Std 8.2 #11 28th edition

[KKidd]

Has anyone reviewed the new edition of the AABB standards? Under 8.2 #11 (monitoring), how do you intend to comply with this standard? Thanks!

[Mabel Adams]

I was wondering the same thing! First, what is a "critical laboratory result"?

[Liz]

I dont have the 28th ed yet.

Is it:

"How do you document critical results? Who do you contact?" ???

I was faced with that with an inspector if its this..and got out of being cited.

[goodchild]

With this Standard in mind, the quality manager for the whole laboratory has been wanting us to identify our "critical laboratory results" and provide a process/procedure of notification, documentation, and a means of monitoring its effectiveness. What values/results/circumstances does your transfusion service consider critical and how are you tracking this?

We had our CAP inspection very recently and the inspector stated that she had identified only transfusion reactions as her critical value and that was because she already had a process in place of notifying medical director and patient's physician in a timely manner for the other applicable standard.

[BANKTECH]

At our most recent inspection, the inspector told me the only thing she considered a critical result is a trasnfusion reaction also.

[Mabel Adams]

Our AABB assessor really wanted us to have critical results defined but under JC rules we would have to notify the provider every time. It has to be something the docs want to be awakened at 3 am to be told--not just that this patient still has anti-Fya. I hold that hemolytic transfusion reactions would fit the bill but we would all be so excited taking care of everything once every 10 years that it happened that we probably would forget to document that we phoned it and got "readback" etc. etc. etc. We have it in our SOP for reactions to notify the provider of serious reactions.

I don't think this new standard says anything about notification of critical results. It just says we are to "monitor" them pre and post transfusion I think). It implied that we were supposed to pull data on the lab values of all transfusion patients to watch for trends or something. This sounds like a good question for the AABB meeting "ask the standards committee." I think I'll submit it if I can figure out how.

[bbonnema]

Has anyone found an answer?

[Mabel Adams]

Both the Ask the Stds Committee at the annual meeting and a recent AABB teleconference on the new Stds said it was pretty vague. I think they will be changing the wording from "critical" to something more like "pertinent" lab results next time. They said they had no intention to get into the "critical values" realm. They felt that many of us were already doing something to compare transfused products to the patient's lab values. We can find any way we want to do that. The idea seems to be to shore up blood utilization and transfusion guidelines.

[David Saikin]

If you go through the CAP inspection process you have to have critical results defined . . .

[bbonnema]

We do have our results defined along with the other departments. This seems like we are to check the Hematology/Coag critical results before and after transfusion. Our quality management department does monitor transfusions and all critical values but does not put them together. Anyone have any ideas?

[Mabel Adams]

They really were very specific that they did not really mean critical values as defined by CAP and joint commission. They just meant related lab values--Hgb for RBCs, Plt count for Plts etc. before and after transfusion. They even recognized that you would not always have pre-transfusion values on OP transfusions etc.

[Dr. Pepper]

Besides positive trans rxn results, we define critical as delivering Moms with IgG antibodies (a contingency now; we closed maternity) and we call any delays in furnishing "call when ready" RBCs or immediate preops. We call the floor and document who we gave the message to.