Medical Director Evaluation of Transfusion Reactions

[jsand]

During our recent AABB inspection the assessor stated that our Medical Director's evaluation of suspected transfusion reactions is not timely enough. At my old hospital, we had a policy that said they would be reviewed on the next business day. I just started at this hospital, and the timeliness of the evaluation is not addressed at all. Would anyone be willing to share how soon the medical director evaluates reactions at their facility?

[David Saikin]

My MedDir is here one day/week.  We fax her our copy ASAP or call her on the phone with workup.  Next day doesn't work for me for Trxn workup unless it is only urticarial.  AABB just says that the MedDir must be notified promptly.  CAP states the interpretation by the MedDir must be made in a timely manner.  Both of these statements appear to be open to interpretation.  So, I guess whatever works for your facility should be compliant based on these 2 standards.

[goodchild]

I agree with David that it depends on whats reasonable for the organization. It would always be best if you document what prompt/timely means for your institution in the transfusion reaction policy. We do next business day.

[LABLAD42]

I think more than anything the inspectors are looking at notification documentation and preliminary notification.

I include a  form  in each Tx rx workup and they never have given me a hard time.

My former boss drafted the form after a citation that  was corrected .

I use it since and  had only compliments since.

Edited October 6, 2015 by LABLAD42

[ChrisW]

Our procedure spells out that the Medical Director will review promptly, normally within 24 hours of completion of investigation. We also include specific criteria for notification of the MD when an immediate response is indicated.

[LKSchroed]

Transfusion reaction workups that are negative (no hemolysis, DAT neg, clerical checks OK, etc.) are left for the next business day for the pathologist to review. 

 

I am curious how many institutions wait for pathologist approval to continue transfusions.  Currently transfusion reaction workups that are negative, the tech releases any additional units for transfusion, but our new blood bank pathologist is reconsidering this policy.  A review of CAP and AABB regulations do say one way or the other unless I missed something.

[goodchild]

Transfusion reaction workups that are negative (no hemolysis, DAT neg, clerical checks OK, etc.) are left for the next business day for the pathologist to review. 

 

I am curious how many institutions wait for pathologist approval to continue transfusions.  Currently transfusion reaction workups that are negative, the tech releases any additional units for transfusion, but our new blood bank pathologist is reconsidering this policy.  A review of CAP and AABB regulations do say one way or the other unless I missed something.

 

We will notify the on-call pathologist upon completion even with the negative workups.

[TreeMoss]

We have 24 hours for pathologist review in our Transfusion Reaction workup procedure.  When we have our FDA inspections, they look at all of the reactions since the last inspections -- and they had best all be reviewed by 24 hours!

[Dr. Pepper]

We also use next business day if the workup is negative. If there is eveidence of a reaction, the patient's MD is notified ASAP.

[AMcCord]

We specify that we will issue a prelimary report within 24 hours, though in reality much faster. This includes notification of the pathologist on call for that day. In that notification we report symptoms and the preliminary workup. We then document the preliminary determination made by the pathologist and any recommendations he/she makes for patient treatment, if any. We also document the call we make to the nurse with date/time when we pass along the prelimary determination. We will continue the investigation with further testing as directed at that point. The pathologist must approve release of additional units for transfusion. The final report is made by the pathologist in the same system they use for all other path reports - we say it must be released in a 'reasonable' time and let pathology define what is reasonable for a path report. Our medical director tracks report times as a quality measure.

[L106]

We also use next business day if the workup is negative. If there is eveidence of a reaction, the patient's MD is notified ASAP.

 

Same here.