Initiation of a Massive Transfusion Protocol

[PaulSunV]

I am looking for some ideas on how other facilities handle the Initiation of a Massive Transfusion Protocol. What we had is a patient that received RBCs at a small facility and it became apparent that the patient’s condition was so severe that they couldn’t handle it. The patient received 6 units of blood during that initial hospital visit and during transport to the larger facility which is where I am. While in the emergency room at my facility the patient received another 4-6 units of blood before being transferred to the operating room where more RBCs were ordered. The bottom line is that during this entire period no one considered the need for plasma products before patient received close to 18 RBCs. So how do other facilities track the volume of product that a patient has received where there have been numerous physicians ordering product without a clear understanding of what the patient has received? The Trauma committee thinks that the transfusion department is in the best position to be aware of when a physician should start thinking about ordering an MTP. The difficulty I see is that my staff has no way of knowing what units have actually been transfused as often we send blood out in coolers that doesn’t get transfused and never makes it from the emergency room to the operating room. That coupled with the grave yard tech doesn’t always know what the afternoon shift tech has issued. Anyway does any other hospital with a MTP require the transfusion department to act as a reminder department for the physician?

[KKidd]

I work at a 100 bed facility and we contact the physician after 10 units of RBC. We ask if plasma or platelets are required. It takes at least 2 hours to received platelets from our supplier. The protocol was initiated after a surgeon thought had told the OR nurse to order platelets on his patient. Turns out he didn't ask for them and didn't like the delay either. Now the responsibility lies on us to make sure that the MD's minds are read correctly. Is it BB ESP?

:peaceman:

[rravkin@aol.com]

PaulSunV,

At the facility I work our Massive transfusion protocol is 6RBC's and 6FFP's per round of products and initiated and continued until the floor staff call the BB to cancell. In practice the BB staff will sometimes call the floor and speak directly to personel to find out thier needs. The coolers are kept track of as well via these calls. Our ER staff and the BB have a policy that if the patient is going to the OR the cooler is to follow. The BB follows up with the movement of the coller. We keep a record of products issued by keeps a copy of each unit tag paper clipping them together with each round of products given. Also, other products such as Platelets or Cryo are ordered by the floor staff or else phoned to the BB. On our off shift we maintain a good line of communication with the unit caring for, and initiating, the massive.

Hope that helps.

[David Saikin]

At our small facility (40 beds) it is up to the MDs to determine when the MTP goes into effect. Everyone is a generalist and we are not about to make that call.

[LindseyN]

I work in a Level I trauma hospital. Our massive transfusion protocol must be initiated by the MD (usually the trauma surgeon in the ED). We sometimes will call and question if they are taking alot of RBC's without plasma products, but ultimately the doctor has to make the call.

[Eagle Eye]

same here. Our trauma surgeon initiate massive transfusion protocol. we send set amount of blood products every 15 mins until they stop MTP.