Hamoudi A C, Cecalupo A J, Wolf M L, Coe S A, Menke J A
Department of Laboratory Medicine, Children's Hospital, Columbus, Ohio 43205.
Am J Clin Pathol. 1991 Mar;95(3):389-92. doi: 10.1093/ajcp/95.3.389.
To comply with the requirements of the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) and to facilitate the review process, the authors designed a program to screen for the appropriateness of packed red cell (PRC) and platelet concentrate (PLT) transfusions. The purpose of this report is to describe the methodology of the review process. A quality assurance (QA) monitor was created in the Laboratory Information System (LIS) to screen indicators: hemoglobin for PRCs and platelet count for PLTs. Numerical value limits were defined to determine acceptable ranges. Each week, the LIS compiles a list of all patients who received transfusions and for whom the QA monitor determined that the values of the screened indicators were outside the defined appropriate limits. A detailed transfusion record is generated for each patient identified. During a six-month evaluation of this program, a total of 1,788 PRC and 3,109 PLT units were transfused. Of these, 582 PRC (32.5%) and 2,219 PLT (71.4%) units were within the acceptable guidelines. Lists for the remaining 1,206 PRCs and 890 PLTs were generated. Review of the transfusion record and other laboratory values from the LIS established the appropriateness of 1,052 PRC and 782 PLT transfusions. At the conclusion of the six-month period, the medical charts for 181 (11%) PRC and 108 (4.5%) PLT transfusions required chart review. This method provided major reduction in time of the transfusion review process. Similar guidelines may be used to monitor other transfusion products such as fresh frozen plasma.
为了符合医疗机构评审联合委员会（JCAHO）的要求并促进审核流程，作者设计了一个程序来筛查浓缩红细胞（PRC）和血小板浓缩液（PLT）输血的适宜性。本报告的目的是描述审核流程的方法。在实验室信息系统（LIS）中创建了一个质量保证（QA）监测器来筛查指标：PRC的血红蛋白和PLT的血小板计数。定义了数值范围以确定可接受范围。每周，LIS会汇总所有接受输血的患者名单，QA监测器确定这些患者的筛查指标值超出了规定的适宜范围。为每个确定的患者生成详细的输血记录。在对该程序进行的为期六个月的评估中，共输注了1788个PRC单位和3109个PLT单位。其中，582个PRC单位（32.5%）和2219个PLT单位（71.4%）在可接受指南范围内。生成了其余1206个PRC单位和890个PLT单位的名单。通过审核输血记录和LIS中的其他实验室值，确定了1052个PRC单位和782个PLT单位输血的适宜性。在六个月期末，181例（11%）PRC输血和108例（4.5%）PLT输血的病历需要病历审核。这种方法大大缩短了输血审核流程的时间。类似的指南可用于监测其他输血产品，如新鲜冰冻血浆。
