Consent For Transfusion Research Articles

Shared decision-making for patients with vaccine-related concerns of blood transfusion: A single institution experience.

Some patients express concerns regarding receipt of allogeneic blood transfusions from donors potentially vaccinated against SARS-CoV-2 (COVID-19). However, limited information exists about patients' expression of these concerns or how to address them during the blood transfusion consent process. In this study, we describe our experience of working collaboratively with patients with vaccine-related transfusion concerns prior to elective surgery, summarizing treatment decisions and clinical outcomes. This observational descriptive study includes patients seen in our Bloodless Medicine and Surgery clinic between June 2022 and June 2024 for vaccine-related transfusion concerns prior to elective surgery. A shared decision-making framework was employed to foster conversation, share information, provide reassurance, reconcile conflict, and match preferences with available care options. Patient characteristics, treatment decisions, and surgical outcomes were reviewed and summarized. Thirty-five patients were included, with median (1st, 3rd quartile) age of 61 (53, 69) years. Cardiac surgery was the most common type of surgery (29%). Twelve patients (34%) were anemic preoperatively, and all received preoperative treatment. After discussion with a Bloodless Medicine specialist, 24 (68.6%) decided to consent to the use of all blood products, 5 (14.3%) accepted only red blood cells, and 6 (17.1%) declined all blood products. Among 28 patients undergoing surgery, only 4 (14%) received allogeneic transfusion perioperatively. Many patients concerned about the vaccination status of blood donors may ultimately consent to allogeneic blood products after shared decision-making with a Bloodless Medicine specialist, highlighting the importance of patient empowerment and collaborative care.

Surgical Safety Checklist as an optimal organizational model in ensuring the maximum degree of preparedness for intraoperative incidents (case report)

Objective. The use of checklists for quality and safety control of medical care is an effective tool for reducing the frequency of errors, dangers and complications in any section of medical practice.The aim is to demonstrate the possibilities of minimizing and leveling the potential risks accompanying surgical intervention using the example of routine application of the surgical safety checklist.Object and methods. Patient A., 55 years old, was admitted to the emergency department of Samara City Clinical Hospital №1 named after N.I. Pirogov on 24.04.2023. with complaints of pain in the right upper abdomen, nausea, vomiting, general weakness. The diagnosis was Cholelithiasis, acute calculous cholecystitis with the formation of a perivesical abscess. It required laparoscopic cholecystectomy operation. While filling in the surgical safety checklist (SSC) and analyzing possible intraoperative incidents, the attending physician executed an informed voluntary consent for transfusion of donor blood components. The corresponding components were ordered. Having weighted up the potential intraoperative risks specified in the part "Before anesthesia" of SSC, the anesthesiologist installed a catheter into one of the central veins and performed the urine bladder catheterization. Surgical intervention was complicated by bleeding, which required conversion of surgical approach. Upper median laparotomy, cholecystectomy, surgical hemostasis were performed. Total blood loss was 1000 ml, plasma and red blood cell were donated to the patient. The operation was completed by drainage of the subhepatic space and suturing of surgical wounds.Results. The clinical case describes the importance of a team approach at the stage before the operation, as well as the role of all specialists provided life support and medical care for the patient. It results from attentive work with the checklist which shows a clear liability for each member of the operating team at different stages of preparation and treatment of a surgical patient.Conclusions. The development of a culture of surgical safety is an important way to minimize the risks associated with surgical intervention for each individual patient and for the institution by optimizing the work of operating units.

Optimizing Informed Consent Discussions: Developing a Narrative for Transfusion Consent.

