Orders for Blood Products and the Joint Commission

[tcoyle]

Wondering how your institutions are handling getting an order from surgery for blood products? Do you require it before you issue the product? Do you just get the orders after the fact? How does your facility handle this Joint Commission patient safety goal requirement to have the order prior to administration?

We are a larger facility with many, many, many OR rooms...

Thanks for any help.

[L106]

When surgery (or anywhere in the hospital, actually) wants blood (or blood components) to be issued, they have to order the appropriate "Issue" in the computer. (ie: We have test codes set up in the computer for "Issue-RBC X 1", "Issue-RBC X 2", "Issue-Pltpheresis X 1", etc.) This accomplishes three things for us:

1. Patient ID/Safety - This is Blood Bank's proof of who they are requesting blood for.

2. It makes it clear exactly what blood product and how many units they are requesting.

3. These test codes generate the charge for the processing fee(s) for the unit(s).

Works for us.

Donna

[Liz]

Thats impressive, how do you know an order has arrived Donna? does the pc ring a bell or do you keep checking

We still have hard copies of Transfusion Requests sent to us. Then there is the Release Request that comes down with the messenger. And of course the log books. We enter our work and release in the Computer.

[hmust1]

Like L106, we require an order to be placed in the hospital computer system before any product is prepared for issue. For each order (regardless of ordering location), a hard copy prints in the blood bank (the order is visible on an electronic pending tracking screen as well). When the product is 'ready', as indicated in the electronic medical record once we result the crossmatch, the nursing unit knows to come and get the unit. For the OR, we have a refrigerator in their area, and we deliver the ordered products directly to them. The OR staff then signs blood out from their refrigerator on a log.

In the beginning we got a lot of, "It's the OR, we don't have time to put orders in the computer." But, in this electronic day and age, and when faced with delaying their patient's surgery for lack of product readiness, they're usually willing to learn/comply pretty quickly.

[L106]

Thats impressive, how do you know an order has arrived Donna?

Unfortunately, the order does not automatically print out on the label printer in Blood Bank (and, no, the pc doesn't ring a bell. That would be nice!) So whenever Surgery (or anyone) wants a unit of blood issued, they also have to call Blood Bank.

We (primarity our lab aide) deliver the blood to the nursing units and Surgery - no one comes to Blood Bank to pick up blood (alas!)

[tbostock]

OR orders blood in the HIS and we get the order in the Blood Bank. The only exception is emergency release of O Neg in an extreme emergency. They balk at using the computer sometimes, but we have an EMR now, so if the order is not in the computer, it doesn't exist.

[Liz]

Balk means to cringe away from, but I wonder if it originated from bark.

Anyhow, can you kindly give me the names of your Blood Bank softwares. I have been subjected to the demo of many at the AABB, and here by teleconference and live...

There is a plan to install a well known brand for the hospital and univeristy BUT the BB part demo was through teleconference and we couldnt make anything out, we are still negotiating.

Donna, Terri and hmust1 do you use a specific BIS? if so, which ones? if hospital wide HIS which ones? Thank you very much. Oh, and if you are not pleased with your system, mention it somehow in morse code

[tbostock]

We have SoftBank as our Blood Bank software. We LOVE it! I highly recommend it.

We have Epic as our HIS, full electronic medical record. It's a great system overall; they didn't have Blood Bank, so we had to pick a stand-alone system for Blood Bank. They do have a Lab system, but it's new and still needs a lot of work. Implementation and go-live was pretty rough, but we are getting there.

[L106]

Our Hospital system is McKesson (Care Manager, Physician Order Entry, Electronic Medical Records, etc.), our Lab system is McKesson Horizon Lab, and our Blood Bank system is HCLL (HemoCareLifeLine Transfusion Service) by Mediware (& is interfaced with the Horizon Lab system.)

[blarney]

Hi tbostock,

We have EPIC as our EMR, HCLL as our BIS and HBOC as our current LIS. We are to go live on Epic Lab (Beaker) next Oct/Nov 2012. Are you on Epic lab? and if so, what were your implementation issues, problems with the HCLL/Beaker interface???

[hmust1]

We have Meditech as both the Hospital and Laboratory (including Blood Bank) Information System. I don't have a problem with it...other than I wasn't the one to originally set it up for Blood Bank. Unfortunately, sometimes it's harder to fix problems than just deal with them.

[Liz]

Dear tbostock, thank you for the information, does the SoftBank interface with any (in-house made, or Cerner) LIS and HIS?

Dear Donna, thank you, you predicted my question of interface!

[Liz]

thank you hmust1, sound good, I shall lookd it up

[Liz]

Millie your post is going to be deleted by Cliff, for advertising here.

[tbostock]

Liz, yes, SoftBank interfaces with many other HIS systems.

