sgoertzen

I've attached copies of our procedure and our worksheet.  Our Heme/Onc docs also order them on our patients post-transplant, and we occasionally get them ordered on kids where they suspect some sort of immune deficiency disease.  
TO-310 Isohemagglutinin Workup - Test and Titer__uncontrolled_copy (2).pdf TO-310F01 Isohemagglutinin Test and Titer Worksheet__blank_copy_id_8428444.pdf

I've attached our MTP procedure and worksheet.  We are a children's hospital with a level 2 pediatric trauma center.Massive Transfusion Protocol - MTP.pdfMassive Transfusion Protocol - MTP Worksheet.docx.pdf

I've attached our MTP procedure and worksheet.  We are a children's hospital with a level 2 pediatric trauma center.Massive Transfusion Protocol - MTP.pdfMassive Transfusion Protocol - MTP Worksheet.docx.pdf

I work at a children's hospital and we use WellSky and Epic/Beaker.  We built an orderable test called "Isohemagglutinin Test and Titer" specifically for reporting out the presence and strength of Anti-A and Anti-B.  This test is not affiliated in any way with the regular patient Blood Type test.  It's mainly ordered at my facility to monitor and follow patients with immune deficiencies or who have had an ABO mis-matched bone marrow or stem cell transplant, but it sounds like it would also meet your needs with heart transplants.  I've attached our procedure and worksheet.  This is how the results display in Epic.  If you're interested in building something like this, I can put you in contact with our WellSky & Beaker IT gurus who built this for us.  My contact is sgoertzen@valleychildrens.org 
 

TO-310 Isohemagglutinin Workup - Test and Titer__uncontrolled_copy (1).pdf TO-310F01 Isohemagglutinin Test and Titer Worksheet__blank_copy_id_7905995.pdf

I work at a children's hospital and we use WellSky and Epic/Beaker.  We built an orderable test called "Isohemagglutinin Test and Titer" specifically for reporting out the presence and strength of Anti-A and Anti-B.  This test is not affiliated in any way with the regular patient Blood Type test.  It's mainly ordered at my facility to monitor and follow patients with immune deficiencies or who have had an ABO mis-matched bone marrow or stem cell transplant, but it sounds like it would also meet your needs with heart transplants.  I've attached our procedure and worksheet.  This is how the results display in Epic.  If you're interested in building something like this, I can put you in contact with our WellSky & Beaker IT gurus who built this for us.  My contact is sgoertzen@valleychildrens.org 
 

TO-310 Isohemagglutinin Workup - Test and Titer__uncontrolled_copy (1).pdf TO-310F01 Isohemagglutinin Test and Titer Worksheet__blank_copy_id_7905995.pdf

I work at a children's hospital and we use WellSky and Epic/Beaker.  We built an orderable test called "Isohemagglutinin Test and Titer" specifically for reporting out the presence and strength of Anti-A and Anti-B.  This test is not affiliated in any way with the regular patient Blood Type test.  It's mainly ordered at my facility to monitor and follow patients with immune deficiencies or who have had an ABO mis-matched bone marrow or stem cell transplant, but it sounds like it would also meet your needs with heart transplants.  I've attached our procedure and worksheet.  This is how the results display in Epic.  If you're interested in building something like this, I can put you in contact with our WellSky & Beaker IT gurus who built this for us.  My contact is sgoertzen@valleychildrens.org 
 

TO-310 Isohemagglutinin Workup - Test and Titer__uncontrolled_copy (1).pdf TO-310F01 Isohemagglutinin Test and Titer Worksheet__blank_copy_id_7905995.pdf

