Our hospital supports three clinics close to us. In one we transfuse out-patients. The staff is employed by our facility, the nurses and doctors are trained in transfusion policies and procedures, and follow all the main hospitals guidelines. For this reason we allow transfusions to be done there.

Is there a regulation that states what the actual rules are for off site transfusions?

A question has come up as to wether it is legal and if we can transfuse there why not at the local cancer center (which is not at all affiliated with us.)

Thanks for yor help.

Our facility used to provide blood for a local dialysis unit that ws not affiliated with the hospital. We did not have control over storage of the blood or coolection of samples and transfusion protocols. Eventually we decided to only allow people trained here to draw samples and all transfusions are on site. For me it came down to assuring our patients that their transfusion was the safest possible event.

:juggle::juggle::juggle::juggle::juggle:

You will have to check with your local/state regs. to deteremine what licensure is required. Whatever you decide, be sure to involve legal counsel and make sure all the responsibilities of each party are clearly specified in the service agreement.

Also, be careful to review the reimbursement guidelines. If the clinic you're currently providing is legally part of the hospital, those patients may be considered "hospital out-patients" and therefore subject to APC reimbursement guidelines. But physician offices, nursing homes, etc. are not considered "hospital out-patients" so the Medicare reimbursement guidelines do not apply to these settings. If you decide to provide compatibility testing and products to these types of facilities you should consider billing the facility and not the patient. If the location does not qualify as a "hospital out-patient" there is basically very little to no reimbursement for these activities. If the facilities are charged, the clinic facility will quickly realize they are losing tons of money and determine they no longer want to offer this service (unless it's a boutique service and their patients can afford to pay out-of-pocket accordingly). If your facility is directly billing the patients, your facility will be likely be losing money for each transfusion provided. Dialysis centers have their own unique Medicare reimbursement rules

If you choose to provide compatibility testing and products to a non-affiliated facility, make sure that the contract is clearly written as to which facility is liable for which functions. You will want to clearly delineate that your responsibility begins and ends with the testing performed at your facility (i.e. the specimen you received is compatible with the product you issued); if employees from your facility do not collect the pretransfusion specimen, you cannot claim that the product furnished is compatible with the patient. Responsibility for proper patient identification has to be expressly assigned to the facility collecting the specimen & transfusing the product. I have also insisted on doing periodic inservices with the contract facility concerning proper patient identification, specimen collection, handling of blood products, etc. You will need a policy/procedure that clearly defines labelling and specimen requirements and you must insist that it be followed. You will also probably want to define how they transport the product (type of cooler needed, etc); I've always insisted that they bring an appropriate transport container and do not issue if the transport container is not brought to the lab at the time of pick-up. The policy should also state your return policy if a product is not used for some reason; I have never allowed return of a product that went outside of our control, if you do, get with your blood center because this may affect your ability to return consigned products. You will also need to decide how you will handle possible transfusion reactions.

I have worked in several different places that have these types of contracts and it hasn't been a problem. When setting up the process, you need to make sure that you think out every single step and every possible liability and clearly delineate this in the contract &/or policy/procedure.

SMW and shelleyk482 gave presented accurate information. We used to perform the compatibility testing for a non-affiliated dialysis center, pack the donor units (with ice) in an approved Red Cross box, and a dialysis nurse would come picked up the donor units and transfuse them during dialysis. However, several years ago Medicare stopped reimbursing for transfusions in that setting (so the dialysis center no longer transfuses and blood.)

(Those of you in a hospital setting: Don't you wish you could just stop doing things that are not reimbursed??)

(Those of you in a hospital setting: Don't you wish you could just stop doing things that are not reimbursed??)

That would be a dream come true! Reimbursement is one of the bigger headaches in blood bank.

I agree that you should check your state regs. In NYS, you can't do it unless the off site clinic applies for a license to be a limited transfusion service. Quite a cumbersome process.

Adding a question in here..

 

We provide blood and platelets  in coolers to our cancer center down the street. 

We have a strict ONE NURSE   ONE PATIENT issue policy to our nurses in our hospital.

Lately, our cancer clinic has been coming to pick up blood and wanting to get  2 coolers on 2 different patients by ONE nurse.

They have a policy at the cancer clinic that states they can pick up a maximum of 2 units on 2 patients at a time.

My boss was thinking about having us mirror their policy.  But they want to come pick up 2 coolers for 2 different patients because it's convenient for them.  But I don't want to I think they should follow our policy of one nurse one patient.

 

I couldn't find an AABB standard or anything in the technical manual that stated anything to help me.

 

What do you think?

 

 

I can tell you that we never allow one individual to pick up products for more than one patient at a time. In my understanding, that's a blood bank procedure/process/policy and would fall under the discretion of your medical director (and you as blood bank supervisor).

On 1/21/2016 at 3:32 PM, goodchild said:

I can tell you that we never allow one individual to pick up products for more than one patient at a time. In my understanding, that's a blood bank procedure/process/policy and would fall under the discretion of your medical director (and you as blood bank supervisor).

Agree.

I definitely think the hospital policy for the blood bank of 1 patient, 1 nurse trumps the cancer clinic's policy.  

Agreed !  i put my foot down and talked to my pathologist again and we are sticking to our guns about it.  

I don't think I'd be brave enough to argue with you!!!!!!!!!!!!!!!!!!!!!!!!!!!