Updating And Enforcing My MSBOS

[jhaig]

I am looking for some information on certain procedures for which my MSBOS may be in need of updating. Specifically, I'm wondering what other hospitals are doing regarding surgical orders for total knee arthroplasties (single or bilateral) and total hip procedures (arthroplasty, Austin Moore, etc.). We have a group of orthopedic physicians which just can't seem to get on the same page regarding what to order. As of now, our MSBOS requires a type and screen for a knee and 2 units of either packed cells or autologous units for surgery. Some doctors insist on having either 2 units of packed cells or 2 autologous units for a knee arthroplasty. My last study indicated that when the patient's pre-op hematocrit is 40% or more, 9 out of 10 auto units collected for surgery are not transfused and are ultimately discarded. This is a tremendous drain of time and resources. The Transfusion Committee is trying to not so much refine our guidelines but to enforce them without irritating the physicians. I realize that every patient is different, but the numbers ususally don't lie. Any ideas?

[normam]

We have a policy for Preop to extend the validity of the sample to seven days only if they meet certain criterias and our protocol requires a type and screen be done on knee surgeries and other minor surgeries. It eliminates unnecessary crossmatches and preserve our blood inventory. If blood is needed,it takes only five minutes to crossmatch when we have the type and screen already completed. It saves time and patient don't get charge for unnecessary crossmatches.