Transfusion Slips

[MRPalisades]

We have an issue with blood transfusion forms coming back incomplete to the Blood Bank.  We have educated the nurses and sent memos with the blood products.  Does anyone have any other suggestions?

[tbostock]

We send our incomplete forms to the attention of their Nursing Director.  Some are good about getting their staff to complete them, some not so much.

 

We tried to get the Nursing Directors to review them before sending them down to us, that didn't go over well either.

 

We audit them each month, we're anywhere from 90-95% complete, and I wonder if that is the best it gets with handwritten forms.

[Justina]

For a year we would review the record once we received it and if it was incomplete we would sent a copy to the Nursing Manager to go over with the nurse that didn't complete the record or that went over 4 hrs/missed a increase in temp, etc.... We sent a form with it that the Nursing Manager would send back to us stating what action was taken, usually nursing education.

 

Compliance has improved significantly. Now we submit incomplete records as online occurrences.

[Sko681]

Every morning we go through the previous days tranfusion sheets, highlight the information that is missing and send a copy to the nurse manager of that floor.  We keep a copy on file so that we have record it was sent.  We also have only every achieved  between a 90-95% completion rate and we enter them in as an occurrence.  We even gave the form to nursing to tell us how they thought the form could be improved so that they would have better document completion and it didn't do any good!

[cthherbal]

Our policy is that the nurse returns the slip to BB in person after the transfusion and we check it. If there are any problems they are corrected at that time. If there are any that are missing, there is a team of nurses who go to medical records and get us a copy. There are very few that go missing entirely each month (~3) which get incident reported individually. The idea is that nursing must take ownership of their part and get support from nursing leadership. Return compliance is 98% or better (we require 95% or better).

[Eagle Eye]

That is great cthherbal.....We transfused ove 1700 to 1800 components each month and we are above 90% after chasing....but is is not easy for us as we have almost 50-60 forms to check everyday. We have a staff who is assigned to follow up on them.

[SMILLER]

Simular to Terri, above.  Not sure what our compliance rate is.  If there is a bit of missing info or discrepancy on a tag that is returned, it goes with a form to that associate's manager as an educational service.  The manager is responsible to ensure that both they and the associate sign off on the form and send it back to us.

 

It would be awesome if we could figure a way to have all-electronic tags for this type of transfusion documentation, but I do not think our HIS (Sunrise) supports it.

 

Scott

Edited March 18, 2014 by SMILLER

[AMcCord]

When we were using paper flow sheets, we reviewed each one daily (we were transfusing only about 130 units/month). All records with errors or missing information were sent back to the nurse who completed the form with a note that said what was wrong. The expectation was that the problem was to be corrected and the blood bank copy of the flow sheet had to be returned to us with the corrections shown. We had the support of the department managers, which helped tremendously. We also reported to the quality committee and transfusion committee. When we stopped using the paper forms, our compliance rate was 98-99%. With our current electronic version...not quite as good, but still approaching 95%. I think part of our current problems stem from the turn-over rate in nursing service - lots of new people working on every floor.

[bxcall1]

I used to review them, highlight ommissions and send them back with a pre-printed note.

For the past couple of years Quality Management has done this for me. Compliance has been @95% with the ommissions usually being forgotten pt location or some other minor detail. Two nurse signatures and vital signs run close to 100%.

Edited March 17, 2014 by bxcall1

[cthherbal]

We are going electronic this year using SCC Transfusion ID.

[Brenda K Hutson]

Yes....make your Transfusion Form a single copy Form and let Nursing audit their own process! Here is my experience (and 2 cents worth....as I am currently changing my protocol).

I have worked at a number of places, and at most of them, the only Transfusion Slip that went with the unit was the one to be placed on the patient's chart. Also, most of this information is recorded in the computer by Nursing; so I think part of the non-compliance is that they feel they are duplicating their work.

In the couple of places I have worked where we got a copy back:

1. We then became responsible for auditing them for completeness; and ultimately, responsible for the degree to which they completed (or did not complete) them

2. There were always problems with Forms being incomplete....and on top of that, constant complaining from Nursing that we were "always returning Forms to them."