Ensuring patient informed consent is a key tenet of modern medicine. Although transfusion of blood products is among the most common medical procedures performed in hospitalized patients, there is evidence that informed consent for transfusion is at times incomplete, poorly understood, hurried, and/or inaccurate. This study aimed to develop a narrative that can be used as a framework for practicing physicians and for educational purposes to optimize the process for obtaining informed consent for blood transfusion. The narrative was developed using a modified Delphi approach with 5 Rounds that included feedback from transfusion medicine (TM) experts, transfusion-provider physicians, and lay people. The surveys collected qualitative and quantitative data analyzed using thematic content analysis and descriptive statistics, respectively. Results from Rounds 1 and 2 generated a draft narrative and Rounds 3 to 5 informed further modifications. Round 1 included draft narrative scripts from 28 TM experts; thematic coding generated 97 topics. In round 2, 22/28 of the initial experts rated items identified from Round 1. Those with a content validity index (CVI) ≥ 0.8 were used by the authors to develop a narrative. In Round 3, 20/24 participants from Round 2 reviewed the narrative with 100% agreeing on the items included and 90% agreeing the flow was logical. In Round 4, 23 transfusion prescribers (non-TM physicians) reviewed the narrative for flow, manner, length, and usability; there was 83% agreement with the nonexclusion of important topics; 91% felt it would be effective for teaching trainees. Round 5 included 24 nonmedical laypeople of different demographics. Most participants (92%) thought that the script was appropriate in length and there were opportunities to ask questions. Participants could also identify the adverse transfusion reactions and understand that they could refuse the transfusion. A narrative for obtaining informed consent for blood transfusion was created through multiple rigorous iterations of review and feedback with both transfusion providers and the lay public. The narrative, developed for a specific clinical scenario, was well-received by medical and nonmedical participants and can be used, and modified, to help ensure patients understand the risks and benefits of blood transfusion.

Assessment of Patient's Knowledge about Blood Transfusion and Impact of Structured Information on this Knowledge: Single-Center Report from India

Background and Objectives: Blood transfusions are frequently prescribed for acute and chronic conditions. When transfused judiciously, blood can save life and improve the health of the patient(s). However, transfusion of blood and blood components is never risk-free. Despite this, transfusion consent may not be obtained satisfactorily. We assessed the knowledge of patients about their blood transfusion and consenting process and the impact of structured information on their knowledge. Methods: A cross-sectional qualitative study design was employed. The study included all consenting adult patients who were intended recipients of red blood cell transfusion. Patient information sheet (PIS) along with pre- and postquestionnaire was administered to study patients. Results: Our study examined patients “knowledge and their attitude” about blood transfusion and recalling of their decision on consenting to transfusion. For the reason of being transfused, 58.5% were not aware, while 73% were unaware about the benefits of blood transfusion. Similarly, 85.5% were unaware about the risk of blood transfusion. There was a lack of knowledge about the “alternative option” of blood transfusion. Our findings also suggest that a standardized informed consent process was not being carried out. Conclusion: There is a need for strengthening IEC in the blood transfusion process. The present study has highlighted the role of printed/written information (PIS) in the native language and in imparting knowledge in the context of blood transfusion.

Prospective Audit of Blood Transfusion Practices among Nurses and Role of Education and Intervention at a Tertiary Care Hospital

Background and Objectives: Periodical internal audits evaluate the process flow of transfusion which arrests the spectrum of adverse events. The objective of the study was to provide evidence that blood is being ordered, handled, and administered according to transfusion guidelines and to highlight the deviations with the secondary objective of improving knowledge and practices in nursing officers. Methods: Nursing officers were audited on 50 patients each in P1 and P2 phase. Training of 243 nursing staff was done after P1 phase. Training comprised education and interventions over 45 days – 18 didactic lectures and 36 bedside classes. Nurses were audited both before and after the completion of the training. Results: One hundred and forty-five nurses had knowledge and practice score in between 11 and 15 in P1 which improved to 243 (100%) in P2. Transfusion order for one patient was not written in P1, whereas 100% compliance was seen in P2. Noncompliance in taking consent for transfusion improved from 5 to 1 in P2. Blood request error and sample labeling error reduced from 8% to 0% and 4% to 0%, respectively, in P2. Sample labeling was inappropriate in 2 patients in P1 which improved to nil in P2. Checking of vital signs check and intravenous cannula patency improved from 96% to 98%. Crosscheck of packed red blood cell nursing officers before transfusion reduced from 8% to 0% and from 30% to 2% among medical officer (P < 0.05). Delay in the initiation of transfusion, reduced from 7 to 2 patients. Conclusion: Timely audit of transfusion practices reduces mistakes and errors hence improved patient care.

