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Level 1 trauma center Massive Transfusion protocol


ANKling
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Hello everyone! I work in a level 1 trauma center and we are revisiting our MTP protocol. Right now we manually write all of the unit numbers on a 3 page carbon copy sheet and continue to do so until the Type and Screen is complete on the patient. We use SOFTBank/Lab and EPIC. We would ultimately like to use our Emergency Release in SOFTBank but I’ve seen it’s a common issue with other users. Would you be willing to share what you do to decrease the amount of writing (and therefore time/errors) of unit numbers for your MTP’s? Any thoughts are welcome and appreciated!

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Last  Aug we stopped using the Quick Release sheets where we documented the  T & S, wrote all the units down, document the dispense time; and initials of who listened, read and picked up. Now for dispense documentation we use the regular dispense log where the patient's label is place, the number of products that went out and what type, also the initials of involved. The dispense log is reviewed the next day for accuracy and usually there hasn't been any discrepancy. The ones we had were able to be figured out.

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I'm in a trauma I center with an MTP policy that was forced to update post mass casualty. We set up MTP packs ahead of time and have them at the ready for any moment. Each pack is distinguished by gender (O NEG set up for females, O POS set up for males), and is complete with 6 units of RBC, a carbon copy form, cooler card, and pulled segments. The carbon copy form has the record of the unit numbers, but we use stickers from the unit itself. The only info really handwritten is the ABORh of the units, the product code, and the time/date whenever the pack is issued to a patient. Since the pack is set up ahead of time, one tech prepares the pack and a second tech verifies that the units are in an acceptable status to issue, and that the pack is overall assembled correctly -- therefore reducing a number of potential errors. At time of issue, we use ADT labels printed from EPIC that include the pt's information, and this sticker is applied to the carbon copy sheets and the BTRs already tagged to the units.

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Ward_X we have a similar process as you except we have a 3 page carbon copy MTP form and we hand write the unit numbers. As you can imagine, writing a bulk amount of numbers quickly can result in errors. Do you just place the unit labels on both copies of your trauma sheet? Thanks for the reply!

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bowerj1, 

this is exactly what we would like to be doing in SOFTBank. Right now our LIS doesn’t have us using the Emergency Release option in SOFTBank. For time saving purposes, our ER calls us with the request for MTP and let’s us know whether they are male or female. We have premade trauma packets for male and female with uncrossmatched blood set aside. We start packing the cooler and manually write the plasma and platelets. We carry the paper and cooler to ER and then grab the trauma patient labels( which is usually just a generic trauma name). Later when the patient information is updated, we add everything that was sent to that patient and issue it (and/or return/release) depending on what all was given during the trauma. Are you a SOFTBank user using emergency release?

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1 hour ago, ANKling said:

Ward_X we have a similar process as you except we have a 3 page carbon copy MTP form and we hand write the unit numbers. As you can imagine, writing a bulk amount of numbers quickly can result in errors. Do you just place the unit labels on both copies of your trauma sheet? Thanks for the reply!

Yup! On each sheet of the carbon copy packet. We also have a barcode replicator (BUI) to copy and make scan-able unit stickers if we needed (although seldom ever needed).

I'm used to HCLL, where emergency issue is sort of a separate function from regular issuing... does Softbank not have this capability?

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2 hours ago, ANKling said:

Ward_X we do have the function with SOFTBank but ours is currently turned off since we need the patient account first before being able to issue. I’ve been researching ways around it and hoping to find a work around. 

Is there a sort of alias/admission MRN that can be created upon the pt coming to the hospital, that can later be merged? We use this with EPIC, they get an alias name and MRN that we can use for issuing until it is later merged with their real ID. We have names generated that avoid using Jane/John Doe.

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On 10/2/2019 at 5:43 PM, Ward_X said:

Is there a sort of alias/admission MRN that can be created upon the pt coming to the hospital, that can later be merged? We use this with EPIC, they get an alias name and MRN that we can use for issuing until it is later merged with their real ID. We have names generated that avoid using Jane/John Doe.

We do have a unique trauma name/number/MRN upon admission of the trauma. We need SOFTLab to have an order for the patient to show up in SOFTBank. So that is where the current hold up is. 

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Hello,

         We also have Softbank/Epic. We issue everything in softbank. In EPIC the first 2 units of the MTP are completely entered in BPAM like a regular transfusion. After the first 2 units are completely documented the nursing staff will just enter in a total volume for products transfused. All patients are registered in epic as a trauma.

