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transfusion reactions


galatea04

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Nurses often call us to inform us if they have a patient that they think is having reaction to the transfusion. Most of the time their question is what to do next ? We would then advise them according to procedure.

 

Questions 

  •  Is it required to document the time Blood Bank was notified of a possible transfusion reaction ?

                    If so, how would you document it ?

  •  Do you follow- up if they didn`t send it for work-up ?

 

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I cannot help you with this one, as I work in a Reference Laboratory, and my own area of knowledge is strictly red cell immunohaematology, but I see that this is your first post, and that you are a newbie.  You have joined a simply fantastic site (thanks Cliff) and I am certain my fellow members, who are so generous with both their time and their knowledge, will do so.

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I had to admit that we had not do  good enough to share with you.

Just for reference.

We will document the time.

We will document the time, the symptoms

We call them if we have not receive report of the patient's conditions

I am from China

Edited by shily
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It was the physician's call on if the patient was in need of a transfusion reaction workup so in the case you described we would refer the nurse to the physician who ordered the transfusion.  More often than not the physician would not order a workup and it ended there.  If I remember correctly we actually became involved when a physician would order the workup and everything started then including the documentation.  Usually in this case the nurse would call and say, "Dr. So and So wants a transfusion reaction work up on patient XYZ.  What do I do now?"  We would then take it from there.  These were so rare that the nurse seldom if ever remembered what to do.  :ohmygod:

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we put a sticker on the back of the unit with abbreviated instructions. Rarely do they read it. But, when they call, we instruct them to use a form and on the form is the time they notified the doctor, as well as vitals and other pertinent data.

(we also tell them to flip the unit over and read the sticker!)

Liz

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Wards are informed to return RBC units with transfuse equipments. They also fill a form that orders transfusion reaction investigation so we don't fill any documents. We get phone calls from time to time and we inform them of course. But it is their responsibility to fill the forms and inform us and send units back to us. Mostly wards inform us when they have fill the form and are returning units. They do not call us (I haven't recieved these calls) if they suspect the situation may develop into possible transfusion reaction.

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Nurses often call us to inform us if they have a patient that they think is having reaction to the transfusion. Most of the time their question is what to do next ? We would then advise them according to procedure.

 

Questions 

  •  Is it required to document the time Blood Bank was notified of a possible transfusion reaction ?

                    If so, how would you document it ?

  •  Do you follow- up if they didn`t send it for work-up ?

 

No it is not required but some hospitals do this.   It can be documented in an endorsement log or other forms.   Tech reviewing endorsement log will pass on info to BB medical director who can follow up with patient/patient's physician and start a transfusion reaction investigation if needed.  

Edited by R1R2
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If we get a call, we tell the nurse to call the physician and see if they want to call a transfusion reaction. About a third of the time we never hear back from them so I suppose the physician didn't want to call a reaction. If the physician does want to call a reaction, then the order is placed in the computer system and we get the ball rolling.

 

All of the info of what a nurse should do is in the nursing procedures but we have a sheet that we can fax to them with  clear instructions because they are sometimes somewhat freaking out. It helps us to get what we need from them in a timely fashion.

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For institutions that require the physician to order a transfusion reaction workup (or leave the ball in their court), from a risk management perspective, how would it be handled if an RN suspected a reaction, the physician declined to do a workup, and the patient subsequently experienced an adverse event?

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In our facility, if BB receives a call it is worked up. The attending is also notified but bears no decision making in the reaction workup until completed. The patient isn't charged for any part of it, therefore; we have decided to do what is best for patient care.

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For institutions that require the physician to order a transfusion reaction workup (or leave the ball in their court), from a risk management perspective, how would it be handled if an RN suspected a reaction, the physician declined to do a workup, and the patient subsequently experienced an adverse event?

 

 

If you are Joint Commission accredited in your lab, this is no longer a problem.  Joint has a standard QSA.05.18.01 that states specifically "The requirement that suspected transfusion related adverse events are reported immendiately to the lab, whether or not the the physician responsible for the patient deems it necessary to report the event."

 

This changed what we do to: if we hear about it - it gets worked up.  (that's if my team member remembers the change!!!)

 

I have attached our old paperwork for the Transfusion Reaction Workup Request and the Transfusion Reaction Workup.  Feel free to use what might help you.  We are still struggling to get this in Meditech - tried to make it too fancy and have finally decided to back down to simple T-Tests, but now don't have the time to build them with my IT Coor. (Oh well!)