I'm the supervisor at a children's hospital in Central California and here are our indications for the transfusion of RBCs:
Neonates: Term and near term neonates and infants < 4 months of age*
Hgb/Hct < 7g/dl / 21%
         Stable anemia with no clinical manifestations
Hgb/Hct < 10 g/dl / 30%
         Moderate cardiopulmonary disease
         Major surgery
         Increased oxygen (FiO2) requirement <35%, on CPAP lower setting
         Significant apnea or bradycardia, tachycardia or tachypnea
         Low weight gain
Hgb/Hct <12 g/dl / 35%
         Fi02 requirement greater than 35%, on CPAP higher setting
         Recovering from major surgery
         Severe traumatic brain injury
         Significant deterioration of cardiorespiratory status
Hgb/Hct < 15 g/dl / 45%
         FiO2 requirement > 35%
         Severe cardiopulmonary disease or congenital heart disease
         On extracorporeal membrane oxygenation (ECMO)
*No clear transfusion RBC threshold guideline for low birth weight neonates (BW <1500gm) is available. Randomized clinical trial (Transfusion of Prematures) was started in 2013 and is ongoing.
 
Pediatric patients >4 months old through adult
Not bleeding
Reasonable in almost all patients if Hgb/Hct < 7 g/dl / 21%
Almost never indicated if Hgb/Hct >10 g/dl / 30% unless patient is on ECLS
For Hgb between 7-10 g/dl (Hct between 21-30 %):
         Based on organ dysfunction and ability to handle inadequate oxygenation
         Respiratory or cardiac failure
         Chronic disorders of red cell production, severe platelet dysfunction
         Oncology patients
Intra/perioperative conditions or significant bleeding
         Rapid blood loss exceeding >15% blood volume
         Intraoperative period as clinically determined by anesthesiology and/or surgeon
         Immediate postoperative period to restore hemodynamic stability
 
We have built an alert in Epic with our "Prepare RBC" orders (both in mL and in Units) that warns the provider whenever they are placing an RBC order on a patient with a most recent Hgb value > 7 g/dl (or there is no recent Hgb value in the computer on that patient).  This alert must be overridden with a reason from this drop down menu (below) in order for the provider to continue placing the order.  We can run a report on all transfusions that triggered an Override when the order was placed (that also lists out the trigger value, the override reason, and the patient's problem list) and then the medical director performs an appropriateness review on only those outliers.
BPA Overrides: RBC Orders (in mL) and (in Units):
Warning if: No Hgb result or Most recent Hgb > 7 g/dl
Appropriate criteria:
Neonate w/Cardiopulmonary Disease
Respiratory or Cardiac Failure
ECLS Patient
Sickle Cell Patient
Thalassemia Patient
Active Chemotherapy/Immunosuppressed Patient
Hematopoietic Disorder
Rapid Blood Loss
HOLD for Pre-Op/Procedure
Post-Op Hemodynamic Instability
Other – specify as Comment

I'm the supervisor at a children's hospital in Central California and here are our indications for the transfusion of RBCs:
Neonates: Term and near term neonates and infants < 4 months of age*
Hgb/Hct < 7g/dl / 21%
         Stable anemia with no clinical manifestations
Hgb/Hct < 10 g/dl / 30%
         Moderate cardiopulmonary disease
         Major surgery
         Increased oxygen (FiO2) requirement <35%, on CPAP lower setting
         Significant apnea or bradycardia, tachycardia or tachypnea
         Low weight gain
Hgb/Hct <12 g/dl / 35%
         Fi02 requirement greater than 35%, on CPAP higher setting
         Recovering from major surgery
         Severe traumatic brain injury
         Significant deterioration of cardiorespiratory status
Hgb/Hct < 15 g/dl / 45%
         FiO2 requirement > 35%
         Severe cardiopulmonary disease or congenital heart disease
         On extracorporeal membrane oxygenation (ECMO)
*No clear transfusion RBC threshold guideline for low birth weight neonates (BW <1500gm) is available. Randomized clinical trial (Transfusion of Prematures) was started in 2013 and is ongoing.
 
