Transfusion Order Form

[pbaker]

Does your facility utilize any type of Transfusion Order Form to be completed by the physician? This could be paper or electronic. Does it have indications for transfusion that the physician must complete? Would anyone be willing to share a copy of any order form that you use?

We are trying to improve our transfusion committee and educate the physicians on the "proper" utilization of blood products. Currently, if they ask for it, we give it, the end.

Thanks for any help you can give:)

[Malcolm Needs ☆]

We are trying to improve our transfusion committee and educate the physicians on the "proper" utilization of blood products. Currently, if they ask for it, we give it, the end.

GOOD LUCK!!!!!!!!

:devilish::devilish:

Mind you, there are also many sensible ones out there too!

[mjshepherd]

Here is a copy of the form I designed for use at our facility. We require a copy to be submitted to the blood bank before units are issued then I review them monthly for appropriatness, this makes my utilization review much more effective then randomly selecting a percentage of patients.

[ATTACH]496[/ATTACH]

Blood Product Order Form 3.doc

[tbostock]

We have our blood product order online now, we just went live with Epic EMR. The physicians select the blood product order, order pre and post transfusion tests, and pre and post meds all in one order set. The criteria are very much similar to mjshepherd's (see above post), but we were even brave and took out "other". When we were on paper, they wrote very entertaining reasons in "other" (my favorite "patient going to Italy"). So our process now is...if a physician complains that an indication for transfusion is not on the list, he/she has to bring it to Transfusion Committee with supporting literature (written after 1980 or so hopefully). Only one physician has ever done this, his reasons were pretty valid, so we added it.

At my previous employer, we even had the physician attest that he/she has explored all other transfusion alternatives before ordering the blood product. A nice reminder that they should try iron first in an iron-deficient patient instead of just transfusing red cells.

[adiescast]

[ATTACH]497[/ATTACH]

We have designed a form and are in the process of obtaining permission to mandate it. I would love to have it computerized for easier tracking. Do you use your form for all patient populations Terri? As you can see in this draft, we had made it adult only, but that has now changed even though some of the "normal" values and transfusion indications can differ.

transfusion order form final draft.pdf

[Townsend]

We are also on Epic electronic medical record, and our orders usually get placed directly into the EMR. However, we still have a couple of areas not live with Epic who use our manual order form. (I've attached a copy.) Page 2 is actually on the back of the form. It is a 2-ply form, the yellow carbon copy gets sent to the blood bank.

[ATTACH]498[/ATTACH]

Stephanie Townsend, MT(ASCP)SBB

LA-3 Physician Order Form.pdf

[tbostock]

Adiescast and Townsend: love your forms. Encouraging to see that most hospitals are improving blood utilization. It's a lot of work, but we have seen our inappropriate transfusions reduced drastically when the physicians have to document their rationale up front.

Adiescast: currently, we don't transfuse babies, but when we move to our new location in August, we will add NICU, so we will build this same process for babies. Right now, we only have the one Blood Administration order set built.

[MJorgenson]

Would anyone be willing to share screenshots of their Epic Blood Orders? I am working with an organization in revising their current orders.

Thanks!

Melanie Jorgenson, RN BSN

Hospital Transfusion Safety Officer

Puget Sound Blood Center- Seattle, WA

[donellda]

Our EMR commitee is currently working on new guidelines and orders for all of our blood products. We had a meeting with them last week and the more we talked about it, the more complicated it became.

[Eagle Eye]

Do you know if EPIC has 510K approval for blood orders?

Would anyone be willing to share screenshots of their Epic Blood Orders? I am working with an organization in revising their current orders.

Thanks!

Melanie Jorgenson, RN BSN

Hospital Transfusion Safety Officer

Puget Sound Blood Center- Seattle, WA

[KKidd]

We tried to institute a form similar to Adiecast. Our Nurse Exec Committee shot it down before any physician even saw it. Congratulations!

[LCoronado]

I am just wondering how outpatient transfusions are handled. Are these forms distributed to physicians' offices? Also, I realize the intent is to use these forms in non-emergent situations but the definition of "emergent" is quite debatable, especially when it concerns Emergency Department patients, so are ED physicians required to complete these as well?

[tbostock]

No 510K needed to order products, so we do have our order set for blood products built in Epic. But their blood administration module is not 510K approved, and that IS required to be, so we chose not to use that. We stayed on paper for our blood admin documentation.

Do you know if EPIC has 510K approval for blood orders?

[tbostock]

Yes, even ED have to use our order set in Epic to order blood products, even if a Mass Transfusion Protocol. Our outpatients (since all docs don't have access to Epic from their offices) use a paper form, designed to mimic our online ordering so that it is consistent. We sent copies to all physicians who send patients here for transfusion, and we also have it on our hospital Intranet for the docs to access.

I am just wondering how outpatient transfusions are handled. Are these forms distributed to physicians' offices? Also, I realize the intent is to use these forms in non-emergent situations but the definition of "emergent" is quite debatable, especially when it concerns Emergency Department patients, so are ED physicians required to complete these as well?