Surgery Schedules

[SRTECH]

Does any one else do this?

About a year ago we began asking our Operating rooms to send us their surgery schedule the night before surgery. Our third shift staff will then check the schedule and compare it with orders in our computer system(dispatched, collected). If anything looks amiss, they will contact the floor(for inpatients) and preop(outpatient) to rectify the issue. Also one of our a Blood Bank Staff attends a 6.30am meeting to compare what products the Blood Bank has ready for each patient. They various doctors will then notify us of any changes then. Since it"s inception, we"ve had fewer isuues with the ORs, even if it's additional work for our BB staff.

Is any or everybody else doing this? How long do you keep the surgery schedules? Please share your method of keeping surgery HAPPY .

Thanks

[Deny Morlino]

We too receive a schedule from surgery for the next day. A comparison is made with the list generated by our PAT (presurgical) orders to see if any names expected are missing from the schedule or if any are present for surgeries "expected" to use blood that blood bank is not prepared to handle. If any of the above occurs, a call is made to surgical scheduling to make sure blood bank and surgery are on the same page. If a patient is due for surgery the next day blood bank is not prepared for, phlebotomy is flagged to expect the patient in the AM and to draw and band the patient appropriately for blood bank. The above keep the phlebotomists out of the surgery theaters 99% of the time, and allow us to provide better service to the patients having surgery.

[SRTECH]

Thanks for your response Deny!

Do you keep your surgery schedule for a specified period of time, in case there are issues later?

[Deny Morlino]

Sorry I forgot that part of the post. I keep the schedule until the next calendar day. Any issues seem to materialize rapidly from surgery here. I have not had a need for the schedules past this point.

[SRTECH]

Thanks

[Auntie-D]

We get a surgery schedule a week in advance then daily to allow us to maintain our stocks at a good level cuts down wastage brilliantly!

[jill]

We type out an internal surgery schedule on day shift for the next day surgeries. At this time, previous transfusions, available

autodonors, antigen negative units needed, and samples are ready and frozen(we freeze up to 30 days prior) are all verified.

The second shift gets the revised schedule and goes over the schedule made out on 1st shift to make any revised changes.

2nd shift faxes over to PSS the patients who still need a sample to be drawn.

I believe the last 3-4 months of surgery schedules are kept on file (not sure exactly).

freezing PAT samples up to 30 days prior does allow problems. Sometimes samples are frozen in wrong date, poured off from

the EDTA tube incorrectly, or do not get poured off at all. Some facilities allow refridgerator temp samples up to 21 days long.

So I was curious as to how many facilities separate the plasma from PAT samples and freeze them for the future OR date.

[JOANBALONE]

Surgery department is responsible for ordering pretransfusion testing/blood and they don't forget to do it. I have not seen a surgery schedule in decades.

[Steven Jeff]

I am with Joanbalone on this, it is not my job to babysit the surgical or medical departments, they have a responsibility to the patients in their care. They have their own checks to make prior to any surgical procedure which includes checking on blood component availability.

Steve

[Auntie-D]

I am with Joanbalone on this, it is not my job to babysit the surgical or medical departments, they have a responsibility to the patients in their care. They have their own checks to make prior to any surgical procedure which includes checking on blood component availability.

Steve

And how do you make sure that you have enough stock to cover the ops? Guesswork? Stocks can be kept much lower if a surgery schedule is known in advance

[Likewine99]

I agree with Joanbalone, that it is not our job to babysit the surgery dept (or the surgeon!) but we do receive a schedule in the BB and it's reviewed mostly for BB staff piece of mind and to make sure we have enough plts on hand.

Deny has a good point, keeping the surgery schedule for more than one calendar day probably isn't necessary since once the surgery date has passed it becomes a moot point, even if the BB ends up bailing out the OR for something that was missed.

