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Nurses, Pathologists and the Laboratory: Working Together Outside the Blood
Bank Walls A Joint Patient Safety Project Developed by the American
Organization of Nurse Executives (AONE) and the American Society for Clinical
Pathology (ASCP)
Roslyn Yomtovian, University Hospitals, Cleveland, OH; Lucia Berte, Quality
Systems Consultant, Westminster, Colorado; Debra Adornetto, University of
Colorado Hospital, Denver, Colorado; and et al.
While application of technology over the last two decades has vastly
improved blood component safety, little attention has been devoted to blood
transfusion process safety, which includes all processes and procedures to
ensure a blood component is safely administered to a patient. These processes
and procedures represent a complex interplay of activities occurring within the
blood bank/transfusion service, at the patient bedside, and at a variety of
interdepartmental interface points in between. In order to improve the safety
of the transfusion process, the ASCP in collaboration with the AONE convened a
multidisciplinary task force, which identified four areas of the blood
transfusion process specimen procurement, blood component dispensing, blood
component transport, and blood component administration - as particularly
error-prone. These were analyzed in detail and mapped on flowcharts. Each
flowchart depicts the essential activities comprising each process and
indicates the specific standard operating procedures (SOPs) needed to
operationally support each process activity. These flow charts were used to
construct SOP Inventory Checklists designed to be used by healthcare facilities
as an audit tool to assess that 1) all essential process activities required to
ensure safe transfusion practice are in place, 2) these processes are supported
by institutionally-appropriate SOPs, and, 3) each of these SOPs includes clear
instructions for steps to be taken in the respective transfusion practice
activity. A detailed understanding of the processes comprising blood component
administration, assurance of the necessary supporting SOPs, and a clear
delineation of the key personnel responsible for each process activity will
help improve the safety of the blood transfusion.
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