Informed Consent: A Tool for Patient Education; Not Merely a Regulatory Requirement

Informed consent is an ethical and legal requirement for medical treatment. Informed consent is the process by which a blood center educates a donor and patient regarding their safety, benefits, and adverse effects using the twin tools of blood donor consent and blood transfusion consent. In case of other patient procedures, the health-care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention. Consent by the patient may be implied (where a patient passively cooperates in a process without a formal consent), verbal (where the health-care professional provides information to patient regarding the procedure and its relevance through effective communication), or written. It is important for medical practitioners to have written and signed informed consent from their patients before performing any invasive or irreversible procedures. Informed written consent is also needed to publish scientific data regarding patient and incorporating images of the patients while publishing case reports. Written consent may have fixed formats or may be personalized adapting to the needs of the patient and the practitioner. The purpose of obtaining consent must be to make the patient understand the procedure planned and give him/her an opportunity to make a decision about whether to undergo the procedure or intervention. Informed consent may be waived in emergency situations if there is no time to obtain consent or if the patient is unable to communicate and no surrogate decision-maker is available. The process of informed consent is shifting-focusing more on communication and less on obtaining signatures. No matter how well worded the consent form is, if the patient does not understand what is being communicated, the purpose of it lost, and it does not stand well in the court of law. The present review addresses some of the vital issues and nuances regarding informed consent when providing medical care. Literature search for the present article was conducted using databases such as PubMed, Medline, and relevant articles published in peer-reviewed journals.

A comparison of ear amputations replantation techniques

BackgroundThe management of traumatic ear amputations remains a rare and difficult occurrence for surgeons. This is due to the fact that the chosen replantation technique must ensure the best vascular supply and the surrounding tissues have to be preserved as to not jeopardize a future auricular reconstruction in the event of replantation failure. ObjectiveThis study aimed to review and synthesize the literature about the different surgical techniques described to date in the management of traumatic ear amputations (partial or total). Materials and methodsRelevant articles were searched on PubMed, ScienceDirect, and Cochrane Library databases in accordance with the PRISMA statement guidelines. ResultsA total of 67 articles was retained. When possible, microsurgical replantation enabled the best cosmetic result but required important care. ConclusionPocket techniques and local flaps should not be performed because of the lower cosmetic result and the use of the surrounding tissues. However, they could be reserved for patients without access to advanced reconstructive techniques. When possible, microsurgical replantation can be attempted after patient consent for blood transfusions, postoperative care and hospital stay. Simple reattachment for earlobe amputations and ear amputations up to one third is recommended. When microsurgical replantation cannot be attempted, and if the amputated segment is viable and bigger than one third, simple reattachment may be attempted with an increased risk of replantation failure. In case of failure, an auricular reconstruction by an experienced microtia surgeon or prosthesis may be considered.

WITHDRAWN: A comparison of ear amputations replantation techniques

The management of traumatic ear amputations remains a rare and difficult occurrence for surgeons. This is due to the fact that the chosen replantation technique must ensure the best vascular supply and the surrounding tissues have to be preserved as to not jeopardize a future auricular reconstruction in the event of replantation failure. This study aimed to review and synthesize the literature about the different surgical techniques described to date in the management of traumatic ear amputations (partial or total). Relevant articles were searched on PubMed, ScienceDirect, and Cochrane Library databases in accordance with the PRISMA statement guidelines. A total of 67 articles was retained. When possible, microsurgical replantation enabled the best cosmetic result but required important care. Pocket techniques and local flaps should not be performed because of the lower cosmetic result and the use of the surrounding tissues. However, they could be reserved for patients without access to advanced reconstructive techniques. When possible, microsurgical replantation can be attempted after patient consent for blood transfusions, postoperative care and hospital stay. Simple reattachment for earlobe amputations and ear amputations up to one third is recommended. When microsurgical replantation cannot be attempted, and if the amputated segment is viable and bigger than one third, simple reattachment may be attempted with an increased risk of replantation failure. In case of failure, an auricular reconstruction by an experienced microtia surgeon or prosthesis may be considered.

Patient perspectives on intraoperative blood transfusion: A qualitative interview study with perioperative patients.

While red blood cell (RBC) transfusions are frequently administered during surgery, little is known about patient perspectives regarding intraoperative transfusion. The aim of this study was to understand patient perspectives about intraoperative RBC transfusion and explore their willingness to engage in transfusion prevention strategies. This descriptive qualitative study used semi-structured patient interviews before and after surgery. Purposive sampling was used to select adult patients with varying perioperative courses, including having perioperative transfusion or postoperative anemia. Inductive and deductive thematic analyses were conducted to identify themes. Twenty patients (nine preoperative and 11 postoperative patients) were interviewed. The following themes were identified: Risk-benefit perception of transfusion, transfusion acceptance, trust, patient involvement in transfusion decisions, acceptance of transfusion prevention interventions, and communication. Patients perceived transfusions as low-risk compared to the surgery itself. Factors influencing transfusion acceptance included trust in the healthcare system and the perception of the treatability of transfusion-related complications. Some patients preferred to defer transfusion decision making to the perioperative team, citing trust in professional judgment and building a positive relationship with their surgeon. Others wished for their preferences to be incorporated into transfusion decisions. Some desired detailed blood consent conversations and most were willing to participate in strategies to reduce intraoperative transfusion. In our sample, patients consider intraoperative transfusions as low-risk high-reward interventions and trust the healthcare system and perioperative team to guide intraoperative transfusion decision making. However, preoperative transfusion consent discussions were recalled as being superficial and lacking nuance. Targeted strategies are required to improve blood consent discussions to better integrate patient preferences.