Our organization doesn't want the surgery schedule floating around any more than it needs to to comply with HIPAA laws. After one day ours goes into the confidential recycle bin. A Risk Mgt professional told me one time, after we had something that was missed by the nsg staff at handoff, that the "surgeon has ultimate responsibility" for making sure everything is ready prior to starting a case. We just need to keep in mind what is best for the patient.

[Steven Jeff]

Submitted in duplicate for some reason!!!!!!!

Edited February 19, 2012 by Steven Jeff

[Steven Jeff]

And how do you make sure that you have enough stock to cover the ops? Guesswork? Stocks can be kept much lower if a surgery schedule is known in advance

We record our stocks on a daily basis,usually in the morning. Later in the afternoon we place our orders for blood components to be delivered by routine delivery the following day. We have what we call our minimum and maximun stock levels and we aim to keep them at those levels.

In summary we have daily routine deliveries with the exception of Saturdays. We also have the option of extra ad-hoc deliveries (cost extra) should stocks get too low or we have special requests. Finally, we have the option of emergency 'Blue light' deliveries which are to be used in an emergency only, and the requesting clinician has to give their approval/authorisation before we make these requests. We do not have a wastage problem. I wouldn't call it guesswork, more experienced judgement on what is a reasonable stock level.

Steve

:)

Edited February 19, 2012 by Steven Jeff
spelling

[Auntie-D]

We record our stocks on a daily basis,usually in the morning. Later in the afternoon we place our orders for blood components to be delivered by routine delivery the following day. We have what we call our minimum and maximun stock levels and we aim to keep them at those levels.

In summary we have daily routine deliveries with the exception of Saturdays. We also have the option of extra ad-hoc deliveries (cost extra) should stocks get too low or we have special requests. Finally, we have the option of emergency 'Blue light' deliveries which are to be used in an emergency only, and the requesting clinician has to give their approval/authorisation before we make these requests. We do not have a wastage problem. I wouldn't call it guesswork, more experienced judgement on what is a reasonable stock level.

Steve

:)

We found, with having the surgery schedules, we were able to reduce our maximum stock levels, and to a degree, the minimum too, and still be comfortable in having sufficient provisions. As a result we found our wastage due to expiry was reduced and it also meant that we were able to 'free up' units to the general populus If every large hospital was able to reduce their maximum stock (confidently) by 10 or 20 units then it could help with the shortage problem... We have managed it and we are a tiny remote and rural 3 hours from our nearst blood center.

[Eoin]

Our Hospital Information System generates op lists of planned surgery in advance (usually a week). They are pulled off by the Phlebotomy Department the day before and any not already collected are chased down by them. They know admission times for any late ins (including medicals by the way) and can chase them as well. I know the idea of not holding surgery depts hands all the time, but we find planned work-flow a whole heap better than lots of late urgent surprises. Works really well for us.

Cheers

Eoin

[Eoin]

We type out an internal surgery schedule on day shift for the next day surgeries. At this time, previous transfusions, available

autodonors, antigen negative units needed, and samples are ready and frozen(we freeze up to 30 days prior) are all verified.

The second shift gets the revised schedule and goes over the schedule made out on 1st shift to make any revised changes.

2nd shift faxes over to PSS the patients who still need a sample to be drawn.

I believe the last 3-4 months of surgery schedules are kept on file (not sure exactly).

freezing PAT samples up to 30 days prior does allow problems. Sometimes samples are frozen in wrong date, poured off from

the EDTA tube incorrectly, or do not get poured off at all. Some facilities allow refridgerator temp samples up to 21 days long.

So I was curious as to how many facilities separate the plasma from PAT samples and freeze them for the future OR date.

Hi Jill,

We separate the plasmas (labelled and barcoded) at testing time for Group, Screen and holds. We can then pull and crossmatch when required (usual provisos of no antibodies, no pregnancy or transfusion in preceding three months). We will hold frozen (-30oC) for 30 days.

