tms8313

I was wondering how other facilities are meeting the requirements for CAP TRM.41300 and AABB BBTS 5.28.3 regarding the bedside verification performed by nursing staff before transfusion.  We were recently cited for no documentation that nursing staff was reviewing the interpretation of crossmatch testing and if special transfusion requirements are met (CMV, Irradiated, etc).  We have that information included on the transfusion report that goes with the product to the nursing unit.  We use the Bridge administration system and it records all of the other required information by scanning the patient armband and the blood product.  Also the nurses have to answer questions in Bridge before they start the transfusion, such as  1. consent form signed? 2. physician order reviewed?  along with some other information.  
I am wondering how other facilities document what information the nurses are checking.  I can add an additional question in Bridge to document that the nurse has checked for special transfusion requirements ordered by the physician but I am not sure how to proceed with the crossmatch interpretation.  Nearly all of our crosssmatches are compatible and the RN could document that in Bridge, however what do you all do if you have to give least incompatible units as in the cases of warm autos?  It is marked that way on our transfusion reports but I am imagining some of the nurses not understanding the situation and not wanting to take responsibility for giving the unit.
Any suggestions, advice or how you handle these situations is greatly appreciated!

We have the ABO/Rh confirmation order built so that it can only be ordered by lab staff when needed. We don't allow surgery staff to put the order in. Blood Bank knows when we get an order if a second type is needed and this prevents OR staff from drawing two tubes at the same time and trying to say they were drawn at different draws.

Here we have a list of requirements that the tranfusionist completes by checking off that they performed the task. This is on the transfusion tag that is attached to the unit. 2 of the items are Verify Interpretation of Crossmatch Tests if Performed and Verify Special Transfusion Requirements. Inspectors have been ok with these.

There are hospitals now that has switched their verbiage from "least incompatible" to "most compatible". Which is true! This blood is the BEST blood possible considering the patient's situation. There is nothing you can do about the patient's auto, but you can make sure to provide the "best" compatible unit to the patient.  Of course you do this by making sure there are no underlying clinically significant alloantibodies in the patient's plasma.
 
Some places just straight out say "incompatible" on the transfusion report/tag.  The physician is then notified and made aware of this.  Some places make the doctor sign a form acknowledging the "incompatible" units and the risks involved, but where I work, a verbal "ok" would suffice.   We are all on the same team, working towards the same goal, the welfare of the patient.  We are not trying to "pin the blame" on anyone for possible hemolytic transfusion reactions.  We all want the same thing. 
 
Here is a really good podcast on the subject from the Blood Bank guy. It is really interesting and goes deeper into the subject and "what to do when everything is incompatible".  Good day. 
https://www.bbguy.org/2020/06/17/085/
 
 
 
 
 
 
 

I was wondering how other facilities are meeting the requirements for CAP TRM.41300 and AABB BBTS 5.28.3 regarding the bedside verification performed by nursing staff before transfusion.  We were recently cited for no documentation that nursing staff was reviewing the interpretation of crossmatch testing and if special transfusion requirements are met (CMV, Irradiated, etc).  We have that information included on the transfusion report that goes with the product to the nursing unit.  We use the Bridge administration system and it records all of the other required information by scanning the patient armband and the blood product.  Also the nurses have to answer questions in Bridge before they start the transfusion, such as  1. consent form signed? 2. physician order reviewed?  along with some other information.  
I am wondering how other facilities document what information the nurses are checking.  I can add an additional question in Bridge to document that the nurse has checked for special transfusion requirements ordered by the physician but I am not sure how to proceed with the crossmatch interpretation.  Nearly all of our crosssmatches are compatible and the RN could document that in Bridge, however what do you all do if you have to give least incompatible units as in the cases of warm autos?  It is marked that way on our transfusion reports but I am imagining some of the nurses not understanding the situation and not wanting to take responsibility for giving the unit.
Any suggestions, advice or how you handle these situations is greatly appreciated!

I was curious about the transfusion practice of other facilities when presented with a patient that has autoantibodies (excluding warm autos with specificities).
If the patient has autoantibodies NOT associated with a warm auto with Rh-specificity what are your protocols for giving antigen negative units?
Example:  if a patient is identified with an auto-M or an auto-Jka, what units would you crossmatch for transfusion?  Our policy states to give antigen negative units if the auto antibody is currently reactive, however our reference lab (who is a certified IRL) does not give the recommendation of giving antigen negative units to patients with any autoantibodies.  This can be quite confusing for transfusion service staff who are 90% crosstrainers and usually follows what the reference lab recommends.  I am looking for references to present to our medical director to determine what our policy should be.

Is anyone else able to produce a dry cell button? I can't get a dry button, there is always about 2 drops of saline in the tubes after the wash cycles are complete. What is "normal" for this equipment?

we do not want "extra" Blood Bank tubes drawn unless it is a critical patient situation.  We made a new policy:  If the patient is critical, we hold the tube for 60 minutes to allow the orders to be written and placed in the computer.  If no orders are received, then the tube is discarded and a new specimen is collected when orders are placed. 
The problem we had in the past was either 1) when the "extra" BB specimen was drawn, a BB armband was not issued to the patient (as required at the time of specimen collection).  When orders were received, testing done, and products issued, then everything had to be redone because there was no corresponding armband on the patient   or 2) a BB armband was issued, but no orders were ever placed so no testing was performed.  This confused the OR staff when they saw a pink armband on the patient and assumed a type and screen/crossmatch had been done.