Rh Immune Globulin for Outpatients

[LCoronado]

I would like to pose a few questions about process, to hospital blood banks that perform work-ups and /or dispense Rh Immune Globlulin.

1. Do outpatients present with orders from a prescription pad or do you accept another form of written order?

2. Do you require the physician to provide detailed information such as the gestational age and reason for the order (i.e. is it a 28 week prophylaxis, as opposed to post invasive procedure or post trauma) or do you rely on information given by the patients?

3. Do you issue the RIG for administration in your facility or do the OB offices actually give the injection?

4. If given in your facility, what patient care area(s) are involved?

I know this is quite a lot to ask, but our current process is being critiqued in detail and mercilessly by "others" (Not Blood Bankers!) and I need to know where to give and take in my position.

Thank you!

[Deny Morlino]

1. The physician's send an order on an order sheet for the workup, not a prescription pad.

2. Details are provided by the physician office on the order. If questions need answered we may ask the patient for clarification, but the final place for information is the physician.

3. RhIg is administered at our facility and one offsite facility that is hospital owned. The offsite facility posed several challenges including patient history checks prior to administration of the injection and full accounting for all the RhIg. We have overcome these issues, but it is a bit long for a post here.

4. Within our facility during their hours of operation our outpatient speciality center administers the injection. During the hours this center is closed the OB department within the hospital administers the injection.

[butlermom]

Patients come with a written order on a prescription pad slip. Occasionally the order will be written on a hospital order sheet. We draw a sample for ABORh and antibody screen and the Rh Immune Globulin is picked up from us and injected by a nurse in our outpatient infusion department. We don't require any detailed info from the physician. Many of our patients receive their 28-week dose in the physician's office so we never see them until they come to deliver (with a nice anti-D due to RhIG)!

[LCoronado]

Thanks for your input. We like to know the details in order to determine whether or not the patient needs a fetalscreen. We also ask if and when they received RhIG previously to clue us in as to whether we are dealing with a passive or active Anti-D. Also, there are sensitivity issues around the reason for the order - it's helpful to know whether you are dealing with a happy mom-to-be or a woman dealing with a devastating loss.

[David Saikin]

our orders come with prenatal testing . . . we give the RhIg to the pt after the blood draw, as they are going to the ob office, where it is injected.

[dgibaud]

At our facility the patient presents with an "order form" from the physician. As long as we have a previous record of Rh type, and no evidence of ALLO anti-D, we give the Rhogam to the patient to take back to the physician office. The patient only needs to wait about 5-10 minutes. We do the workup (abo/rh/screen) at our leisure.

We issue at our main site, and also 2 other satellite drawing sites.

Don

[rcollins]

I would like to pose a few questions about process, to hospital blood banks that perform work-ups and /or dispense Rh Immune Globlulin.

1. Do outpatients present with orders from a prescription pad or do you accept another form of written order?

2. Do you require the physician to provide detailed information such as the gestational age and reason for the order (i.e. is it a 28 week prophylaxis, as opposed to post invasive procedure or post trauma) or do you rely on information given by the patients?

3. Do you issue the RIG for administration in your facility or do the OB offices actually give the injection?

4. If given in your facility, what patient care area(s) are involved?

I know this is quite a lot to ask, but our current process is being critiqued in detail and mercilessly by "others" (Not Blood Bankers!) and I need to know where to give and take in my position.

Thank you!

Hi,

Our outpatients bring any kind of written order from their OB that includes gestational age. If they haven't included gestational age on the order, then the outpatient registrars call the office. We have included a field in our LIS asking for the gest. age when they order RhIG so they follow up with that. We (that would be phlebotomy) draw type and screen and perform at least the type before we release the RhIG. Meanwhile, the patient is making her way from phlebotomy up to the 2nd floor of the hospital. Our MIC (maternal/infant center) Triage ladies come pick up the RhIG from us and administer it.

Becky

[GilTphoto]

our current process is being critiqued in detail and mercilessly by "others" (Not Blood Bankers!) and I need to know where to give and take in my position.

Thank you!

Do you work for TENET? Our process is about to change because of switching to Cerner Millenium. We are only 3 months from 'Go Live' and haven't a clue yet!

I hadn't seen this post yet, so I discussed this further in the thread on Rhophylac vs Rhogam.

[EDibble]

We used to give Rhogam to outpatients quite a bit, but now most patients get it in their OB office. We do give it out occassionally. When that is the case it is either due to the patient is in the ER and may not have a physician, or the patient does have a physician but it is the beginning of a long holiday weekend. If the 72 hour window falls within the time the office is closed, we give the Rhogam. Depending on circumstances, either the ER or our OB floor dispense the Rhogam.

:D:D:D

[LCoronado]

I do not work for TENET, but do use Cerner Millennium. The orders we currently use with Millennium are similar to your Sunquest orders. For outpatients, we included some required "prompt" questions" in the Care Set in order to be sure that the appropriate information gets to the Blood Bank tech who needs to determine whether or not a Fetal Screen is required and also who would like no surprises such as a positive antibody screen for a patient who recently received RhIG elsewhere. We started a discussion on how to involve Pharmacy in our process (see "Rhophylac vs. RhoGam") and ended up with a much broader discussion including what kind of orders we should accept, who is responsible for the background information on the patient, and who will administer the dose. Right now when an Outpatient arrives, it becomes a game of "hot potato": no one really wants the responsibility. Our docs do not administer RhIG in their offices. Years ago we used to issue the dose to the patient who would take it to the office but the docs did not confirm to us that the patient was ever injected, and we felt there was room for mishandling the dose (ex. was it kept refrigerated until used?).