UDHQ Task Force Responds to Concerns About “Attention” Questions

When the new UDHQ was being revised, AABB’S Donor History Questionnaire Task Force recognized the need to ensure that donors were paying attention to and properly answering the questions. After much discussion, the decision was made to incorporate three “attention” questions that would serve as quality assurance mechanisms to address donor attention. (Other methods for evaluating donor attention that were accepted by FDA, including a donor quiz used by plasma centers, were not deemed appropriate for this questionnaire.)

The UDHQ contains three attention questions. Depending on the donor’s gender, the correct answer is not “yes” or “no,” but is “I am male” or “I am female.” If a donor answers any of these questions incorrectly, blood center staff have an opportunity to determine the reason for the incorrect answer. For example,

• Is the donor able to understand the language? If not, would a form in his/her native language, or the use of an interpreter, be appropriate?
• Is the donor literate? If not, it may be necessary to read the questions to the donor.
• Is the donor not paying attention? Asking him/her to re-do the questionnaire may be an option.

Some blood centers have reported that they are uncertain how to handle donors and products when the attention questions have not been answered correctly, especially when this has not been detected in the staff review performed while the donor is still on site, or at subsequent reviews prior to distribution of the product. To address this problem, the UDHQ task force, suggests the following:

• It is critical that facility standard operating procedures (SOPs) document the process for managing these donors and products.
• It is reasonable to consider contacting the donor the same day, or perhaps within 24 hours, of the donation to clarify the answer. FDA has stated that each center should define this period in its SOP.
• If this is not possible, the unit should be evaluated for discard, as it would be with any question that is not acceptably answered.
• If the unit has been distributed, it should be recalled, and a biologic product deviation (BPD) report would need to be completed.

The process for reviewing the completed UDHQ should be evaluated in an effort to decrease the frequency with which the inappropriate responses are missed. A re-engineering of the process may be needed. One center is considering changing its collection procedure to have the staff verbally review the attention questions with the donor. This step also would give the staff the opportunity to identify and correct the reason for the incorrect answer while the donor is still on site.

The User Brochure, one of the AABB materials accompanying the questionnaire, defines ways in which the format of the questionnaire may be modified to suit the donor interview process in use at each blood center.

Debra Kessler, RN, chair, UDHQ Task Force, offers this note of encouragement: “My own blood center has used the form for two years, and the mistakes made by both donors and staff on these attention questions do decrease as everyone gets used to the new questionnaire.”

To view the donor history questionnaire and accompanying materials, visit:
www.aabb.org/Content/Donate_Blood/Donor_History_Questionnaires/AABB_Blood_Donor_History_Questionnaire