[apfelblosm]

We are also a very large facility with many, many, many OR rooms. We require a manual requisition before issue, or they can order it in the computer. Our computer order print on paper in the blood bank and that is when we set up the blood. The blood waits until they bring a form with the patient's information and what they are picking up when they come to get it. Either way, an order must be in the computer before we even crossmatch the units, otherwise, they get emergency release units if they need them faster then that or they don't follow the protocol.

[Mabel Adams]

We require orders to crossmatch blood and assign other products. If they can't put it in the EMR, they can always tube us down a paper downtime order. This is what we tell them when they balk at putting them in the computer. For massive transfusions, we have a MTP order they can place once in the EMR and then let us know verbally what they need until the MTP is over. We can enter the orders in the Lab computer in this case because we have a procedure that defines this process for the MTP that has been approved by physicians. Also, there is a flowsheet they use in the ED/OR for these on which they record all of the blood units (plus other stuff) and they have the MDs sign this paper form once the case is over. This is also defined in the procedure as being the MD orders to transfuse. The flowsheet gets scanned into the EMR. Our MTP order for BB is basically keep 4 u RBC ahead and 2 units FFP ahead and hand out plts or cryo as they ask for them. There are also guidelines in the procedure that state how many units of FFP are indicated for a certain INR result. We are a level 2 trauma center and get massive transfusions about once a month on average.

I have also been known to suggest to those struggling with order entry in the OR for a patient gone bad to just order our Keep Ahead order once and we will keep up after that. Both Keep Ahead orders and MTP orders come into the Lab computer but do not order specific products in the BBIS.

[Barbarakym]

We (primarity our lab aide) deliver the blood to the nursing units and Surgery - no one comes to Blood Bank to pick up blood (alas!)

How does this work for the two people read of information at issue (to be sure correct unit is being given to nurse? This is done on the floor with all that noise? We STOPPED delivery even in emergency because of chaotic situations are NOT the best place to be doing unit/patient identification, IMO.

[Barbarakym]

We are also a very large facility with many, many, many OR rooms. We require a manual requisition before issue, or they can order it in the computer. Our computer order print on paper in the blood bank and that is when we set up the blood. The blood waits until they bring a form with the patient's information and what they are picking up when they come to get it. Either way, an order must be in the computer before we even crossmatch the units, otherwise, they get emergency release units if they need them faster then that or they don't follow the protocol.

This is what we do as well.

[JOANBALONE]

How does this work for the two people read of information at issue (to be sure correct unit is being given to nurse? This is done on the floor with all that noise? We STOPPED delivery even in emergency because of chaotic situations are NOT the best place to be doing unit/patient identification, IMO.

How do you get blood to the patient care area in an emergency?

[Barbarakym]

How do you get blood to the patient care area in an emergency?

We don't deliver blood. We are the shortest staffed department. If the 1 blood bank person leaves the dept, BB is basically closed to the rest of the hospital. Whichever dept needs blood, needs to come to BB to pick it up. In cases of expected large volume transfusions.... they request a cooler which we prepare while they are on the way to the BB. ANY nurse can pick up blood, but only licensed personel. Works well...

[ChrisH]

During day hours, our OR will Order the units in the computer system. When they want them they will come down with an issue form and we read and they readback name, ID, DOB, BB armband, blood type, unit number. If it is not dayshift when OR is short staffed, we will take a verbal order and enter that persons name along the the doctors name in the computer system.

Wondering how your institutions are handling getting an order from surgery for blood products? Do you require it before you issue the product? Do you just get the orders after the fact? How does your facility handle this Joint Commission patient safety goal requirement to have the order prior to administration?

We are a larger facility with many, many, many OR rooms...

Thanks for any help.

[SMILLER]

Our systems are simular (HCLL for BB, McKesson for Lab), except that we are in the process of converting to Sunrise for the Hospital system (orders still are generated by the legacy system)

The hospital system prints any BB order to a label printer in BB. That way, we are aware of the order even if they do not call us.

Scott

[SMILLER]

We usually require orders put in for additional products for all but OR. When OR calls to ask for units in a cooler or whatnot, we put in the orders ourselves in BB, supposing that someone in the OR has documented the order on the chart for a surgeon or anesthesiologist.

Like many trauma centers, we also have a massive transfusion protocol where we order and process blood products per a set schedule until the MTP is called off.

Scott

[Mabel Adams]

Our current EMR system will accept orders entered into the lab system, but it will not present them to the physician for sign off (like it would if a nurse entered an order into the EMR for the doctor) so we can't get a legal MD order that suits CMS if we enter it for them. They have to order something that have an over-arching order like the MTP or keep ahead orders or they have to send us paper, downtime orders which can then be scanned into the EMR and flagged for MD sign-off by medical records.