Pediatric patients >4 months old through adult
Not bleeding
Reasonable in almost all patients if Hgb/Hct < 7 g/dl / 21%
Almost never indicated if Hgb/Hct >10 g/dl / 30% unless patient is on ECLS
For Hgb between 7-10 g/dl (Hct between 21-30 %):
         Based on organ dysfunction and ability to handle inadequate oxygenation
         Respiratory or cardiac failure
         Chronic disorders of red cell production, severe platelet dysfunction
         Oncology patients
Intra/perioperative conditions or significant bleeding
         Rapid blood loss exceeding >15% blood volume
         Intraoperative period as clinically determined by anesthesiology and/or surgeon
         Immediate postoperative period to restore hemodynamic stability
 
We have built an alert in Epic with our "Prepare RBC" orders (both in mL and in Units) that warns the provider whenever they are placing an RBC order on a patient with a most recent Hgb value > 7 g/dl (or there is no recent Hgb value in the computer on that patient).  This alert must be overridden with a reason from this drop down menu (below) in order for the provider to continue placing the order.  We can run a report on all transfusions that triggered an Override when the order was placed (that also lists out the trigger value, the override reason, and the patient's problem list) and then the medical director performs an appropriateness review on only those outliers.
BPA Overrides: RBC Orders (in mL) and (in Units):
Warning if: No Hgb result or Most recent Hgb > 7 g/dl
Appropriate criteria:
Neonate w/Cardiopulmonary Disease
Respiratory or Cardiac Failure
ECLS Patient
Sickle Cell Patient
Thalassemia Patient
Active Chemotherapy/Immunosuppressed Patient
Hematopoietic Disorder
Rapid Blood Loss
HOLD for Pre-Op/Procedure
Post-Op Hemodynamic Instability
Other – specify as Comment

There is this one thing, I don't know if it is new regulation or it has been around for a while. I think CAP doesn't want any cardboard boxes in the core lab. This is due to card board boxes being porous and prone to biological contaminants. Blood bank is usually the only section that use cardboard boxes, the saline cubes.  Thus the blood bank needs to be in its own seperate room.  I guess contamination is a big no-no for the core lab, but not so much for the blood bank.  I will look for this regulation and see if I can find it. 
 

I'm the supervisor at a children's hospital in Central California and here are our indications for the transfusion of RBCs:
Neonates: Term and near term neonates and infants < 4 months of age*
Hgb/Hct < 7g/dl / 21%
         Stable anemia with no clinical manifestations
Hgb/Hct < 10 g/dl / 30%
         Moderate cardiopulmonary disease
         Major surgery
         Increased oxygen (FiO2) requirement <35%, on CPAP lower setting
         Significant apnea or bradycardia, tachycardia or tachypnea
         Low weight gain
Hgb/Hct <12 g/dl / 35%
         Fi02 requirement greater than 35%, on CPAP higher setting
         Recovering from major surgery
         Severe traumatic brain injury
         Significant deterioration of cardiorespiratory status
Hgb/Hct < 15 g/dl / 45%
         FiO2 requirement > 35%
         Severe cardiopulmonary disease or congenital heart disease
         On extracorporeal membrane oxygenation (ECMO)
*No clear transfusion RBC threshold guideline for low birth weight neonates (BW <1500gm) is available. Randomized clinical trial (Transfusion of Prematures) was started in 2013 and is ongoing.
 
Pediatric patients >4 months old through adult
Not bleeding
Reasonable in almost all patients if Hgb/Hct < 7 g/dl / 21%
Almost never indicated if Hgb/Hct >10 g/dl / 30% unless patient is on ECLS
For Hgb between 7-10 g/dl (Hct between 21-30 %):
         Based on organ dysfunction and ability to handle inadequate oxygenation
         Respiratory or cardiac failure
         Chronic disorders of red cell production, severe platelet dysfunction
         Oncology patients
Intra/perioperative conditions or significant bleeding
         Rapid blood loss exceeding >15% blood volume
         Intraoperative period as clinically determined by anesthesiology and/or surgeon
         Immediate postoperative period to restore hemodynamic stability
 
