Irradiated Units Missed

[lef5501 10]

We recently had a situation where the physician ordered Irradiated units on a new patient through CPOE. He placed a comment in CPOE in all capital letters to give Irradiated units. Even with the comment in all caps, we had 2 techs miss the fact that he wanted irradiated. It was a new patient to us so no history in SoftBank. We now need to figure out a way to make sure it does not happen again. Does anyone have anything in SoftBank that may work that is not a manual process, such as us just adding the Irradiated into the history once the physician orders it. I don't know how 2 techs missed the all caps comment but here we are. How does everyone else make sure they don't miss special product needs? 

[jayinsat 163]

17 hours ago, lef5501 said:

We recently had a situation where the physician ordered Irradiated units on a new patient through CPOE. He placed a comment in CPOE in all capital letters to give Irradiated units. Even with the comment in all caps, we had 2 techs miss the fact that he wanted irradiated. It was a new patient to us so no history in SoftBank. We now need to figure out a way to make sure it does not happen again. Does anyone have anything in SoftBank that may work that is not a manual process, such as us just adding the Irradiated into the history once the physician orders it. I don't know how 2 techs missed the all caps comment but here we are. How does everyone else make sure they don't miss special product needs? 

The age old problem of how do you make people pay attention to the details...If you figure this out, let me know. I haven't yet.

Do you not have an "IRRADIATED RBC" product in your dictionary that the physician could have chosen? That puts the responsibility on them, where it should lie. A comment is not an order and, if they are relying on that, they are forcing your techs into a position of failure. I would suggest you add an irradiated product order to your dictionary. If the physician wants that product, they must order that product that way.

 

 

[beverleyj 10]

We just switched from Soft to Meditech; however, in Soft we would add it as a special need or a note to tech. This would pop up anytime the patient's record was accessed. 

[slsmith 64]

The   doctors have a choice  here to selected irradiated red cells rather than red cells and adding a comment . Also once we know a patient needs irradiation we have a "special needs" requirement we can assign to patients. If the Tech tries to dispense a product without the special need they receive a message they have to over ride in order to go on. Of course they can over ride it or not dispense but then they are in deep do do. 

[John C. Staley 1,180]

As long as humans are involved in a process there will be human error!  You best option, as suggested above by jinsat is to have the product ordable by the physician.  Remember, complicating a process never makes it better.  

[Baby Banker 85]

4 hours ago, John C. Staley said:

Remember, complicating a process never makes it better.  

 

O how I wish I could convince people here of that!  

[Cliff 443]

Do you have your own irradiator(s)?  Can you move to 100% irradiated cellular products?

[carolyn swickard 222]

We have a question that the Drs (and myriad other "orderers") must answer on the RBC and PLTPH orders (Meditech Magic) in order to get Irradiated products.  Originally the questions was just "Irradiate?  Y/N"  and we were happily (naively as it turns out) anticipating the Drs having greater control over their orders and getting it right more often - WHAT A JOKE!  Since so many of the Drs do not deal with blood all that often and did not know really what irradiation was or what it was for - there were MANY wrong orders.  We soon changed the Question box to also contain a statement "For Immuno-compromised pts only".  This slowed it down a little, but we still rely on calls, computer history (we can also add a marker in Meditech that comes up every time for the pt) and taking a look at the pt's White Cell count ourselves - lots of calls.  There is a mistaken impression that many providers have that "any" cancer patient is immuno-compromised" and needs irradiated units.  Needless to say - that is not necessarily true.  In fact, our Oncology Service orders less irradiation that almost any other service and sticks to strict, current Irradiation Guidelines.  

So - give them something they have to order (irradiated RBCs/ PLTPHs) or answer (Irradiate Y/N) and still expect a lot of record keeping and phone calls for clarification - "What is the indication for starting irradiation?  is a diplomatic way of wording it.  Best of luck.

[AMcCord 1,289]

If your facility has Epic an order set can be built for product orders that has a list of indications. They have to pick one to complete the order. If they choose 'Other' there is a line that has to be filled in with the indication. That thins down the inappropriate orders quite a bit.

I agree - many providers think 'cancer' is an indication for irradiation. We do make phone calls to clarify those orders. Often when we tell a hospitalist that the patient is seen by Dr So-And-So an oncologist and we don't routinely transfuse irradiated to that patient, they drop the order for irradiation.

[NicolePCanada 27]

This doesn't necessarily speak to your topic of how to get them to order irradiated properly or how to make sure the techs notice it, but I attached the link to the National Advisory Committee Guidelines for when Irradiated blood is required. This is Canadian, but interesting information, none the less.

https://www.nacblood.ca/resources/guidelines/downloads/Recommendations_Irradiated_Blood_Components.pdf

[carolyn swickard 222]

Very nice reference.  Nice to see a concise, clear - recent - rework of irradiation recommendations.  Thanks.