A colleague in Kentucky wonders if hospitals or blood collection centers would comment on their policies regarding the provision of RBC units for transfusion at "off-site" physician offices and the lines of authority (responsibility) that they have in place for this kind of practice. He reports that his hospital transfusion service prepares RBC units for transfusion at an off-site oncology office where multiple physicians practice. His transfusion service limits issuance of RBCs to this location for patients who have no unexpected red cell antibodies and no history of previous transfusion reaction events. His transfusion service issues the RBC units packed in coolers after verifying pick-up information which includes the identification of the intended recipient, that is provided by the physician office personnel. The transfusion service has provided policies and procedures for the office personnel to follow, but has taken the position that the office staff is responsible for documenting its own competencies, orientation of new personnel, etc. The inquiring colleague wonders if anyone would comment on where they think the responsibility lies, should an adverse transfusion event occur at the off-site location, such as giving a unit of RBCs to the wrong patient.

Editor's note: The information at the following links may be of general interest to this discussion:

• Pre-transfusion testing on blood samples that have been drawn from patients who are being treated at home
• Prevention of Mislabelling of Pre-transfusion Compatibility Specimens
• Guidance on the length of time a patient must be observed during the start of a transfusion
• Implementing a home transfusion program
• Methods for ensuring correct identification of patients who have pre-transfusion blood samples drawn before admission for surgery

The following comments have been received.

ADDENDA Oct. 7, 2005

1. A quality manager in Spain reports that his donor center supplies blood for a large University hospital that maintains a busy Home Care Service. The Home Care Service is staffed by physicians, nurses, etc., and treats all kinds of patients, provided they are stable or require only standard care. Patients may include leukemic individuals during their aplastic period, or patients needing postoperative care following trauma surgery, etc. The structure of responsibility for this Home Care Service's transfusion practice is similar to the responsibility structure of the hospital, namely:

• The physician in charge of the patient is responsible for determining if there is an indication of transfusion, and if so, what product to use, what dose to administer, if there is a need for premedication, etc.
• The nurse obtains pretransfusion samples, carries them to the hospital blood bank for testing, and picks up the product from the hospital blood bank after the compatibility tests have been completed.
• The hospital blood bank verifies the records and the samples in the same way as for inpatients.
• The nurse performs all the pre-transfusion verification checks, administers the transfusion, and if an adverse event happens, acts according to the Service guidelines.
• The Home Care Service is responsible for its own staff training, keeping patient transfusion records according to the hospital practice, and adapts the hospital transfusion guidelines as their standard practice.

He reports that over the years several thousands of red blood cell units and platelets have been transfused at the Home Care Service, without major problems.

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