 

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We have Soft and Epic and are a level 1 Trauma Center with approximately 175 activations each year. We pre-label MTP cooler #1 for either Male or Female to a dummy patient (Patient, Massive T) and have a 3 part form to document units on (6 RBC, 6 plasma and 1 platelet) along with the Emergency Release attestation that requires a physician signature.  The first cooler is almost always issued on paper but can be scanned into Epic using the MTP flowsheet (NOT part of BPAM).  Additional units are set up using Emergency Issue with a one step Issue process that prints XM Labels and downtime transfusion records if needed.  In order to streamline the issue of this cooler, it is protocol to only document actual patient trauma ID on the 3 part Emergency release form.  Cooler contains 6 Group O RBC, 6 Group A plasma and one platelet of any type.

Nursing or anesthesia can scan unit numbers into the MTP flowsheet or use an anesthesia workflow from Op-Time to capture scanned blood products in the operating room.  It is not a perfect system and takes some education for the users and we still have problems with documentation and we are 3 1/2 years since conversion to Epic/Soft from Soarian/SunQuest. 

For straight emergency released units from one of 2 remote storage refrigerators, ER nursing can scan unit numbers into an Emergency Released flowsheet for either RBC or plasma.  This actually works really well and is widely used by Trauma staff members before patient moves to OR. It is a simpler version of the MTP flowsheet.

 

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  • 3 weeks later...
On 10/7/2019 at 9:22 AM, jshafer said:

Hello,

         We also have Softbank/Epic. We issue everything in softbank. In EPIC the first 2 units of the MTP are completely entered in BPAM like a regular transfusion. After the first 2 units are completely documented the nursing staff will just enter in a total volume for products transfused. All patients are registered in epic as a trauma.

 

Hello, 

Do you automatically emergency release in SOFTBank with your trauma/MTP? Right now we retroactively add all of the units in and add proper issue/return/release times. It’s quite a lengthy process that we would like to streamline. 

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Hi in our facility we also use SOFTBANK and have EPIC, we encourage the clinician to order the MTP in epic in order to be able to select the units in soft as an emergency release.  This is a good way to prevent transcription errors, and also to make it transparency to our practice, the units are selected to the particular patient, and also help when we have multiple traumas. the transfusion process will be documented using downtime however all the tags are to be scanned in the patient charts.

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MTP is so simple using safetrace Tx. We issue known emergency release. We Always have MR# and even funny name for all trauma patient. So all our MTP packs has patient MR# and name. We send paper copy to document admin and we do not use anesthesia module to document admin as our state requires two verification for every unit. 

My 2nd job has soft and epic

SOFT need to work on their system so we can use emergency release. Currently if there is no blood bank order you can not even issue emergency release that is really good workflow. All sites need to put pressure on SCC to fix this issue. 

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Level 3 trauma designation here. We issue MTP products from SafeTrace Tx, both known and unknown patients. Very quick and easy to use. 

For unknown release if we have other lab orders, or can get info from the ED, we input patient 'name', MR#, birthdate (if known), account # if we have it. When we receive an actual order from Epic or a specimen, they will easily match up with that patient record in SafeTrace Tx,

If we need to very quickly send units to the ED for patients that haven't yet arrived, we photocopy the unit face labels. Once we have patient info (and have time), we emergency release the units from SafeTrace Tx using the photocopied units, making sure to change the release date/time to the actual time the units were sent to the ED.

The ED does sometimes use an emergency transfusion module in Epic for documentation that lets them scan donor info and free text any other information. I've been told by the trauma coordinator that it can be pretty easy to use. If we have a really massive blood release that is going quickly I'm not sure if they would use that module or not - if the staff members who are familiar with using it are working, they might. Other staff probably wouldn't. Surgery doesn't give a lot of blood products here so large volume/emergency/MTP is going to be on paper and probably documented after the fact.

 

Edited by AMcCord
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We are a smaller hospital, but surprisingly we have had a lot of Emergency Releases lately that would have been MTPs had our policy been ready.  It is now!  (It mimics our sister hospital which is a big hospital, although not a trauma center) We have 1 form that we use for the physician signature and the stickers from  4 RBC units and 1 plt unit.  This is given to the Trauma "scriber" and they write down as each unit is transfused.  The paper is returned and we input the dispense times as noted on the form.   We were using our emergency release process in Millennium, but it takes to long to print all those forms and have the physician sign each one. 

 

 

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We are a level II trauma center that averages 4-5 MTP's per month.  We have an order set built in our hospital information system that includes baseline labs, hourly labs, TXA bolus/infusion, and eight rounds of blood components (48 packed cells, 48 plasma, 8 plateletpheresis, and 70 units cryo).  The components cross to our BB LIS (SoftBank).  We issue rounds until told to stop by patient care staff.  We either select/issue or emergency issue based on how much of our compatibility testing is completed.  Although we use the Epic blood product administration module (BPAM) for most transfusions, it's currently too clunky for MTP.  We issue paper transfusion records generated by SoftBank for the RN's to document on.  These are returned to the Blood Bank so that we know what was given & when.  Any missing documentation is included in the comprehensive review that takes place after each event.

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