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Blood component order in the O.R.


Joyous7

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Hi Everyone,

I will appreciate any information you can give me in regards to the regulations of Blood component orders for the transfusion of blood products. Currently we have a component order form that the physician fills out when they transfuse blood on inpatients and outpatients. A copy goes in the chart and a copy is retained in the blood bank.

I am wondering what the typical protocol is for pre-op patients? We have a surgical booking form that the physicians fills out to request the pre-op type, screen and crossmatching to be done. If the patient has not been pregnant or transfused in the past 3 months, we allow the clot to be valid for 14 days. Pre-admissions testing retains the surgical booking form and places it in the patient file. When the patient comes in for surgery and requires the blood products, how are you getting a blood component order?

Thanks

Joy

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We follow a similar scenario and if an XM is ordered the pre-op staff orders it at the time the pre-op sample is drawn.

The day before the surgery we XM the blood, we have the bar code label for the order in the BB and the test hangs out on our incomplete worklist so we don't miss it on the day of surgery. Our samples follow the same 14 day rules.

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when do you get the written order to transfuse the products in the O.R. How do they document that the doctor ordered the blood to be transfused?

We follow a similar scenario and if an XM is ordered the pre-op staff orders it at the time the pre-op sample is drawn.

The day before the surgery we XM the blood, we have the bar code label for the order in the BB and the test hangs out on our incomplete worklist so we don't miss it on the day of surgery. Our samples follow the same 14 day rules.

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We get either a copy of the order or a message ( meditech) along with the specimen. The doctor orders type and cross for 2, for 7 days from today. We do the type and screen and hang the order copy/message up on a "to do" clip. Each day the day shift person checks for surgeries happening the next day and sets up those components the afternoon before surgery. We also give a longer expiration on preops that are not transfused or pregnant. We use 10 days though. We do not order the products in the computer until the day before, when we set them up. If we did, they would release too soon, as we use 72 hours for packed cells to release after they are set up.

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  • 9 years later...
On 8/14/2008 at 11:13 AM, LaraT23 said:

We get either a copy of the order or a message ( meditech) along with the specimen. The doctor orders type and cross for 2, for 7 days from today. We do the type and screen and hang the order copy/message up on a "to do" clip. Each day the day shift person checks for surgeries happening the next day and sets up those components the afternoon before surgery. We also give a longer expiration on preops that are not transfused or pregnant. We use 10 days though. We do not order the products in the computer until the day before, when we set them up. If we did, they would release too soon, as we use 72 hours for packed cells to release after they are set up.

This is also how we do pre-ops, with the Type and Screen being done immediately, then the units set up the the morning of the surgery once the patient arrives and the armband is verified.  We were having too many canceled or rescheduled surgeries, and having units tied up in crossmatch needing to be released when they were crossmatched the day before the scheduled procedure.

Does anyone know of any regulatory standard that states we have to actually have the units "set up" prior to them being needed in surgery?  Specifically, can we do the type and screen, and as long as the antibody screen is negative, wait to actually crossmatch the units until they are requested? (As long as we make sure there is product available, of course.)  The physician's order is for a type and crossmatch, and we would still be able to provide crossmatched units when they are actually needed in OR.  If they are never needed, then we don't crossmatch at all.  Thoughts on this??

We set up so many units, only to have to release them when not needed.:wacko:  I am just trying to figure out if there is a better work-flow for this.

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I have seen a vast improvement in physicians ordering unnecessary crossmatches by having the crossmatch to transfusion statistics, with a goal c:t ratio, reviewed at the Transfusion committee meeting.  The hospital provides an anonymous list of physicians (they know who they are, but no one else knows who they are) so they can compare the data (competition).  There are still a few physicians who order unnecessarily.  We know who they are, and we set up units with long exp dates.

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