Terri, can you tell me what the regulatory requirement is that prohibits the release of blood products until after the med director has signed off on a transfusion reaction? My medical director insists that if there is no serologic evidence of hemolytic transfusion reaction, that he not be called in the middle of the night to sign off on a transfusion reaction.

 

Also, is it in your nursing policy that they draw a blood specimen when a transfusion reaction is reported? Our nursing staff looks for direction from the transfusion service on that; I thought it was 'standard practice' for a blood specimen to be drawn when a transfusion reaction is called.

 

Thanks!

 

I believe it is a Joint Commission regulation; I'll try to find it.

And yes, we have it in our policy that unless the symptoms are urticarial only, we require a post-transfusion reaction specimen to be drawn. A post DAT at the minimum is required by AABB.

Just wanting some information that is somewhat related to this topic...we are moving towards a policy where all signs/symptoms of suspected transfusion reactions are reported to the physician and the Blood Bank, the transfusion is discontinued, and the reaction investigation is ordered.  It will no longer be up to the physician to decide whether or not to "call" the reaction. We have provided a well-defined list of the signs/symptoms in our SOP for Nursing to follow, but they are thinking that they will never finish a transfusion based on these criteria, mostly related to acute drops in BP, and increase of pulse rate, especially in the critical care patients, who already are unstable.  Could others please share how they take the clinical status of the patient into consideration, when determining if the signs/symptoms are truly related to the transfusion?

In our blood administration order set in our EMR, there is a statement that if the patient shows signs of a reaction according to the hospital policy, the nurse is pre-authorized to follow policy and initiate the workup. This was an organizational decision, keeps the physician involved, but not needed to call the MD with each reaction.

The clinical status question is difficult; we always do the workup, the pathologist reviews it and decides after reviewing the EMR if it was due to the blood or not. I say better safe than sorry. Maybe some of your criteria are too general (for example, any increase in pulse rate at all, or is there a range?).

Here, there is no leway in an increase in temp -- if the temp goes up more than 1 C, a workup is done.  In general,a positve DAT stops the transfusion no matter what the physician says. Nursing decides whether a change in BP, uticaria, pulse, etc is significant enough to order a workup. 

 

Scott

All suspected reactions are reported to the physician and the lab. The infusion is supposed to be stopped while contact is made to report. If the physician orders a workup, the infusion is DC'd and no more is issued until a workup is done and the pathologist on call OKs release of blood products. All red cell units are recrossmatched with a post-reaction blood sample. If it's an emergency situation, release of additional blood products has to be approved by the pathologist on call with whatever testing requirements he/she specifies. If we feel that a possible reaction is indicated by symptoms, we can overrule the physician and DC the infusion, following up with a reaction workup.