A blood banker in a Sun Belt state reports that their 'corporate compliance policy' no longer allows their laboratory to "assume that a unit has been transfused" if it has not been returned to the blood bank. In order to comply with this policy, the inquiring blood banker's laboratory now uses a three-ply Issue/Transfusion form. When a blood product is issued, the first page of the Issue/Transfusion form is retained by the blood bank and the second and third copies accompany the blood product to the patient care area. After the transfusion has been completed, the transfusionist sends the second copy of the Issue/Transfusion form back to the blood bank (to document that the transfusion occurred, and the third copy on the Issue/Transfusion form is placed into the medical chart. However, this approach creates extra work for the blood bank in tracking down lost sheets and sheets that were not returned. The inquiring blood banker wants to know how other facilities are documenting that blood products are actually transfused.

The following replies were submitted in response to the above.

1. A blood banker in New York reports that in the past an inspector insisted that his hospital implement a policy similar to that described by the inquiring blood banker. However, the New Yorker says that they did not comply. Rather, he asks if the pharmacy does this with every dose of cytoxan or digoxin? To his knowledge, the pharmacy does not. In the responding New York blood banker's opinion, the record of administration, the definitive one, for all blood components is the medical record. That is where the" assumption" of transfusion begins and ends. The New Yorker concludes asking 'What possible benefit is this additional work providing to the patient or the institution?'

2. A blood banker from Heidelberg, Germany would like to report about the policy of documenting transfusion in Germany. According to the responding blood banker, the German guidelines are very restrictive in the documentation of whether blood components have been tranfused, discarded, etc., after being delivered by the blood bank. In Germany blood components are considered medical drugs, such as antibiotics. Therefore, the responding blood bankers hospital uses a divisible sheet accompanying the blood product where one part is designed to be filed in the patient's record and the other part is to be returned to the blood bank. In the part which is returned to the blood bank the transfusing physician has to report not only the transfusion itself but also the compatibility of the transfusion (for recording and handling transfusion side effects). In the case of returning the blood component to the blood bank when not used, the department has to ensure that the blood unit has been transported and kept under the regulated circumstances (temperature etc.). The responding blood banker concludes saying "This policy clearly increases the expenses for documentation, but also improves the quality in the sense of lookback and blood component excellence."

3. A blood banker from Virginia is wondering if the institution requiring "proof" of transfusion for "compliance" reasons makes the same requirements for pharmacy products?

ADDENDA May 17, 2002

4. A blood banker reports that his hospital recently switched from a three-ply form to a two-ply transfusion form. Both copies are attached to a unit when it is issued from the Blood Bank, and the status of the unit in the computer is changed to 'issued'. When a unit is transfused, the second copy of the transfusion form is returned to the Blood Bank, and the computer record for the unit is updated from 'issued' to 'transfused'. The responding blood banker's computer is capable of generating a report of all units that are in an issued, (but not yet transfused) status for more than five days. Any unit appearing on this report for more than a five days requires an investigation.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator