Blood Utilization

[Candace Schiele]

What all do you report in your Blood Utilization Committee meetings?

[AMcCord]

Usage of red cells, platelets, FFP. Average housewide Hgb when transfusions occur. Average Hgb by Dr. when transfusions occur. # of transfusions at 10.0 gm Hgb, at 9.5, at 9.0, and downward by increments of 0.5 to track effect of education. Transfusion outliers (big outliers) for review so they can be referred to Med Practice committee as needed after review. Quality projects, such as compliance rate with patient ID SOP steps when phlebs collect specimens, compliance rate with patient ID SOP steps at bedside by nursing when units are hung, emergency release of blood products (timing, completion of necessary documentation). And whatever else seems to need a look. (We do not have a blood bank information system, so any information we collect has to be done the old fashioned way, which limits a bit how many things we choose to track) .

[mollyredone]

We do have a committee, but it hasn't met in a year or so...I do audits monthly-PRBCs one month, PPH the next, FFP the next, so each is done quarterly.  I check lab values, diagnosis, whether the documentation by nursing is complete (start time, 15 VS check, done < 4 hours and consent signed.  Then I do a wastage/usage check for all, including how many patients got PRBCs, how many products expired, transferred, destroyed, etc.  I also do a report quarterly for units of PRBCs crossmatched vs transfused.  We are very proactive with transfusions and will call the floor or doctor if we feel it is inappropriate, i.e., platelet count >20<50 we will ask, what kind of procedure is the patient having.  Our computer pops up with appropriate labs (if PRBC ordered, H&H) 1) when product is ordered, 2)when workup is done and 3)when product is issued, so we wouldn't issue a PRBC for a Hgb of 10.

[David Saikin]

We audit all component transfusions.  We use a component request form which the Med Director uses to determine appropriateness of the transfusion. At BUR we discuss the overall CT ratio, individual MD CT ratios and components given to each patient during the previous month.  We also evaluate RhIg and Albumin usage.  We are supposed to meet quarterly but it's lucky if we meet 2x/yr.

The BB supv may request that the Pathologist intervene if there are questionable component requests.  Actually sometimes I will balk at a request, usually for plts of plasma,  and tell the MD that this will need Pathologist approval.  We never turn down a request for red cells for transfusion - the MDs can argue over appropriateness after-the-fact.  My Med Director is only here 1 day/week.

[ESIZENSKY]

Is there benchmarks for C/T ratio and blood product wastage?

[AMcCord]

C/T ideal is 1/1 - goal is to get it as close as possible to that. Work in progress here, but we are making visible improvement and expect to make more with changes to order management for blood products in our new HIS.

[R1R2]

we dropped C/T monitoring after we went to electronic crossmatch