Information technology improves the quality of transfusion practice in China.

Transfusion services in China must establish a quality management system, and regular inspection of quality indicators is an important component of quality management. Although the positive role of information technology in reducing human errors has been widely reported, its role in improving transfusion quality indicators still requires further study. This study explores the role of information technology in improving the quality of transfusion practice. We developed an optimized blood transfusion management information system and then analysed the changes in four quality indicators before and after using the system to clarify the role of information technology in improving the quality of transfusion practice. After using the optimized system, the completeness rate for transfusion request forms increased from 81.5% to 99.3%; an unqualified doctor's signature was the most common incomplete content (0.45%). The appropriate transfusion rate increased from 87% to 99.4%, and red blood cell and frozen plasma utilization in most surgical departments decreased. Although the reporting rate for adverse transfusion reactions increased from 0.22% to 0.49%, these increases might be partly due to changes in transfusion regulations. The adequacy rate of transfusion medical records increased from 74.8% to 90.4%. Overall, the inadequacy of informed consent for transfusion, pre-transfusion laboratory tests and documentation of the transfusion process were reduced from 6.4%, 6.2% and 12.6% to 1.7%, 2.0% and 5.9%, respectively. Information technology can play an important role in improving the quality of transfusion practice, as part of a programme of medical education, regular audit and other measures.

Levels and in-unit stability of 11-nor-9-carboxy-9-tetrahydrocannabinol (9-carboxy-THC) in donor platelets and whole blood: is enough present to have an impact on recipients?

Abstract Objective The safety of the United States donor blood supply has been questioned in the context of recreational marijuana legalization in Colorado and other states nationwide. It is unclear whether cannabis use by donors presents a danger to recipients, either through direct toxicity or socioeconomic ramifications. Our objectives are to both determine if the active metabolite of tetrahydrocannabinol (THC), 11-nor-9-carboxy-9-tetrahydrocannabinol (9-carboxy-THC), is present in donated units in a dosage high enough to impact the recipient and to assess for in-unit metabolism or degradation. Methods We will quantify the amount of 9-carboxy-THC in platelet units donated by self-reported cannabis users through liquid chromatography with tandem mass spectrometry (LC-MS/MS) testing and correlate the assay data with donor survey responses. To gain insight into in-unit metabolite stability, we also will test whole blood units at several time points throughout storage, collected from participants who self-report taking a known oral dose of THC prior to donation. Results Institutional review board approval for a study evaluating marijuana at a children’s hospital presented a challenge, requiring the addition of an organizational risk review and an update to the hospital transfusion consent for approval. Thus, the projected timeline of this study has been extended. Study recruitment flyers and an email screening survey have generated interest from volunteer donors. The email survey was sent to 9,208 donors who had previously donated at least once, from which we received 372 responses (4.04% response rate). Of the respondents, 49 individuals reported daily marijuana use, 33 reported marijuana usage 4-6 times per week, 32 reported usage 1-3 times/week, 30 reported usage 1-3 times/month, 52 reported rare usage, and 167 reported never using marijuana. Overall, out of the survey respondents, over 50% reported at least some marijuana usage, and 31% reported at least weekly marijuana usage. Although this number is small, our prior study found that many were repeat donors. Research visits are currently being scheduled for interested participants. Conclusions This study highlights the challenges of performing marijuana research at a children’s hospital and illustrates why there is a lack of published data evaluating the effects of recreational marijuana legalization. Although completion of this project investigating this controversial topic has been delayed, persistent advocation for this area of interest is opening doors for future studies and will hopefully pave the way to fill our knowledge gaps. The results of this research study will inform decisions regarding donor eligibility and safety of the national blood supply as well as address associated socioeconomic implications.

Development and validation of informed consent for blood transfusion questionnaire.

