Our Medical Director is looking for some examples of a form letter to use when blood product usage is not in compliance with our established criteria. Does anyone have some standard form letters for this topic that they would be willing to share with me?

Also - for the moderators - what is the best way to give an email or fax number for contacts to send me the requested information?

Below is the form letter we always use. Then I attach a copy of our Transfusion Review Criteria and the patient's chart. It's worked for us for years. I think it is worded nicely to keep the doctors from getting all defensive.

June 16, 2008

Dear Dr. _______, M.D.:

In keeping with JCAHO requirements, the Transfusion Committee regularly reviews blood component transfusions using guidelines and criteria approved by the medical staff. Transfusions that are not within the guidelines are reviewed by the Transfusion Committee. Such transfusions are not necessarily problematic; frequently clinical issues surface at the time of the Transfusion Committee review that indicate the transfusion was entirely appropriate.

If there is any question as to the transfusion not meeting guidelines, the transfusing physician is asked to submit a response to justify transfusion. This is the case for ______________(patient), MR #01234567, admit date 06/16/08.

Please review and respond as soon as possible so the Transfusion Committee may note adequate justification for transfusion. A copy of the transfusion review criteria and patient chart are enclosed.

Sincerely yours,

(medical director)

This is the form that we use. It is a Word template with dropdown boxes for easy editing of several fields.

To:

From: XXXXXX MD, Director of Transfusion services

Date: 6/18/2008

Subject: Blood Product Transfusion Audit Outlier

XXXXXXXXXXXXXXXXXX Hospital is required to monitor transfusion practices to determine justification and appropriateness of blood usage consistent with established criteria. The Joint Commission requires peer review of transfusion therapy and physician ordering practices.

The following transfusion failed review criteria. The reason for the transfusion may have been unclear to the auditor or there may have been missing documentation. Please review the patient’s chart and clarify the needed information for this transfusion audit.

Patient Name: MR#:

Admission Date:

Transfused Blood Product:

Transfused Blood Product Number:

Transfusion Date:

Reason for audit:

MSBOS Guideline:

Other comments:

Submit your response within 3 weeks of receipt to:

XXXXXXXXXXXXXXX

Medical Staff Office

XXXXXXXXXXXXXXXX Hospital

cc: XXXXXXXXXXXXXXXX, Physician Peer Review Coordinator

Transfusion Audit File, Pathology

We tried similar letters. The physician's nurse always answered with something like:

1. If Dr. Smith said she needed it, she needed it

2. Doctor's orders- always good enough for me, what's the blood bank's problem

3. HIPPA (not HIPAA) won't let us answer this inquiry

So, our medical director always dropped a dime and made it personal.

BC