Surgery Schedules

[Annadele]

Hi All!

We also use OR schedules. Second shift is responsible for printing them and for filling the orders. It seems as though about half have a TS drawn during an outpatient appointment prior to surgery while others don't have one drawn until they come to the hospital that day. We have so many surgeries scheduled during the week that I can't imagine filling those orders as they come in! I'm not sure how long we keep them but I know that it's longer than a day - my guess would be about a week.

Annadele

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.

[LynK]

I am currently dealing with OR issues similar to what you're posting. By the end of this year, my little rural hospital will be bringing in cardiac surgeries. Can someone out there help me determine how this will affect my blood products inventory? I'm assuming one CABG can a minimum of 4-6 prbc, maybe more?

[Mabel Adams]

LynK, it depends entirely on your surgeons. We have some heart cases that use no blood. I assume you will use blood salvage machines? Maybe you could arrange a meeting with the new heart surgeons to find out what they usually need and to make sure they know that you don't have all of the resources they might be used to at their big teaching hospital--like 4 units of type-specific apheresis plts just for their patients.

[AMcCord]

They'll probably demand a fair number of platelets on hand. One of our neighbors keeps 5-6 single donor apheresis platelets on hand at all times to keep them happy.

[dgibaud]

Lynk

We started a heart program about 2 years ago. We have one surgeon who does 90% of the cases (1-2 per day). He likes 2 units red cells in the OR, 2 units on-hold in the bank. He doesn't normally ask for platelets, but when he does we can usually get them sent with our routine courier within 2 hours. They normally don't need the platelets until they're nearing the later stages of the procedure, so this works well. About 1 or 2 cases a month turn bad and use more blood and platelets. I haven't had to change my inventory, but they DO want fresher blood for these patients.

[RL0121]

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"!!!!!!!!!!!!!!!

We have a case last week, OR called requesting for units but told BB they cant verify the Blood Bank armband number becauses the patient was tucked in and cant be reposititioned (spine surgery). I was pulling my hair because I have to issue emergency O neg units (PT is B+, no antibody). OR surgeon signed the waiver without a fight. I was told that there are hospitals practice this system: OR nurse verifies the blood band number with anesthesia or another nurse. Then the OR the nurse writes the blood band number on their white board and verifies this with anesthesia prior to patient going to sleep and of course prior to positioning. That way everybody has seen the blood band and has documented so once the patient is positioned there is no need to “search” for the band. Staff also know that once you cut the band off you have to retype and cross match. I'm curious to know whether this practice is aceptable. I am not sure this practice will pass AABB, our BB accreditation policy, because there is a real flaw with this practice. If someone does not erase this number and you don’t empty the blood out of the OR BB refrigerator, you have the potential to give the wrong blood to next patient in that room. Any ideas?

[JOANBALONE]

Get rid of the Blood Bank armband policy or have a policy in which the armband may be removed and reattached later. Some armband manufacturers have bands for reattachment.

JB

[LynK]

Thanks for your helpful responses! I will consider these when conversations with the surgeons start.

[RL0121]

We have a case last week, OR called requesting for units but told BB they cant verify the Blood Bank armband number because the patient was tucked in and cant be repositioned (spine surgery). I was pulling my hair because I have to issue emergency O neg units (PT is B+, no antibody). OR surgeon signed the waiver without a fight. I was told there are hospitals who practice this system: "OR nurse verifies the blood band number with anesthesia or another nurse, then the OR the nurse writes the blood band number on their white board and verifies this with anesthesia prior to patient going to sleep and of course prior to positioning. That way everybody has seen the blood band and has documented so once the patient is positioned there is no need to “search” for the band. Staff also know that once you cut the band off you have to retype and cross match. I'm curious to know whether this practice is acceptable. I am not sure this practice will pass AABB, our BB accreditation policy, because there is a real flaw with this practice. If someone does not erase this number and you don’t empty the blood out of the OR BB refrigerator, you have the potential to give the wrong blood to next patient in that room. Any ideas?

Sorry for the type o's from my previous post. I was posting on my break yesterday morning and typing on the phone is such a difficult task :-(

In addition to my post, if OR can verify hospital band but not the blood bank number, can they use the patient chart to verify the Blood bank number instead? Normally, after a BB sample is collected, they attached the BB armband sticker to the patient chart?

[Auntie-D]

We have a case last week, OR called requesting for units but told BB they cant verify the Blood Bank armband number becauses the patient was tucked in and cant be reposititioned (spine surgery). I was pulling my hair because I have to issue emergency O neg units (PT is B+, no antibody). OR surgeon signed the waiver without a fight. I was told that there are hospitals practice this system: OR nurse verifies the blood band number with anesthesia or another nurse. Then the OR the nurse writes the blood band number on their white board and verifies this with anesthesia prior to patient going to sleep and of course prior to positioning. That way everybody has seen the blood band and has documented so once the patient is positioned there is no need to “search” for the band. Staff also know that once you cut the band off you have to retype and cross match. I'm curious to know whether this practice is aceptable. I am not sure this practice will pass AABB, our BB accreditation policy, because there is a real flaw with this practice. If someone does not erase this number and you don’t empty the blood out of the OR BB refrigerator, you have the potential to give the wrong blood to next patient in that room. Any ideas?

No this isn't acceptable - they can check all the details on the white board and still go off and transfuse the blood into another patient. This is why it is imperative that patient checks are done verbally with the patient whereever possible, and by wristband when the patient is unconcious, confused etc.

I assume that the spinal patient was unconcious?

[Mabel Adams]

A tight policy of transferring ID of patients under the drapes in OR can be created so that the right patient gets put into the right OR, ID is transferred from their wristband to the chart or other paperwork using a positive ID check. During their time in that OR the ID paperwork is used instead of the wristband. We have a paper form for this. I would worry more about a white board not being erased than a paper that could go out with the patient but it depends on your system. If we think that our surgery people are routinely crawling under the drapes to check ID we are sadly misinformed, I fear--they just aren't telling us and may not have any system for checking ID. Again, many systems can work as long as everyone agrees that it is important and is trained and compliant.

[Auntie-D]

A tight policy of transferring ID of patients under the drapes in OR can be created so that the right patient gets put into the right OR, ID is transferred from their wristband to the chart or other paperwork using a positive ID check.

The ID MUST be attached to the patient! Any paperwork that is mobile from the patient's bedside runs the risk of being used for a different patient. The only guarantee is a wristband or the patients own mouth (if they are capable).

It is also not unheard of for confused patients to get into the wrong bed...

[JOANBALONE]

I agree with Mabel

JB

[Mabel Adams]

Actually, this is where RFID chips for ID bracelets would be great. The readers can scan through the drapes and you have positive ID at all times. Until then, you have to have a system that is possible and your OR staff will do or else you have no system at all except on paper.