Anyone willing to share their Transfusion Service "Critical Values'?

Thanks.

+absc for same day surgery/ob prenatal; hemolytic transfusion rx; delayed transfusion rx

We don't have "critical values" per se. I ask that techs call the physician office on all pos abs ( first time found) for presurgicals. As far as as the reaction goes, that is nursing's call as far as monitoring vitals. Any temp more than 2 degrees increase, chills, BP drop are all nursing protocols. We also alert physicians if a transfused patient has a pos DAT post and not pre. That is interesting though I had not thought of having formal critical values, everyone here is very very good at making judgements for that kind of thing so I have never thought to institute that.

Pos DAT on a cord blood and incompatible XM's (usually the people with warm autos, we like to give nsg a heads up that they are incomp)

Lara

Are you inspected by CAP? . . . having a critical values process has been one of their standards for at least 6 years.

A. A positive antibody screen on a patient who has a STAT crossmatch ordered.

B. A positive DAT post-transfusion when the pre-transfusion DAT was negative.

C. Discovery of a crossmatch incompatibility on a unit that was signed out of the Blood Bank before completion of the crossmatch due to the patient’s urgent need or crossmatch incompatibility with no compatible blood is available.

D. Discovery of a discrepancy involving the ABO or Rh type of a unit of blood or patient after the unit has already been signed out of the Blood Bank.

Here are our "alert values". The ET code column is just an English Text code that gets put in the computer to document.

Tx Rx Alert Values

No.

Alert Value

ET Code

1

Pink or red plasma.

TXRX1

2

Any shade of red, brown, or black urine except when the urine microscopic shows intact red cells.

TXRX2

3

Positive DAT on post-reaction specimen when pre-reaction DAT is negative.

TXRX3

4

Patient in shock that may be due to anaphylactic reaction or transfusion related sepsis.

TXRX4

5

Record check discrepancy involving patient or unit identification.

TXRX5

6

Positive Gram's stain or culture on transfused unit. (Pathologist and patient care personnel will be notified by microbiology.)

TXRX6

7

Signs and/or symptoms of TRALI.

TXRX9

Other Alert Values

No.

Other Alert Values

ET Code

8

Laboratory received notification from supplier of a positive bacterial detection test on a transfused unit. See RX8.

TXRX7

9

Blood has been issued uncrossmatched and the completed crossmatch is incompatible.

TXRX8

No.

Other Alert Values

10

Compatible Red Cells cannot be obtained for a bleeding patient.

If incompatible blood is to be transfused, initiate a “Medical Necessity for Deviation from Blood Bank Procedure Documentation Form”. Complete the first section, make a copy for the department, and send original to the pathologist.

When the form is returned, complete the last section.

Joint Commission has very thorough requirements for notification of critical values, read back and documentation of the same that makes me want to choose only those that are truly critical, not just abnormal.

Yes, it's a requirement for both CAP and JC. We don't really have "values" in Blood Bank, so we call ours critical results. Included are:

Serious tx rxns (hemolytic, delayed hemolytic, bacterial contam, TRALI)

Pos Ab screen after signing out uncrossmatched emergency release

No compatible blood available for a patient

Pos DAT for cord bloods

We call ours "critical situations" to get around the JC read back requirement. These situations are discussed with a caregiver, preferably an MD. Sometimes the discussion is BB MD to attending MD. Since there is a dialog about the situation with the caregiver, readback would be redundant.