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Transfusion Record


aj2018

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We are having a problem with our transfusion record form being filled out completely by the nurses, so I'm thinking maybe it needs to be simplified.  I was wondering if anyone can send me a copy of their transfusion record form so I can get some ideas on what it looks like and the minimum info needed on it.

currently, the nurses do document all the vitals, but we are having problems with them forgetting to have another nurse sign it even though they do the bedside checks together, forgetting to put the component number, or ABO/Rh, sometimes forgetting to put patient identification on the form (I'm thinking this is probably since its down at the bottom).

I would appreciate any forms you can send so I can take a look.

thank you

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Does the hospital have a quality department or does nursing have a quality department or committee? Is your hospital accredited by The Joint Commission? If so, I would go to the quality departments. We changed our transfusion tag because nursing performed a quality audit and found that the information wasn't being recorded properly. They weren't recording the vital signs in the chart and they wanted them back on the transfusion tag. Now everything is in Epic.

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My transfusion form is electronic - I review for completeness.  When we had a paper form compliance would wax and wane from 50% (when we would become hard-nosed about it) up to 95%.  Currently we are running greater than 95% compliance.  Nursing Admin makes certain that their staff completes all missing data.

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Yes, to all the comments above. If they are expected to comply - and I mean really expected to (which is the hard part - keep plugging!) - then they will. Are you inspected by Joint Commission? the state? Reminding them of the JC has worked wonders here. JC requires policies to be complied with as written. If the policy at your hospital says that elements X, Y, Z, etc must be documented, then they must be documented. We policed paper forms, now nursing polices an electronic record. Compliance isn't 100% but we keep harping on it. The guilty parties are notified by their manager. I also have the ear of the nurses who prepare their education events/materials for transfusion. I let them know where the problems are and they address those topics.

We are preparing to change our HIS and LIS. Hopefully part of the switch will include scanning patient ID at bedside for transfusion ID - when and if that happens, quess what? - the entries for the transfusion record will be in the LIS (which they won't realize because it will be painted onto the HIS) and will become MANDATORY fields :strong:. More than one way to get your way :highfive:!

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When I played for a bit at being boss I gave them 3 chances - first was a reprint of the paperwork to fill in, the second was a letter that went to the charge nurse, 3rd went to ward manager and then a letter went to the chief exec - it was fab having the chief exec on board as he would give them a rocket. We went 3 years with 100% compliance!

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23 hours ago, tbostock said:

We went live with electronic blood admin documentation a couple months ago and we are stuck at 40-50% compliance for accurate documentation.  Ugh!!!  Since the Blood Bank/Lab will get cited, sadly it is my burden.

Wow, that's a problem. However, being cited may not be such a bad thing in the long run. As blood bankers, we like to be perfect and those hits are painful. But they can be turned into a great weapon. I was getting nowhere with nursing education for recognition of transfusion reactions until CAP cited me for it. After that, the earth moved, and not only do we have that education piece, but lab has input.

Chin up and soldier on!

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Yeah, we were just given the mandate by administration to call the transfusing nurse at the 4 hour mark and tell her to complete all documentation for every transfusion.  Then we look in the EMR and if still incomplete it goes all the way up to the head of nursing.  At least we can show an inspector that we take it seriously and have started a corrective action already.  The BB staff is NOT happy though.

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Transfusion documentation is a part of the Medical Record - have your HIM dept flag all the incomplete transfusion documentation and send the charts back for completion.

We had/have some interesting vagaries that Nursing tries to side step, e.g., when they sign in to document transfusion info the system posts the time they sign in.  One of their boxes to complete has to do with the timing of vital signs.  They want the sign in time to be the documented time - we told them no because that is not what the documentation requires.  I think they finally understand that, but then there is the new staff.  Another consideration is to look at how transfusion are documented during surgery - I have to check the anesthesia record.  sometimes it has a unit number, sometimes it has rbc #1, etc.  Dealing with that issue now.  And we still have some areas that continue to use the old paper recording method - I'm not fighting that one yet.

 

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1 hour ago, tbostock said:

Yeah, we were just given the mandate by administration to call the transfusing nurse at the 4 hour mark and tell her to complete all documentation for every transfusion.  Then we look in the EMR and if still incomplete it goes all the way up to the head of nursing.  At least we can show an inspector that we take it seriously and have started a corrective action already.  The BB staff is NOT happy though.

To me, it sounds completely unreasonable to expect blood bank to be responsible for something like that. I imagine you transfuse >=400 products/month.

