Surgical blood orders

[pbaker]

Currently we have a database that matches typical blood orders with the surgery schedule based on physician and/or procedure. The blood bank pulls the schedule 48 hours prior, 24 hours prior and day of surgery to ensure that all the correct orders have been placed. If not, they follow up with the nursing floor and/or place the orders based on the surgery schedule printout. Based on usage date presented by the blood bank, the surgeons agreed to the "standing order" and do not write orders for each surgery.

The hospital is getting a new computer upgrade and the surgery database will no longer be compatible. I would like to see the surgeons resume responsibility for writing orders for each surgery.

What is your practice when it comes to blood orders for surgery?

[Deny Morlino]

We follow our Maximum Surgical Blood Order Schedule. The type of surgery and the orders are handled by the preadmission testing nurses at the presurgical point and double checked against the MSBOS by blood bank personnel prior to performing testing.

[Likewine99]

No MSBOS at our place.

Orders are placed by the physician on a case by case basis as pt is admitted, either as a pretest pt or an inhouse admission.

[tbostock]

We use a MSBOS as well, the physicians approve the list, the protocol, and recommended number of units for each specific type of surgical procedure. We review the OR schedule the day before, look for surgeries that qualify for units and set up that number of units (there is some flexibilty based on patient's pre-surgical Hgb level...if low, we might set up more units, or if very high, we leave it as a type and screen only and do immediate spin crossmatches "on the fly" if needed). If a patient has an antibody, we automatically set up 2 units since antigen typing/Coombs' crossmatches are required. We will also set up more than required if the physician wants them due to a coagulation disorder in the patient.

When it was up to the physicians to order their own units for surgery, we either had no units ordered for a AAA surgery, or 6 units ordered for an appendectomy. So this standardized system works much better for us.

[EDibble]

We used to have a "Standing Order List" but the transfusion committee discontinued it's use several years ago. So many docs had their own ideas of what they wanted set up for their surgeries, that we go on a case by case basis. Most of them stay within certain limits (T&S and either one unit or two for a hip replacement as an example) but, of course, if the situation warrants it, they may order more. The patient has a bleeding history, is in bad shape generally etc.

Our facility has had good luck with this. We do monitor the OR list ahead of time, and do inquire if a procedure that normally has pre-op work seems to have been missed.

[Steven Jeff]

Over the last 6 years the level of cross-matching for surgical procedures we provide blood for, has reduced significantly. There are three main factors that have contributed to this reduction.

1. The implementation of a MSBOS and strict adherence to it, putting the onus on clinicians to justify why they want to cross-match outside the MSBOS rules.

2. The introdution of perioperative cell salvage for knee and hip replacements. This one action alone reduced the orthopaedic red cell requirement dramatically.

3. Reduction of the trigger haemoglobin level to 8 g/dL before transfusion is required subject to the patient not being clinically symptomatic. However, I have a gynaecologist who will regularly discharge patients (young ladies) with a Hb between 7 and 8 g/dL rather than transfuse.

All these three factors work together and have played a part in the reduction of the surgical cross-matching at my hospital.

Kind regards

Steve Jeff

:)

Edited December 5, 2010 by Steven Jeff
puntuation

[Malcolm Needs ☆]

The other thing that has reduced the use of blood Steve, is the fear of vCJD, both on the part of the patient and of the doctor (in case they get sued).

[Bill]

Can your IT Dept help put that database as a free-standing database. Virtually all databases can be exported from one system into a csv file and then imported into another--even if it is a MySQL or Access database.

[Townsend]

We discontinued the use of the MSBOS years ago. Each physican/surgeon is responsible for their own blood orders on a case-by-case basis.

[AMcCord]

We discontinued the use of the MSBOS years ago. Each physican/surgeon is responsible for their own blood orders on a case-by-case basis.

Same for us.

[L106]

We discontinued the use of the MSBOS years ago. Each physican/surgeon is responsible for their own blood orders on a case-by-case basis.

Same for us.