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Requirements for Issuing Blood Products?


ritaberry

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The system Mabel describes has been on my list for some time. The LIS went up at our facility before the floors transitioned to electronic ordering, etc. It is very common for nursing to put a transfuse order into the system. Presently we do not have an orderable test for transfusion of the unit, but I am strongly considering it. We will be relocating the laboratory mid to late summer and part of the process is the addition of a pneumatic tube system connecting us to ED and OR (presently we are located between the areas). We were consulted about the specifics of the system prior to purchase and the installation is progressing now. The described process sounds like a good place to start once we go to transporting via a tube system. Remote issuing of blood units is a concern, but a larger area hospital has successfully used this sort of system for several years now so I have a local expert when it comes time to implement this process.

Edited by Deny Morlino
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When the Lab Asst delivers the blood does she go over the information with the BB tech? Hmm. I wonder if we even have pharmacy techs.

When the Lab Asst is issuing blood, she signs it out in the computer. She does not check the info with the BB Tech. (Our computer system and BB wristband system incorporate many checks, bells, and whistles to ensure that we are issuing the right blood to the patient that they requested.)

When we have a Pharmacy Tech deliver the blood, a BB Tech signs it out in the computer. The BB Tech does check the info with the Pharmacy Tech when he/she comes to pick it up.

Donna

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The system Mabel describes has been on my list for some time. The LIS went up at our facility before the floors transitioned to electronic ordering, etc. It is very common for nursing to put a transfuse order into the system. Presently we do not have an orderable test for transfusion of the unit, but I am strongly considering it. The described process sounds like a good place to start once we go to transporting via a tube system. Remote issuing of blood units is a concern, but a larger area hospital has successfully used this sort of system for several years now so I have a local expert when it comes time to implement this process.

Deny - Thought I would share with you....

Yes, we built orderable tests for all of our Transfusions. (We even built tests for multiple units....ie: "Issue - RBC X 2", and for the various blood components.) If you do go this route, you will have to figure out exactly what you want to do with these test codes (ie: interfaced with your BB computer system or not, etc.)

For us, the test code stays in the Lab Info System (there was no reason to interface it with our BB Info System.) When the nursing unit orders a "Transfusion" test code, it charges the patient for the blood processing fee (so we don't have to do any manual charging) and documents in the Lab Info System the date & time the unit was issued.

Regarding the use of the pneumatic tube system to deliver blood.....We don't have that luxury, but if we did I would invent a simply system to guarantee that the receiver received the blood in a timely manner. (Either return a tag to the BB in the pneumatic tube, give a quick call to BB or something.) Of course you want to make sure that a unit of blood isn't left in a tube.

Donna

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Donna,

Thanks for the information. That is the part I love about this site! I don't have to completely re-invent the wheel very often as someone has been there before me and is so willing to share. We are not on a BB computer system at this point. I am not sure when we will "go computerized", but when we do it will be determined from a patient safety standpoint, not a workload standpoint. The pneumatic tube situation is a far closer reality for us. Great suggestions for closing the received loop! Thanks again.

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Attached is the "pick up" slip I designed for sending blood in the tube system. I stole from many sources, so I won't try to give credit here...

Our process is the floor sends the pick up slip through the tube. We send the blood and the slip to them (we use the secure feature in the tube system). They sign the slip and return it to us. If we don't get the signed slip back in 10 minutes, we call to find out what happened to the blood.

This is a very new process for us and we are only using it in a very low volume area right now, so I won't make any claims about its success rate.

Pick up forms 090110.xls

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We currently use a pick up slip and require the nurses to check the transfusion order and consent and document on the transfusion record. We are preparing to require the physicians to use a transfusion order set that has check boxes for the reason for transfusion. We are hoping to capture a picture of appropriate use in this fashion. The form is designed so that it can be computerised when physician order entry is implemented (at some unstated VERY future time). Is anyone else using a system like this to capture appropriateness of use data?

We designed one last year and it was accepted by the Transfusion Committee but I have yet to see one used. The forms aren't even kept at the nurses stations. Physicians continue to write orders for blood products on the chart along with all other orders. No justification is ever given.

Rita

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I had the same experience in 2006. The form I have now is a variation on that form that no one ever used. We have electronic forms that the nursing staff can print out with the patient information already on it and they still don't use it. It is going to take the Med Exec Committee mandating it to get them to use it.

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Request for issue blood / blood components can be completed by nurse and presented by porter. However, when issuing unmatched blood in emergency case or incompatible blood in WAIHA case, a physician consent must be presented at the counter for collection.

CK Cheng, MSc, SBB(ASCP), CQA(ASQ)

Hong Kong

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Do you document that you received the form back for every issued product and that it is completed accurately? We use a form similar to yours and this question came up. Sometimes I think documentation can get out of control. How many of us are documenting that we documented something?

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Don't understand what do you mean by 'Do you document'? What we do is we have a blood/blood component release form which required to be completed by nurse or physician.