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On 2/18/2016 at 3:56 PM, David Saikin said:

My transfusion form is electronic - I review for completeness.  When we had a paper form compliance would wax and wane from 50% (when we would become hard-nosed about it) up to 95%.  Currently we are running greater than 95% compliance.  Nursing Admin makes certain that their staff completes all missing data.

dear David
i want to know how do you ensure the identity of staff identifying the patient and staff extracting the sample from the patient.
also what about the authorized person to order the blood products.
how do you manage these things electronically
 
regards, 
drwajiha
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On Saturday, February 20, 2016 at 0:03 PM, drwajiha said:

 

dear David
i want to know how do you ensure the identity of staff identifying the patient and staff extracting the sample from the patient.
also what about the authorized person to order the blood products.
how do you manage these things electronically
 
regards,
drwajiha

The staff sign/initial the specimen tube upon collection.  Patients have a discrete blood bank id band (bloodloc).  I don't worry about who is authorized to order blood products . . . that is the purvue of Med Staff admin, I'm only the blood bank guy.  The docs can order electronically but usually it is the pt's nurse or the ward clerk that generates the computer orders.

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On 2/19/2016 at 10:07 AM, David Saikin said:

Transfusion documentation is a part of the Medical Record - have your HIM dept flag all the incomplete transfusion documentation and send the charts back for completion.

We had/have some interesting vagaries that Nursing tries to side step, e.g., when they sign in to document transfusion info the system posts the time they sign in.  One of their boxes to complete has to do with the timing of vital signs.  They want the sign in time to be the documented time - we told them no because that is not what the documentation requires.  I think they finally understand that, but then there is the new staff.  Another consideration is to look at how transfusion are documented during surgery - I have to check the anesthesia record.  sometimes it has a unit number, sometimes it has rbc #1, etc.  Dealing with that issue now.  And we still have some areas that continue to use the old paper recording method - I'm not fighting that one yet.

 

Oh so familiar!

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A little late on this subject but I thought I would chime in anyway.  We suffered the same problem as you described a few years and 2 employers ago.  When trying to determine what to do about it we discovered that the nurses were being "required" to document the same information in multiple places.  This made no sense so I worked with a team from the nursing department and we came up with a system that only required the documentation in a single place and did away with the other locations.  An example is that they were being required to document vitals both in the patient's chart and on the transfusion record.  Obviously they were much more in tuned to documenting this info on the chart so we removed it from the transfusion record.  Any inspector who wanted to see the info was shown the chart.  Over the years I have discovered that simplifying a process usually enhanced it.  :clap:

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54 minutes ago, John C. Staley said:

A little late on this subject but I thought I would chime in anyway.  We suffered the same problem as you described a few years and 2 employers ago.  When trying to determine what to do about it we discovered that the nurses were being "required" to document the same information in multiple places.  This made no sense so I worked with a team from the nursing department and we came up with a system that only required the documentation in a single place and did away with the other locations.  An example is that they were being required to document vitals both in the patient's chart and on the transfusion record.  Obviously they were much more in tuned to documenting this info on the chart so we removed it from the transfusion record.  Any inspector who wanted to see the info was shown the chart.  Over the years I have discovered that simplifying a process usually enhanced it.  :clap:

Great post and exactly my point. Blood bank needs to ensure that our requirements are met but it's a nursing documentation/workflow issue.

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On ‎2‎/‎19‎/‎2016 at 11:07 AM, David Saikin said:

Transfusion documentation is a part of the Medical Record - have your HIM dept flag all the incomplete transfusion documentation and send the charts back for completion.

We had/have some interesting vagaries that Nursing tries to side step, e.g., when they sign in to document transfusion info the system posts the time they sign in.  One of their boxes to complete has to do with the timing of vital signs.  They want the sign in time to be the documented time - we told them no because that is not what the documentation requires.  I think they finally understand that, but then there is the new staff.  Another consideration is to look at how transfusion are documented during surgery - I have to check the anesthesia record.  sometimes it has a unit number, sometimes it has rbc #1, etc.  Dealing with that issue now.  And we still have some areas that continue to use the old paper recording method - I'm not fighting that one yet.

 

David, what EMR do you use?  We have Epic and we were told that it cannot flag incomplete documentation?

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On ‎2‎/‎17‎/‎2016 at 6:21 PM, pinktoptube said:

We performed a daily review on all returned transfusion record carbon copies and any missing information was highlighted on a copy. This was sent as an official occurrence to the nurse manager for follow-up. It took a little over of a year of this before we consistently received over 95% compliance.

I also review all forms.  Ware usually at around 90% compliance.  If all information was recorded it would be more like 95% or more

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We put the transfusion information on the form because an assessor couldn't find the vitals in the chart. I then started reviewing the back copy of the transfusion forms daily & sending the incomplete information to the charge nurse. Our compliance rose to 97%. Then, in our next assessment, the original was not scanned into the chart they pulled so we were cited. (I still had my complete copy on file, but it was not in the chart so policy was not followed.)  So, I started reviewing a percentage of transfusion forms on the scanned chart instead of a copy of the form returned to Blood Bank.  Our company did not buy the blood administration module for the computer, but recently added a place in the computer where the transfusionist could document some of the required info, but not all.   First I knew of the change was when a nurse asked why they now had to document certain info in the computer & on paper.  

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Have any of you gone away from paper transfusion tags attached to the blood products and instead using label/sticker technology and the transfusion record is either completed electronically or as a distinct nursing/blood bank form?

This is the road that I want to go down but I'm wondering if there are any others out there I could learn from.

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