Hippy.

Thank you. Actually I feel the same way, since I've already got helped for my first question.

[nsfirm]

Welcome Nova!

Thank you

[nsfirm]

Welcome Nova! This group is very helpful on any topic. Opinions on forms are frequent here (most likely you will have a huge amount of information to choose from). I am not familiar with the WHO recommendations regarding transfusion vitals and time frames, but whatever the time frames given happen to be I would say that is your best practice to follow. Good luck in your pursuit of JCI certification.

Thank you.

about lots of forms to choose from, I have downloaded many forms, but there are times I don't think that I can't use any of those forms since it's too perfect I have to make sure, that it's enough for safety reason, but not too much so the overloaded nurses will be able to fill the forms correctly. it will be very hard to audit, but one step at a time is the thing that I should do at the moment.

the problem is when I try to modify the forms, some important points will be lost, so I need other people to point those points out for me.

about vital signs recording, I know that it's different for each place, my hospital doesn't regularly check the vital signs while transfusing, but at least in the wards, they have regular vital signs check.

if your hospital doesn't use the WHO recommendation, what do you use?

[nsfirm]

Welcome Nova Hippy. Our outpatients are discharged a short time after the transfusion is ended but they are given an information sheet with signs and symptoms of a reaction and instructions on how to proceed should they experience a reaction.

that's one of the suggestion that I think possible to do in my hospital, but it means I have to make the information sheet, which is another problem since I don't know how detail it should be.

could I have the copy of the information sheet?

and when the patient come to the hospital again (in my hospital most of the ambulatory patient usually comes back for other transfusion session, e.g. thalassemia patients, hemophiliac, cancer patients), do you ask again whether they have transfusion reaction?

and how do you record it?

so many questions...

[nsfirm]

[ATTACH]584[/ATTACH]

Welcome Nova,

We also do a lot of out patient transfusions and send them home after 1 hour with an instruction sheet. I attached an example of the instruction sheet we use.. You should develop one that matches your procedures. Good Luck

Nancy

[ATTACH]584[/ATTACH]

thank you for the sharing..... like I wrote before, it really helps me in making the information form in my hospital.

but I would be glad, if you share more about...

when the patient come to the hospital again (in my hospital most of the ambulatory patient usually comes back for other transfusion session, e.g. thalassemia patients, hemophiliac, cancer patients), do you ask again whether they have transfusion reaction?

and how do you record it?

thank you...

[Deny Morlino]

if your hospital doesn't use the WHO recommendation, what do you use?

We are certified by HFAP. They follow the CMS/FDA rules here in the States.

[nsfirm]

We are certified by HFAP. They follow the CMS/FDA rules here in the States.

Do you have the copy of the rule? is it possible to give a copy to me? or where can I get it?

I know that I have to follow the latest rule, but if it's going to be too much, e.g. have to check the vital sign every 15 minutes, it will not be applicable in my hospital.

considering that my hospital is also a teaching hospital (with a high turn over rate of doctors), it will be hard to make a new policy with too much detail to do.

but if I it's going to be easier to comply, then I'll choose that one.

I know that JCI ask us to do things according to the local rule, but the problem is the local rule is still not established, yet. so, another work and extra work.

[Deny Morlino]

I am pulling information from the 17th edition of AABB's technical manual and giving our facility's interpretation :

Because patients can experience transfusion reactions several hours to days after the transfusion is complete, medical staff should continue to monitor the patient periodically for 4 to 6 hours after the end of the transfusion to detect febrile or pulmonary reactions that may be associated with blood administration. If the patient is not under direct medical supervision after the transfusion event, medical staff should provide written instructions to the patient and caregiver about signs and symptoms to be aware of and report, and they should ensure that the patient has a phone number to call or a person to contact should a reaction occur later.

We monitor the outpatient transfusions for 1 hour after the completion of the transfusion and then the patient has written instructions detailing transfusion reaction signs and symptoms, a contact number to call, and further instructions to present to the Emergency Department if symptoms progress. Hope this is what you were looking for.