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Would a hospital protocol of 'Keep 2 units ahead' be accepted as a doctor's order


A Fiddler

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If Cardiac Surgery has a written policy to 'Keep two units ahead', does this fulfill CLIA, CAP, JCAHO requirements to obtain an MD's order for each lab test ordered?

CSU has tasked the Blood Tech dept with ordering units ahead as indicated by the acute useage of the patient.

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The nursing unit informs us if we need to "keep ahead" on a patient. They are responsible for putting the order in the computer for the crossmatches. We let them know when the order is needed. My favorite MD is the one who writes keep ahead X units for 48 hours. It takes out much of the guess work.

:wave:

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At our hospital, we tell the nurses that thanks for the information, but that it is their responsibility to order more units if desired. My Medical Director nor myself respect these "stay ahead orders". It is our opinion that by having the blood bank personnel order the ahead units that constitutes them writing the order and we do not feel nor do we want the responsibility for ordering the units.

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At the last hospital I worked there was only one keep ahead order that we followed and that was on Trauma I cases and in those cases I had the Trauma Committee's procedure, signed by physician, state that it was only the BB staffs’ requirement to maintain the ahead orders for 24 hours. Other ahead orders where placed but we would just place a sticky on the patient's information and then when we were no longer ahead we would remind the clerk, at time of issuing, of the level of blood available and inform them that if they wished to have blood available that they would have to order it.

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At my last posting, I failed to remember that we do have one stay ahead protocol and that is if there is a massive transfusion going on. But this is the only time, and it is very delineated in my policy about what and when.

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Our doctors in specific units (ICU and Burn) have an order to Keep Ahead X units for 72 hours. We match the 72 hours to the expiration date of the type and screen. It works very well for us. We have not had any problems with any of our inspectors. We can stay on top of our patients needs easier when they are in surgery or having a large bleed if we are the ones ordering as we know when the last unit walks out our door and don't have to wait on anyone else to realize that nothing else is ready. Even with this procedure in place, we maintain an average C:T ratio of 1.3:1.

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Our doctors in specific units (ICU and Burn) have an order to Keep Ahead X units for 72 hours. We match the 72 hours to the expiration date of the type and screen. It works very well for us. We have not had any problems with any of our inspectors. We can stay on top of our patients needs easier when they are in surgery or having a large bleed if we are the ones ordering as we know when the last unit walks out our door and don't have to wait on anyone else to realize that nothing else is ready. Even with this procedure in place, we maintain an average C:T ratio of 1.3:1.

This is very similiar to experiences I have had in hospitals with busy transfusion services. All of them had "keep ahead" orders, whether it was from the trauma center or from surgery or ICU. I agree that it worked well with the blood bank monitoring when the last unit went out and when it was time to have a new sample drawn again. It sure cuts down of the "panic" and super-stat orders. Also creates a cooperative atmosphere within the "transfusion team".

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We accept that type of order, but it is up to the nursing unit to place the orders. Blood Bank does not place the orders, but may inform the unit of the patient's current inventory. Also, how do you handle this when you have a low inventory of blood supply?

John

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We also use a a 'stay ahead' order. Most notably for post heart surgery (stay ahead 2 units for 24 hrs post op). Although this order is sometimes abused in cases other than heart surgery it's worked ok for us and we haver never had a problem with inspections.

Edited by bxcall1
typo
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