We have built an alert in Epic with our "Prepare RBC" orders (both in mL and in Units) that warns the provider whenever they are placing an RBC order on a patient with a most recent Hgb value > 7 g/dl (or there is no recent Hgb value in the computer on that patient).  This alert must be overridden with a reason from this drop down menu (below) in order for the provider to continue placing the order.  We can run a report on all transfusions that triggered an Override when the order was placed (that also lists out the trigger value, the override reason, and the patient's problem list) and then the medical director performs an appropriateness review on only those outliers.
BPA Overrides: RBC Orders (in mL) and (in Units):
Warning if: No Hgb result or Most recent Hgb > 7 g/dl
Appropriate criteria:
Neonate w/Cardiopulmonary Disease
Respiratory or Cardiac Failure
ECLS Patient
Sickle Cell Patient
Thalassemia Patient
Active Chemotherapy/Immunosuppressed Patient
Hematopoietic Disorder
Rapid Blood Loss
HOLD for Pre-Op/Procedure
Post-Op Hemodynamic Instability
Other – specify as Comment

I'm the supervisor at a children's hospital in Central California and here are our indications for the transfusion of RBCs:
Neonates: Term and near term neonates and infants < 4 months of age*
Hgb/Hct < 7g/dl / 21%
         Stable anemia with no clinical manifestations
Hgb/Hct < 10 g/dl / 30%
         Moderate cardiopulmonary disease
         Major surgery
         Increased oxygen (FiO2) requirement <35%, on CPAP lower setting
         Significant apnea or bradycardia, tachycardia or tachypnea
         Low weight gain
Hgb/Hct <12 g/dl / 35%
         Fi02 requirement greater than 35%, on CPAP higher setting
         Recovering from major surgery
         Severe traumatic brain injury
         Significant deterioration of cardiorespiratory status
Hgb/Hct < 15 g/dl / 45%
         FiO2 requirement > 35%
         Severe cardiopulmonary disease or congenital heart disease
         On extracorporeal membrane oxygenation (ECMO)
*No clear transfusion RBC threshold guideline for low birth weight neonates (BW <1500gm) is available. Randomized clinical trial (Transfusion of Prematures) was started in 2013 and is ongoing.
 
Pediatric patients >4 months old through adult
Not bleeding
Reasonable in almost all patients if Hgb/Hct < 7 g/dl / 21%
Almost never indicated if Hgb/Hct >10 g/dl / 30% unless patient is on ECLS
For Hgb between 7-10 g/dl (Hct between 21-30 %):
         Based on organ dysfunction and ability to handle inadequate oxygenation
         Respiratory or cardiac failure
         Chronic disorders of red cell production, severe platelet dysfunction
         Oncology patients
Intra/perioperative conditions or significant bleeding
         Rapid blood loss exceeding >15% blood volume
         Intraoperative period as clinically determined by anesthesiology and/or surgeon
         Immediate postoperative period to restore hemodynamic stability
 
We have built an alert in Epic with our "Prepare RBC" orders (both in mL and in Units) that warns the provider whenever they are placing an RBC order on a patient with a most recent Hgb value > 7 g/dl (or there is no recent Hgb value in the computer on that patient).  This alert must be overridden with a reason from this drop down menu (below) in order for the provider to continue placing the order.  We can run a report on all transfusions that triggered an Override when the order was placed (that also lists out the trigger value, the override reason, and the patient's problem list) and then the medical director performs an appropriateness review on only those outliers.
BPA Overrides: RBC Orders (in mL) and (in Units):
Warning if: No Hgb result or Most recent Hgb > 7 g/dl
Appropriate criteria:
Neonate w/Cardiopulmonary Disease
Respiratory or Cardiac Failure
ECLS Patient
Sickle Cell Patient
Thalassemia Patient
Active Chemotherapy/Immunosuppressed Patient
Hematopoietic Disorder
Rapid Blood Loss
HOLD for Pre-Op/Procedure
Post-Op Hemodynamic Instability
Other – specify as Comment

