"Special Needs" Product Orders

[bbbirder]

I would like to find out how other facilities handle orders for CMV neg and/or Irradiated products.

Currently, we just have 'one' option for ordering RBCs, and they must add a comment that CMV neg/Irrad is needed. Once we get an order like this, we add a patient marker, so that we provide all future products CMV neg/Irradiated.

Do you have a computer code for Irrad/CMV neg RBC (PLT, etc.) for the nursing units or physician to order? If you do, how do you handle it when you have an history of special needs and they don't order it the next time?

I want to keep this as simple as possible, and not replace one potential problem with another.

Thanks!

Linda Frederick

[adiescast]

We actually have a second screen that comes up for them to pick requirements. The requirements still come to us in a comments field, but it gives the person ordering the blood discreet options instead of requiring them to string the requirements together. We then put the requirement into a permanent computer file like antibodies so that we get a warning if we are about to issue blood that does not meet the requirement. The biggest problem we have is when the first tech misses the order comment (they actually have to look at these comments as part of the history check, but there is nothing to force it) and does not transfer it to the antibody field.

[Cliff]

In our current computer system, we add "restrictions". There is logic that warns the user if the product does not meet the restrictions upon reserving, or issuing.

These restrictions are ordered by the patient care giver and entered by blood bank staff. Once the restriction is placed, it will be honored, regardless of the product ordered.

So, if you had restrictions for pheresis platelets, irradiated products and leukoreduced products entered in the past, and platelets are ordered today, they will be irradiated, leukoreduced and pheresis.

[Mary]

We use a Modify Products function in our computer(Cerner). For example, we modify a leukoreduced RBC to an irradiated leukoreduced RBC which has it's own computer code and charges.

For CMV-, we add on a charge and add the attribute CMV- to the product in the computer.

We keep track of the patients with a patient comment function in the computer. If they fail to order the special products, we call and ask if they want to continue to use special products. Sometimes they discontinue the order, in which case we add an additional comment.

We also set up "dummy" antibodies (Anti-CMV and Anti-Irr) which work like antigen/antibody verification and alert the user in result entry.

Hope this helps.

[Kathy3171]

Our patient care areas can order irradiated but have to add the CMV neg comment. The first time this happens, we enter a comment,a maker as well as call the CMV an antibody so the computer alerts us to the product requirements. I wrote a letter to all our oncologists telling them that once these products are ordered, we will continue to honor this request until we are told by the original ordering doctor to discontinue. This alleviates the possibility of the doctor on call not knowing the patient transfusion requirements. I also included in the letter, that once the patient tests CMV positive, we will discontinue the requirement for CMV neg products. We have it set up in our system that the patients most recent lab results (H&H, PLTC, PT, CMV, etc) show up at the time we access the patient information. That helps alot.