The bearer form contains (1) patient's particulars/information (2) location (3) number of units (4) what kinda blood/blood component (5) special requirement like CMV-neg, irradiation, etc.. (5) nurse/physician code and signature and (6) date.

In WAIHA case, an adddition physician consent must send together with the bearer form stating that the physician in-charge knows the units is incompatible, understand the risk of transfusing incompatible blood, and closely monitor the patient during transfusion.

In emergency case, physician must sign a release unmatched blood form and physician knows the risk of transfusing unmatched blood.

We keep all documents/forms in blood bank and keep them for years, depends on the Requirements.

Hope that helps.

CK Cheng, MSc, SBB(ASCP), CQA(ASQ)

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When you say "Do you document that you received the form back for every issued product and that it is completed accurately?" are you thinking about an audit to be sure that the form is produced accurately each time it is required?

I do think we overkill on the documentation, but sometimes it is like pulling teeth to actually get people to produce the required forms, completed properly, at the required checkpoints. Having audit results that show whether they are complying or not can help spur them to actually do it.

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We have been using a form for a few years. The form is a performance improvement tool. Basically, a check list. it is a way for us to make sure we are makeing sure the chart has the required documentation for a blood product transfusion. I our facility the nurse brings the chart to the blood bank hospital transfusion services. We make sure the consent is signed, the order for the administration is present and the product requested. We also as them to explain the indications for the transfusion.

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  • 9 months later...

In the Epic re-build at one of the facilities that I am working with, we hope to build a requisition that the RN can print when the administration order is placed. This requisition would have the patient's name, MRN, product requested with modifications/attributes etc. In addition it would ask the the following questions with check-marks: 1. Is this transfusion indicated based on patient symptoms and/or lab values? 2. Does the patient have a current signed consent for transfusion in the medical record? 3. Does the patient have a patent IV? 4. Are you prepared to monitor the patient for suspected transfusion reaction?

The RN would be required to check these boxes - before the lab would release the component. Any suggeestions of other questions? Feedback?

Melanie Jorgenson, RN BSN

Hospital Transfusion Safety Officer

Puget Sound Blood Center - Seattle, WA

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Could you, or would you want to, build this requisition as an order in the system with these questions attached (sort of like them answering coag or drug dose information on those tests in the computer when they order them) so that the RN has to answer them electronically and then the "order" would go via the computer to the Blood Bank so they would know to get the blood ready for issue? I have wondered about doing some such in our system. Might work best if you are issuing via pneumatic tube. Just a thought.

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We now do. Scenario - patient with a massive haemorrhage - stock running low - more blood ordered for patient *and* stock and flying squad replacements. Doc intercepts the delivery driver and takes ALL the blood! And then high tails it out of the hospital to the airport to helicopter the patient away. With a lab staff member giving chase to retrieve the A+ blood that really wouldn't be suitable for the O+ patient...

Our forms now include instructions that the products are only ever to go to the laboratory!

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  • 5 years later...

Do any or all of you require a patient ID form for emergency released blood. We are having an issue with staff from the floors showing up and requesting "red tag" blood and without the ID form we have no idea where or who may be receiving the products??

 

 

Delisa

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If emergency release blood is requested before the patient arrives at the hospital, there isn't much we can do except issue it without a name.

We require a patient demographic label if the patient is in the system, and try to issue it in the computer so documentation is more complete.

Do your emergency release blood requests usually come from the floor?  That seems really unusual to me.  If the patient is on the floor, they should be in the system and we would require a demographic label.

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My - how things have changed since this thread started in 2011. 

We no longer get a paper copy of the Dr's request - they now have to do electronic orders and we built several questions in that make them enter the justification for the transfusion. 

We do require them to bring a photocopy of the signed page of the Transfusion Consent form every time they pick up a unit.  That has lead to 100% compliance with the signed consent form being in the chart (now all scanned in electronically).  Even in emergencies - they know to bring a small pickup slip with a patient demographic label on it.

For our Emergency Release form - we do eventually require patient demographics so we know who the unit went to.  We can release without it, but require it later.   As above (from mollyredone) if the patient was on the floor - we could enter electronically for uncrossmatched units because the patient will be in the computer.  We are being pushed by the hospitalist physician's to give them uncrossmatched, Emergency Release blood too - very rarely I hope.  The one time they thought we weren't "fast enough", we discovered that they did not even know that a STAT Type and Crossmatch takes about an hour and that there is no way to shorten the incubation time.  We had to teach them the whole uncrossmatched, emergency release procedure and the correct way to request it and that they would have to sign the Emergency Release form as the requesting physician.  We will have to see how that all goes, all of my techs know to offer "uncrossmatched" now if everyone is "excited" about the "blood is taking too long!!"  In the past - Emergency Release only went to ER or OR and they were familiar with the procedure - the floor RNs had never even heard of it.

Might be worthwhile to find out why the "floors" suddenly need your Red tag units.  May be a training issue.  Good luck.

 

 

 

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