Suspected Transfusion Reaction Workup 742-002.pdf

Suspected Transfusion Reaction Workup Request 742-001.pdf

Edited by carolyn swickard
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The physician rates the reaction from mild to severe where I work, if the reaction is considered mild, we don't do anything other than document it in the computer system so that we can see if there are additional transfusion reactions connected to that specific blood donor, or if a certain patient often has a reaction. If we get a call about a suspected reaction and they don't send us any samples I usually just assume it was rated as mild, depending on what information I've gotten.

We do not document the time ourselves, the nurses are required to fill in a form which covers all that.

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If you are Joint Commission accredited in your lab, this is no longer a problem.  Joint has a standard QSA.05.18.01 that states specifically "The requirement that suspected transfusion related adverse events are reported immendiately to the lab, whether or not the the physician responsible for the patient deems it necessary to report the event."

 

Exactly exactly exactly. The last thing we want is physicians in their infinate wisdom to gloss over a fever due to a hemolytic reaction because they thought the patient was going to spike a temp then anyway.

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Nursing fills out a suspected transfusion reaction form and sends it to the lab. They document the time, symptoms, vitals etc.  Our BB director reviews all forms whether a transfusion reaction work up was ordered by the physician or not.  It is stated in our SOP that the BB medical director can order testing at his discretion.  Honestly (and fortunately), he has never had to do that.    

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Whenever a suspected transfusion reaction is called, we ask the caller to stop transfusion right away and to notify patient's physician.

 

When i worked in hospital, we waited for the patient's physician to call transfusion reaction, floor was responsible for evaluating patient's situation and consequent actions (floor might decide to give patient tylenol or benedryl or maybe blood was given too fast or whatever reasons), after evaluation, if the doctor decided to call it a transfusion reaction, floor would send us a completed form with all information (clerical check, unit check and information, date/time of start and stop, symptoms, vitals...), plus post-transfusion samples and remaining blood bag, we then work up the reaction. In hospital where there is chemistry, usually LDH and bilirubin are ordered together.

 

Now, i work in a blood center, we still ask caller to stop transfusion and to notify physician. We will start the workup without waiting for decision of patient's physician. The calling facility has to fill out a transfusion reaction form to document the event, one copy to us, one copy on patient's chart,  if no post-transfusion sample sent, we repeat the pre-transfusion sample, perform clerical and visual check, give all findings to our own medical director to do interpretation and recommendation.

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  • 2 weeks later...

Exactly exactly exactly. The last thing we want is physicians in their infinate wisdom to gloss over a fever due to a hemolytic reaction because they thought the patient was going to spike a temp then anyway.

 

This.

 

Transfusion records are entered directly into the patient EMR. There is a list of things on the 'Blood' tab (where vitals, etc are recorded) that are automatic triggers for a reaction workup - if they click one or more of those items because their patient is experiencing that symptom, we automatically receive the order for the workup. The record also has a place for them to document when they called us and when they called the doctor. It all rolls from there. The physician's decision is whether or not to treat the patient based upon the symptoms reported, not whether or not the workup is done..

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If you are Joint Commission accredited in your lab, this is no longer a problem.  Joint has a standard QSA.05.18.01 that states specifically "The requirement that suspected transfusion related adverse events are reported immendiately to the lab, whether or not the the physician responsible for the patient deems it necessary to report the event."

 

This changed what we do to: if we hear about it - it gets worked up.  (that's if my team member remembers the change!!!)

 

I have attached our old paperwork for the Transfusion Reaction Workup Request and the Transfusion Reaction Workup.  Feel free to use what might help you.  We are still struggling to get this in Meditech - tried to make it too fancy and have finally decided to back down to simple T-Tests, but now don't have the time to build them with my IT Coor. (Oh well!)

This is correct if you are accredited by the JC, you will get cited for having the physician order the reaction or continuing a transfusion when there are signs/symptoms of a reaction. Ours is policy based (medical staff approves the policy), they have signs/symptoms, they get the workup...period. We even have a statement in the policy that the physician cannot restart a transfusion that the nurse has stopped until the Medical Director evaluates the workup and gives the OK to release more units.

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I like that Terri,

Maybe we could include necessity of getting Consultant Haematologist, BB approval before recommencing any unit. Mind you, if we find anything in the workup, the unit is taken down immediately. We educate them to be very cautious. Apart from minor allergic reaction where they are given meds and recommenced slowly, I would rather a unit come down even if unnecessarily wasted than a patient go on to develop a major reaction.

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I do not have this implemented at my hospital yet...but another hospital I visited to check out their blood bank module has a really great idea.

On the unit tag, they have one side the patient and unit information, and the other side a quick reference guide for the steps to follow if they think the patient is having a reaction. I like this idea a lot, is right there readily available.

 

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