Blood transfusion warrants written informed consent from the patient. However, patients have poor knowledge regarding blood transfusions as evidenced by nonstandardized information retained by patients from the informed consent discussion. The problem stems from suboptimal patient knowledge on the elements of informed consent. This study describes the development and validation of a new questionnaire to assess the knowledge on informed consent for blood transfusion from the patients' perspective. The development phase consisted of literature review, small group discussion, expert review meeting, content, and face validity. We evaluated the psychometric properties of Informed Consent for Blood Transfusion Questionnaire (ICBTQ) using reliability test and item response theory among a sample of 95 patients in Hospital Universiti Sains Malaysia. ICBTQ was formulated to include sociodemographic and knowledge sections. ICBTQ possessed excellent content validity. The face validity index (FVI) of clarity and comprehension were both 0.97. Thus, the universal FVI was 0.96. One item was added following the advice given by one of the content experts. ICBTQ had excellent face validity. For the validation phase, ICBTQ demonstrated an acceptable Cronbach's Alpha value. One item was omitted in view of low corrected item-total correlation. In the item response theory (IRT) analysis, ICBTQ exhibited good difficulty and discriminatory indexes. Assessments of item-fit indicated that all items of the model were well-fitted. Based on the IRT and reliability analysis, the knowledge section of the ICBTQ was psychometrically valid to be used among patients.

Electronic transfusion consent and blood delivering pattern improve the management of blood bank in China

BackgroundThe aim of this study was to improve the blood transfusion treatment consent accuracy, simplify the verification process, prolong the temperature control time before the blood transfusion, and save the blood transportation labor cost.MethodsWe designed the blood transfusion consent electronic signing process, which can generate personalized the text content and can automatically check the filling accuracy. The signal can be transmitted to the blood transfusion management system (TMS) to relieving the blood distribution. For blood delivering pattern, we established the blood transport center, recruited full-time nurses and used temperature-controlled blood transfer boxes to deliver blood in batches on a regular basis.ResultsA quarterly data analysis of blood transfusion quality showed a 100% blood transfusion consent accuracy after an electronic signing process was implemented. The average confirmation time savings between the electronic content and paper content was 26 min for the Department of Emergency (estimated difference 95% CI = 26 (20 to 36), p < 0.05). The blood delivering pattern reduced the time for each unit by leaving the average temperature control by 7.24 min (estimated difference 95% CI = 7.24 (6.92 to 7.56), p < 0.05). Furthermore, $3.67 was saved for the blood transportation labor cost for each unit as well.ConclusionBlood transfusion consent electronic signing process not only ensures the accuracy, but also saves the verification time. Moreover, the blood delivering pattern prolongs the blood temperature control time and saves blood transportation labor costs. Thus, these two improvements could enhance transfusion management.

Informed Consent in Transfusion Medicine: An Ethical Obligation Or a Legal Compulsion to Avert Liabilities for Negligence to the Health Care Provider

Blood transfusion is oftentimes life-saving but associated with risks which ought to be disclosed by the health care provider as an ethical obligation and legal requirement. The practice of informed consent to transfusion medicine is quite new and few studies have comprehensively x-rayed its historical, ethical and legal implications with an in depth consideration of professional negligence using decided cases by the adversarial and arbitration systems. PubMed, PubMed Central, Google Scholar, African Journal on Line (AJOL) electronic databases were searched using combined keywords like; “Blood transfusion and informed consent” “informed choice to transfusion medicine practice”, “consent in transfusion medicine”, “health care giver and consent to transfusion therapy”, “transfusion consent and the health care seeker”, “liability and informed consent to transfusion” and “contemporary issues in medical negligence”. Relatedly, printed materials were considered. The 91 studies that met the inclusion criteria were considered with highlights showing that, informed consent to medical treatment generally is an age long practice running from roman civilization to the present but its advocated practice in transfusion medicine a recent event. The practice is also generally low in comparison with informed consent taken for other treatments in similar settings. The consequences of dereliction including infamous conduct amongst professionals or negligence with direct and vicarious liabilities in adversary systems has been set in precedent judgments. These in addition to the present day patient-centered care model as global best practice and quality in health care delivery is compelling for health care providers to imbibe the practice not as a form of defensive medicine but a repertoire to quality and responsive Medicare service.

Preoperative patient blood management during the SARS-CoV-2 pandemic.

Preoperative patient blood management during the SARS-CoV-2 pandemic.

