proactive blood utilization

[kriti]

Does anyone use a more proactive approach using an order set which allows the physician to select the reason for the blood usage, etc, and if so, can you share how this is set up and how well the process works? Thanks.

[dstoever]

The FDA has a website of policys, The National Guideline Clearinghouse [ngc.gov] has and excellent policy entitled BLOOD TRANSFUSION: INDICATIONS AND ADMINISTRATION, and the Technical Manual.

The Hospital system I work at uses a list of choices and circumstances for each blood product and also provides a 'write-in' area. The above references, especially the Technical Manual, support our catagorical listings. I would need to get permission to present them, and I would like to see how other transfusion services are doing with this program.

What was most encouraging about the form was how quickly it became utilized and how the staff appreciated the transfusion mointoring. The most obvious change was the number of single transfusions that were replacing multiple transfusions.

D Stoever

Edited February 6, 2010 by dstoever

[kate murphy]

We have electronic order entry, and at the time physicians order blood as part of the on-line form, criteria for transfusion is displayed. Right now, physicians do not need to check off or write in any reason. By and large, guidelines are followed, and those not meeting criteria are followed after the fact. We do not yet have a "smart enough" computer that automatically compares lab values with criteria and demand a reason for those not meeting criteria.

Years ago, when we had lots of path residents, they would proactively contact ordering docs when requests were outside criteria. Required lots of time - BB techs would initially investigate lab results and those not meeting criteria would prompt the BB to contact the path resident. A cumbersome system.

[kriti]

Dstoever, has that process ever led to delays in providing the products? Are there any areas or instances where there are exceptions and whatever they order is prepared (ie. trauma, OR)? And the process works well for you? Thanks for your response. kriti