3. So, we had a protocol for returning them to be completed....then documenting them on an Occurrence Form....then me trying to work with Managers to get their Nurses to complete them in the first place.

While there was always some level of success, it was never a high enough percentage to make the Regulatory Agencies happy. And if we were not successful in getting Nursing to do it correctly, we (the Blood Bank) are the ones that would be held responsible by the regulatory agencies and be cited. If we do not get a Form back, there is no process to audit.

Do we "want" to know that Nursing has documented all of the required information; that the transfusion was completed within 4 hours; etc. etc.?? Of course we do; because as Blood Bankers, we want things to be accurate and regulations to be followed. But given my experiences, I think this is another area where we are being asked to babysit Nursing in an effort to get them to do their job (as spelled out in their Policy). We have our Policies to follow in the Blood Bank as far as documentation. The details of a transfusion are the responsibility of the Transfusionist...and I say let "them" make sure they are doing "their" job.

So, my current Form (which is a duplicate; and was so when I started here) is currently in the Print Shop and will come back as a single Form; to be compeleted by Nursing and to be placed on the patient's chart by Nursing.

Signed, the rebel......

Brenda Hutson

[SMILLER]

And is Nursing doing a better job with review of tag completion than the BB?

The thing is, it doesnt matter who gets dinged - nursing or the BB - the facility still gets cited when the FDA or JCAHO or whomever checks for incomplete records. This is besides the safety issue.

If BB does a better job than nursing or OR or whatever in tracking stuff like this, then they probably should be doing it - its better for the patient, right?. At least until the primary problem - hospital associates not following policy - is addressed.

Scott

[Brenda K Hutson]

 

It matters to me who gets cited in that since this is a Nursing responsibility, them getting cited by JCAHO may be what it takes for them to clean up their process. When it is the Blood Bank getting cited, we become the ones working hard to change the process (performing the audits instead of Nursing performing their own audits; writing up Occurrence Reports; meeting with Nursing Management; etc.). I believe Nursing will address JCAHO citations against them....but they may not be as quick to respond to a nagging Blood Bank (and it may not hit home for them, the implications of their incomplete documentation). I remember at the one place I worked at where the Tissue Bank resided in the Blood Bank instead of the OR. To me, that was insane....it was so much extra paperwork and documentation for us; we did not know interchangeable names for these tissues but the OR staff does; and they would not necessarily know what size they wanted so they would pick up a number of sizes and then return all but one). To me, the Tissue Bank belongs in the Blood Bank. But the reason it was placed in the Blood Bank in the first place was that the OR staff said we would be better at monitoring storage temps. Excuse me....but if they can perform surgery on a patient, they can certainly "choose" to monitor temps. appropriately. What it took for me to get that moved back to the OR was....I called our State Dept. of Health and got a list of every Hospital in the state with a Tissue Bank License; then called every one of those Hospitals to find out whether the Tissue Bank resided in the Blood Bank...or the OR. By far, they resided in the OR. It was armed with that information that our Medical Director was able to get the tissues back to the place that made the most sens....in the OR.

Brenda

And is Nursing doing a better job with review of tag completion than the BB?

The thing is, it doesnt matter who gets dinged - nursing or the BB - the facility still gets cited when the FDA or JCAHO or whomever checks for incomplete records. This is besides the safety issue.

If BB does a better job than nursing or OR or whatever in tracking stuff like this, then they probably should be doing it - its better for the patient, right?. At least until the primary problem - hospital associates not following policy - is addressed.

Scott

 

[SMILLER]

Good points Brenda.

We have gone back and forth a bit over tissue ourselves over the years. OR had some trouble with documentation w JCAHO some years ago -- that's when someone figured out that our BB IS could be used to keep track of tissue. (While you would HOPE that people that work where bodies are cut open would be good at monitoring things like this, they are no where near as good as a tech).

So anyway, we have been doing this "OR" stuff very well for quite some time. I believe we have even had compliments on it from FDA inspectors. Sometimes one has to live with the fact that the best solution for a problem situation is for you to take on resposibility for it, as the appropriate department just can't handle it. If we were making hubcaps or flipping hamburgers maybe it would not be such a big deal.