I'm the supervisor at a children's hospital in Central California and here are our indications for the transfusion of RBCs:
Neonates: Term and near term neonates and infants < 4 months of age*
Hgb/Hct < 7g/dl / 21%
         Stable anemia with no clinical manifestations
Hgb/Hct < 10 g/dl / 30%
         Moderate cardiopulmonary disease
         Major surgery
         Increased oxygen (FiO2) requirement <35%, on CPAP lower setting
         Significant apnea or bradycardia, tachycardia or tachypnea
         Low weight gain
Hgb/Hct <12 g/dl / 35%
         Fi02 requirement greater than 35%, on CPAP higher setting
         Recovering from major surgery
         Severe traumatic brain injury
         Significant deterioration of cardiorespiratory status
Hgb/Hct < 15 g/dl / 45%
         FiO2 requirement > 35%
         Severe cardiopulmonary disease or congenital heart disease
         On extracorporeal membrane oxygenation (ECMO)
*No clear transfusion RBC threshold guideline for low birth weight neonates (BW <1500gm) is available. Randomized clinical trial (Transfusion of Prematures) was started in 2013 and is ongoing.
 
Pediatric patients >4 months old through adult
Not bleeding
Reasonable in almost all patients if Hgb/Hct < 7 g/dl / 21%
Almost never indicated if Hgb/Hct >10 g/dl / 30% unless patient is on ECLS
For Hgb between 7-10 g/dl (Hct between 21-30 %):
         Based on organ dysfunction and ability to handle inadequate oxygenation
         Respiratory or cardiac failure
         Chronic disorders of red cell production, severe platelet dysfunction
         Oncology patients
Intra/perioperative conditions or significant bleeding
         Rapid blood loss exceeding >15% blood volume
         Intraoperative period as clinically determined by anesthesiology and/or surgeon
         Immediate postoperative period to restore hemodynamic stability
 
We have built an alert in Epic with our "Prepare RBC" orders (both in mL and in Units) that warns the provider whenever they are placing an RBC order on a patient with a most recent Hgb value > 7 g/dl (or there is no recent Hgb value in the computer on that patient).  This alert must be overridden with a reason from this drop down menu (below) in order for the provider to continue placing the order.  We can run a report on all transfusions that triggered an Override when the order was placed (that also lists out the trigger value, the override reason, and the patient's problem list) and then the medical director performs an appropriateness review on only those outliers.
BPA Overrides: RBC Orders (in mL) and (in Units):
Warning if: No Hgb result or Most recent Hgb > 7 g/dl
Appropriate criteria:
Neonate w/Cardiopulmonary Disease
Respiratory or Cardiac Failure
ECLS Patient
Sickle Cell Patient
Thalassemia Patient
Active Chemotherapy/Immunosuppressed Patient
Hematopoietic Disorder
Rapid Blood Loss
HOLD for Pre-Op/Procedure
Post-Op Hemodynamic Instability
Other – specify as Comment

Here is our titer worksheet.  We do a lot of prenatal titers for our Maternal-Fetal Center (high risk pregnancies).
TO-300F01 Antibody Titration Worksheet.docx

Here is our titer worksheet.  We do a lot of prenatal titers for our Maternal-Fetal Center (high risk pregnancies).
TO-300F01 Antibody Titration Worksheet.docx

Re:  We still have concerns about pre-op patients who aren't wearing any Epic band to scan when their pre-admit specimen is drawn. (I'm taking advice on how others manage these.)  Likewise for outpatient transfusions. 
Epic told us that their system is not designed to use the process of banding outpatients and pre-op patients.  WE INSISTED since 1) we've always banded any patient getting their blood drawn... especially for blood bank testing, 2) we were determined to meet AABB Std. 5.14.5.3) requiring an electronic (scanned) identification system, and 3) we decided that we were NOT going to go backwards after all these years and create a new system in Epic that was less safe just because they said that's their design.  I insisted that PPID scanning be used for the specimen collection/labeling and that the same armband be presented on the day of their admission or outpatient transfusion. The patient is given strict instructions (an instruction sheet that they must sign and is scanned into the EMR) that they are to keep the band on or at least have it in their possession on the day of admission/transfusion. The original band used for specimen collection is replaced with their new encounter band only after the 2 bands are compared side-by-side and match exactly for Name, MRN, DOB.  It was a bit of a struggle to get everyone on board to veer from the Epic "Foundation" methods, but we were finally able to convince people that this was a significant patient safety issue and was necessary.

