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with our ordering scenario, the MD can provide the order to transfuse w the orders for components. I do not f/u on orders, we do not have access to the MD order set. The only time I call is to the OR. Everything is electronic.

Hi Blood Bankers, This question may have been brought up in the past, but I did not do a proper search of the forums to see if it has. My Question: As Blood Bankers, how do you make sure that the Nursing Orders to Transfuse (or Administer) Blood Products are followed - for example...Physician orders Products to be crossmatched but not transfused...Nurse sees that blood is ready (or receives a phone call from Blood Bank that they are ready), does not check the Administer orders and comes down and is issued the product and hangs it. Or second scenario...Blood is ordered to be Administered (and of course is crossmatched). Nurse never comes down to pick it up from the Blood Bank. We do not call nursing a second time - once is our practice to call when the blood is ready (plus they can see it in the EMR on their side). Thank you.

Wow! things must come in a bundle. This week, we just had a case with a broadly specific antibody, non reactive with K0 cells. K-k-Kpa-Kpb- and SNP genotyping predicted a presence of KEL gene. We are on the same page with you on our patient as well, in the process of sequencing.. It will be very interesting to see the sequencing results. Please keep us posted when your sequencing is done. Our patient is a bleeder, so we gave one Ko unit. yike!!

FIRST SCENARIO: We have Epic as HIS and it has a module called BPAM which allows patient/unit bedside scanning. When we receive order to Prepare product we complete the order and it available for nursing to see that it is ready in the EMR. When nursing is ready to Transfuse they must "release" the Transfuse order in Epic. A copy of the released Transfuse order that includes patient id'ing information and the component and any special requirements. If we don't get the released Transfuse order we don't issue the unit MAINLY because, if they didn't do the release correctly they will not be able to scan the unit into the EMR at the bedside hence delaying the transfusion and possibly wasting the unit. SECOND SCENARIO: We frequently get Prepare orders but the unit is never transfused. That is not an issue for us since it doesn't affect our inventory in any way. We do mainly computer assisted crossmatches so we don't actually "crossmatch" the unit to the patient until the do the release Transfusion order (see above). The only crossmatches we do at time of Prepare order are those patients who don't qualify for computer assisted crossmatch i.e. have antibodies. If there was an issue as you described above I would write up a Safety/QA report and as long as you were following SOP then the onus for transfusion errors is on nursing not blood bank especially if you cannot see the orders.

We phone once. When a nurse signs out the blood (electronic) we have a place where they must confirm the consent form and the physician's order to transfuse is on the chart.

If you read the paper carefully, the major difference in outcomes is reoperation and other complications clearly unrelated to transfusion triggers. Poor choice of endpoints and data analysis and totally non-credible conclusion regarding clinical outcomes in my view. The immense body of data showing that restrictive transfusion is not only safer but likely superior tells us this is a small pilot study with little to no real meaning for clinical practice. Cannot imagine what the reviewers were thinking when they let them publish this with these conclusions in the current form.

We've seen one of those patients with the antibody who had the severe anaphylactic reaction - impending sense of doom, etc., just like the books say. Fortunately the nurse was very attentive when the transfusion was started and caught it immediately. My advice is to instruct the nurses to watch very closely if she is transfused and make sure they know how to recognize a reaction if it occurs.

might be worth checking to see if she actually has antibodies to IgA

Most patients with IgA deficiency and even with anti-IgA do not have anaphylactic or allergic reactions. Unless she has a history of anaphylaxis/atopy I wouldn't worry. In an hemorrhagic emergency, just transfuse and, as always, have some epinephrine on hand for reactions. It's well established now that most anaphylactic reactions happen in atopic patients and IgA deficiency has nothing to do with it, in general. See work by Gerald Sandler, et al. on the subject or listen to the Blood Bank Guy podcast by Sandler. Be happy, don't worry.