Cheers

Eoin :cool:

[AMcCord]

I don't see a surgery schedule - it has been determined that I 'do not have a need to know'. We do most of our surgical cases about 40 minutes before they are scheduled to roll into the OR. We do have a policy for preadmission testing which is seldom utilized. Makes life a little exciting at times - especially when an antibody turns up. Do I like being in the dark?...No, not really, but that's the way it is, so we do the best we can. The vast majority of the time, it is not a major problem. Surgicals are a small percentage of the patients that actually use blood, so they really don't affect our stock decisions much.

[Malcolm Needs ☆]

I don't see a surgery schedule - it has been determined that I 'do not have a need to know'.

Utter stupidity. They'll learn one day, when they get their fingers burned - but they'll blame everyone else!

[Liz0316]

We get a surgery schedule for the next day about 1 pm each day. The schedule is checked by the techs to be sure the PAT specimens are in the rack, and within the 21 day window. It also allows us to check for surgeries that we believe may take units (we do a lot of orthopedic and long back surgeries). While this may seem like enabling the surgeons, we are nearly 2 hours from our supplier and like to be prepared. We discard the OR schedules about once a month, this way we can look back and see if there is a PAT sample on hand when the inevidable call comes in the morning (without looking in the computer).

Liz

[SRTECH]

Thanks everyone for your responses. Unfortunately, using the surgery schedule is a must for us. Hospital Admin mandated that we use them. Prior to that we had sooooooo many issues with surgery because they either:

1. Forget to order blood/blood products

2. Put in the wrong order

3. The other placed had the wrong attributes

4. Put in the orders,(dispatch status) but forgot to send a specimen. etc..etc...

The surgery schedule has greatly reduced friction between the OR and BB. It's feels so good not to have anaestheologist screaming at us that we " are killing their patients"!!!!!!!!!!!!!!!

[Mabel Adams]

Those a.m. admit pre-op crossmatches could be a thing of the past if the Joint Commission proposed blood management standards ever go into force. They require tracking what percentage of ortho, gyn and cardiovascular pre-op Type and Screens & xms are complete before start of anesthesia. Is see the question is in the blood utilization survey that AABB just sent out too.

[Malcolm Needs ☆]

It's feels so good not to have anaestheologist screaming at us that we " are killing their patients"!!!!!!!!!!!!!!!

That is just bullying, because they know that they screwed up their end. Be as strong as you can and point this out to them, and ignore the unjustified (and unjustifiable) comments. I know it's difficult, but it works (I used to work in a hospital before I went into Reference work).

[Steven Jeff]

Malcolm is entirely correct, I will do my best for the benefit of the patient, but would not hesitate to let a clinician know that they may be at fault. Fortunately I believe that in the UK we are well respected in Blood transfusion and accepted that we are expert in our field, we expect compliance with our standards (as required by the MHRA) in order to provide a safe blood transfusion service.

Steve

:)

[bmarotto]

We get two surgery schedules a day....a preliminary one for the next day around 10-11 am and a final one mid-afternoon (although nothing is ever really "final"!). The blood orders are on it from the MSBOS. It does help us manage our inventory and is especially helpful when there is a patient with antibodies on the schedule. We antigen type and have units ready for crossmatch in advance. For patients with multiple antibodies, we can preselect a selected cell panel to expedite things. This little bit of work the day before greatly reduces stress the day of surgery. The OR is responsible for placing the order in the computer and sending us the sample; we do not babysit them and remind them if a sample is not sent. Schedules change and procedures get canceled.

[AMcCord]

Those a.m. admit pre-op crossmatches could be a thing of the past if the Joint Commission proposed blood management standards ever go into force. They require tracking what percentage of ortho, gyn and cardiovascular pre-op Type and Screens & xms are complete before start of anesthesia. Is see the question is in the blood utilization survey that AABB just sent out too.

This is what I'm hoping for ... it's going to be a rude awakening for some folks if/when it happens.