Consent for blood transfusion: summary of recommendations from the Advisory Committee for the Safety of Blood, Tissues and Organs (SaBTO)

The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) decided that its 2011 recommendations on consent for blood transfusion needed to be reviewed and revised due to evidence of poor compliance and recent legal guidance on consent. The recommendations are to ensure that patients are informed about and understand the purpose, benefits and potential risks of transfusion, and have an opportunity to discuss their treatment options. They should be incorporated into local practices for all patients.

Reducing Stress and Anger Among Family Members.

Reducing Stress and Anger Among Family Members.

Embedding best transfusion practice and blood management in neonatal intensive care

BackgroundTransfusion is a common procedure for neonates receiving intensive care management. Recognising a paucity of patient blood management (PBM) programmes in neonates, we aimed to embed blood management and best...

Quality Improvement Initiatives to Improve Transfusion Safety and Efficiency for Patients Receiving Daratumumab

Introduction: Daratumumab is an IgG1k monoclonal antibody directed against CD38, a surface glycoprotein expressed on several cell types including erythrocytes and B lymphocytes at various stages in development, including bone marrow precursors and plasma cells. It was initially approved by the FDA in 2015 for the treatment of multiple myeloma and has since garnered additional approvals in other settings leading to a growing number of patients receiving daratumumab. Its anti-B lymphocyte properties are therapeutic in myeloma patients; however, it also binds CD38 on erythrocytes and circulates for up to six months after a dose. This creates a long-term problem when caring for these patients regarding transfusion needs and resources. In particular, daratumumab causes antibody screens to be panreactive, potentially masking the presence of clinically relevant antibodies. Mitigation of this effect requires specialized treatment with dithiothreitol (DTT)-treated reagent erythrocytes to release CD38 from the cell membrane. This step allows for more accurate detection of clinically relevant antibodies, with the noted exception of the Kell system as these antigens are also removed. Methods: When daratumumab was placed on formulary, we started weekly communication between the laboratory and clinical teams in order to establish best institutional practices. Additionally, a list of patients on daratumumab was created in order to track them across the institution and measure the impact of interventions on their care. These have prompted multiple interventions to improve the safety and efficiency of patients on daratumumab receiving transfusions. Results: As of January 2018, our laboratory began implementing in-house DTT testing and eliminated the need to send patient samples to a reference laboratory. Beginning in January 2019, DTT-antibody screens (ABSC) were captured in the electronic medical record (EMR). Over the next six months, 173 distinct DTT-ABSC were performed on 41 patients. Of these, 13 received at least one RBC transfusion for a total of 41 units, with 12 (29%) occurring as an outpatient and 29 (71%) as an inpatient. Importantly, all of these transfusions were on the same-day of the DTT-ABSC, reducing the burden of time and cost associated with travel, as well as the morbidities of delayed transfusion. This is a major step forward in patient care as there were previously no "same-day" transfusions when DTT-ABSC was sent to a reference laboratory. The previous reference laboratory turnaround time averaged 1165 minutes compared with 186 minutes for the in-house testing. These initiatives have also resulted in educational efforts, such as the creation of a daratumumab-specific transfusion consent form to be signed by the attending hematologist at the time of starting therapy, outlining the challenges associated with identifying blood for transfusion and documenting that the benefits of transfusion outweigh the potential risks. This form is valid indefinitely and has subverted previous clinical scenarios where inpatients on daratumumab required urgent/emergent transfusion without an in-house hematologist available to consent for the transfusion. Because DTT also eliminates Kell antigens, clinically relevant antibodies may go undetected in samples treated with DTT. Thus, it is our policy to use Kell-negative products for patients who are on daratumumab, unless the patient expresses the Kell antigen. Conclusions/Future Directions: Daratumumab therapy is becoming increasingly common in hematology practice. Awareness of the laboratory and clinical challenges that accompany its use and working to mitigate them will lead to safer and more timely patient care. In particular, in-house DTT-ABSC has led to same-day results and transfusion on the same outpatient visit. Next steps include additional educational efforts at an institutional level, establishing simple algorithms within the EMR linked with the order for daratumumab (e.g., automatic ABSC prior to administration), and refining our tracking system to better assess future interventions. Disclosures No relevant conflicts of interest to declare.

113 - Increasing Resident Documentation of Transfusion Consent at Kaiser Oakland

113 - Increasing Resident Documentation of Transfusion Consent at Kaiser Oakland