I highly recommend you use this opportunity to discontinue using a separate BB ID band. Using the patient’s regular ID band works great. If you’re using scanned PPID from the wristband for specimen collection & labeling, adding another ID band into the process no longer adds any safety benefits. You’ve already created your closed loop system using the regular hospital ID band and scanning it for both specimen collection and blood administration in BPAM. 

Re:  We still have concerns about pre-op patients who aren't wearing any Epic band to scan when their pre-admit specimen is drawn. (I'm taking advice on how others manage these.)  Likewise for outpatient transfusions. 
Epic told us that their system is not designed to use the process of banding outpatients and pre-op patients.  WE INSISTED since 1) we've always banded any patient getting their blood drawn... especially for blood bank testing, 2) we were determined to meet AABB Std. 5.14.5.3) requiring an electronic (scanned) identification system, and 3) we decided that we were NOT going to go backwards after all these years and create a new system in Epic that was less safe just because they said that's their design.  I insisted that PPID scanning be used for the specimen collection/labeling and that the same armband be presented on the day of their admission or outpatient transfusion. The patient is given strict instructions (an instruction sheet that they must sign and is scanned into the EMR) that they are to keep the band on or at least have it in their possession on the day of admission/transfusion. The original band used for specimen collection is replaced with their new encounter band only after the 2 bands are compared side-by-side and match exactly for Name, MRN, DOB.  It was a bit of a struggle to get everyone on board to veer from the Epic "Foundation" methods, but we were finally able to convince people that this was a significant patient safety issue and was necessary.

Re:  We still have concerns about pre-op patients who aren't wearing any Epic band to scan when their pre-admit specimen is drawn. (I'm taking advice on how others manage these.)  Likewise for outpatient transfusions. 
Epic told us that their system is not designed to use the process of banding outpatients and pre-op patients.  WE INSISTED since 1) we've always banded any patient getting their blood drawn... especially for blood bank testing, 2) we were determined to meet AABB Std. 5.14.5.3) requiring an electronic (scanned) identification system, and 3) we decided that we were NOT going to go backwards after all these years and create a new system in Epic that was less safe just because they said that's their design.  I insisted that PPID scanning be used for the specimen collection/labeling and that the same armband be presented on the day of their admission or outpatient transfusion. The patient is given strict instructions (an instruction sheet that they must sign and is scanned into the EMR) that they are to keep the band on or at least have it in their possession on the day of admission/transfusion. The original band used for specimen collection is replaced with their new encounter band only after the 2 bands are compared side-by-side and match exactly for Name, MRN, DOB.  It was a bit of a struggle to get everyone on board to veer from the Epic "Foundation" methods, but we were finally able to convince people that this was a significant patient safety issue and was necessary.

Re:  We still have concerns about pre-op patients who aren't wearing any Epic band to scan when their pre-admit specimen is drawn. (I'm taking advice on how others manage these.)  Likewise for outpatient transfusions. 
Epic told us that their system is not designed to use the process of banding outpatients and pre-op patients.  WE INSISTED since 1) we've always banded any patient getting their blood drawn... especially for blood bank testing, 2) we were determined to meet AABB Std. 5.14.5.3) requiring an electronic (scanned) identification system, and 3) we decided that we were NOT going to go backwards after all these years and create a new system in Epic that was less safe just because they said that's their design.  I insisted that PPID scanning be used for the specimen collection/labeling and that the same armband be presented on the day of their admission or outpatient transfusion. The patient is given strict instructions (an instruction sheet that they must sign and is scanned into the EMR) that they are to keep the band on or at least have it in their possession on the day of admission/transfusion. The original band used for specimen collection is replaced with their new encounter band only after the 2 bands are compared side-by-side and match exactly for Name, MRN, DOB.  It was a bit of a struggle to get everyone on board to veer from the Epic "Foundation" methods, but we were finally able to convince people that this was a significant patient safety issue and was necessary.