Scott

Edited March 26, 2014 by SMILLER

[Liz0316]

I had similar problems with transfusion documentation. Each time I did an audit, the nurses wanted the transfusion slip changed, add extra copies, change this or that. After 4 huge audits, with no improvement in compliance, I sent the final results to QA / Risk management and basically stated that this is their issue and I was done auditing. I even refused to attend the meeting! Hand the problem back to nursing. Let them deal with the regulators.

I also have similar issues with the tracking of bone and tissue. Basically I told the OR that if they didn't comply, complete the paper work and follow the BB policy that the freezer is on wheels and I would simply push it down the hall and they could take care of the entire process.... we now have compliance.

[tbostock]

Lacking support from nursing or the quality department will land of these issues squarely on the shoulders of the Blood Bank.  The Medical Director of the Blood Bank is ultimately responsible (at least in NY State).  So blood administration records are our problem, and now tissue is our problem.

 

I'm at the point where, if I am going to be cited for something outside my control, I would rather take control of it and fix it.

 

I am ONLY speaking from my experience here, as I know different states, different institutions are at different places.  I envy those of you who have been able to successfully remove yourself.

[Brenda K Hutson]

 

If the Tissue Bank resides in the OR, it would be one of the OR Physicians whose name would be on the license; and who would be responsible for compliance...not the Blood Bank Medical Director. So it is the OR that is a licensed Tissue Bank; not the Blood Bank.

I worked most of my career in California (similar standards as New York) and I can tell you that most places I worked, did not get back a copy of the Transfusion Record and/or audit the charts for completeness of that data. I am not saying it would not be worth the occassional audit of a chart if one chooses to put the owness back on Nursing for their processes....then take it to Nursing Management if your random audits show problems. But speaking for myself and having worked various places, I never had time with all of my other supervisory responsibilities; to also audit all of the Nursing processes. Another example of an audit to perform on occassion, is a Direct Observation to see that Nursing is following their protocol for transfusing (i.e. patient ID; unit ID; everything involved with tubing and filters; watching for Transfusion Reactions; etc. etc.). So I am not saying 'wash your hands of all responsibility and close your eyes to any potential Nursing issues'...it is just that I cannot audit every one of their processes; every time.

Brenda

Lacking support from nursing or the quality department will land of these issues squarely on the shoulders of the Blood Bank.  The Medical Director of the Blood Bank is ultimately responsible (at least in NY State).  So blood administration records are our problem, and now tissue is our problem.

 

I'm at the point where, if I am going to be cited for something outside my control, I would rather take control of it and fix it.

 

I am ONLY speaking from my experience here, as I know different states, different institutions are at different places.  I envy those of you who have been able to successfully remove yourself.

 

[tbostock]

Sadly, not in New York State.  I think I'll move to California...at least for the weather.

 

 
If the Tissue Bank resides in the OR, it would be one of the OR Physicians whose name would be on the license; and who would be responsible for compliance...not the Blood Bank Medical Director. So it is the OR that is a licensed Tissue Bank; not the Blood Bank.
Brenda

 

[Brenda K Hutson]

 

You and me both.....I am in Maine now! Have come to dislike the term "polar vortex."

Brenda

Sadly, not in New York State.  I think I'll move to California...at least for the weather.

 

[Eagle Eye]

Lacking support from nursing or the quality department will land of these issues squarely on the shoulders of the Blood Bank.  The Medical Director of the Blood Bank is ultimately responsible (at least in NY State).  So blood administration records are our problem, and now tissue is our problem.

 

I'm at the point where, if I am going to be cited for something outside my control, I would rather take control of it and fix it.

 

I am ONLY speaking from my experience here, as I know different states, different institutions are at different places.  I envy those of you who have been able to successfully remove yourself.

Same in NJ State. BLood Bank is responsible for auditing the forms. We need to get a copy back in blood bank and we get cited if they are incomplete so we must take control and fix it!!!