Re:  We still have concerns about pre-op patients who aren't wearing any Epic band to scan when their pre-admit specimen is drawn. (I'm taking advice on how others manage these.)  Likewise for outpatient transfusions. 
Epic told us that their system is not designed to use the process of banding outpatients and pre-op patients.  WE INSISTED since 1) we've always banded any patient getting their blood drawn... especially for blood bank testing, 2) we were determined to meet AABB Std. 5.14.5.3) requiring an electronic (scanned) identification system, and 3) we decided that we were NOT going to go backwards after all these years and create a new system in Epic that was less safe just because they said that's their design.  I insisted that PPID scanning be used for the specimen collection/labeling and that the same armband be presented on the day of their admission or outpatient transfusion. The patient is given strict instructions (an instruction sheet that they must sign and is scanned into the EMR) that they are to keep the band on or at least have it in their possession on the day of admission/transfusion. The original band used for specimen collection is replaced with their new encounter band only after the 2 bands are compared side-by-side and match exactly for Name, MRN, DOB.  It was a bit of a struggle to get everyone on board to veer from the Epic "Foundation" methods, but we were finally able to convince people that this was a significant patient safety issue and was necessary.

I highly recommend you use this opportunity to discontinue using a separate BB ID band. Using the patient’s regular ID band works great. If you’re using scanned PPID from the wristband for specimen collection & labeling, adding another ID band into the process no longer adds any safety benefits. You’ve already created your closed loop system using the regular hospital ID band and scanning it for both specimen collection and blood administration in BPAM. 

I highly recommend you use this opportunity to discontinue using a separate BB ID band. Using the patient’s regular ID band works great. If you’re using scanned PPID from the wristband for specimen collection & labeling, adding another ID band into the process no longer adds any safety benefits. You’ve already created your closed loop system using the regular hospital ID band and scanning it for both specimen collection and blood administration in BPAM. 

I highly recommend you use this opportunity to discontinue using a separate BB ID band. Using the patient’s regular ID band works great. If you’re using scanned PPID from the wristband for specimen collection & labeling, adding another ID band into the process no longer adds any safety benefits. You’ve already created your closed loop system using the regular hospital ID band and scanning it for both specimen collection and blood administration in BPAM. 

I highly recommend you use this opportunity to discontinue using a separate BB ID band. Using the patient’s regular ID band works great. If you’re using scanned PPID from the wristband for specimen collection & labeling, adding another ID band into the process no longer adds any safety benefits. You’ve already created your closed loop system using the regular hospital ID band and scanning it for both specimen collection and blood administration in BPAM. 

When blood bank is called to release uncrossmatched blood, we specifically ask who the ordering physician is. The blood banker then places an order in EPIC called "Release of Uncrossmatched Blood" which is the statement (taken from AABB Standards) about the situation being critical enough to warrant the release of blood before compatibility testing is completed.  This order must be electronically co-signed in EPIC by the physician that we name as the ordering physician.   We have EPIC and WellSky (Mediware HCLL), but it shouldn't matter what blood bank computer system you have since this is all done (ordered/cosigned) in EPIC.  I'm attaching our uncrossmatched worksheet that includes the instructions that we follow to place this order in EPIC and assign it to the ordering physician for co-sign.  I check each day to make sure it gets co-signed. Once signed, I print the order with the co-sign tracking information, attach it to our worksheet, and file the paperwork for easy retrieval during future inspections/assessments.   
TO-381F01 Release of Uncrossmatched Blood.docx