Physician order entry a complete mess. Need help.

[Kathy]

I understand the point of physician order entry...so that the orders don't get misinterpreted. We are having a huge problem with our blood bank specimen orders with the type and screen (in SoftBank) getting filled up very quickly and then the system will put any new red cell order on a new order without a type and screen, which is a big problem since we have to keep cancelling the physician's orders and assigning the blood to the type and screen order. I am thinking that maybe it is not such a great idea to have the physician's orders for red cells going directly to SoftBank. It would be much easier the doctors to order the red cells as a dummy test or message that we use to add the products to the correct order (the one with the type and screen). Is this okay to do? I don't see any other way around this mess.

[David Saikin]

WE have the docs order products only and we order whatever we need to in order to complete the order (otherwise they'd order a TS with every order for blood). Ou product orders are: RBC 1U, RBC 2U, etc; same for plasma, cryo, albumin and plts.

[Kathy]

We are a pediatric hospital, so the whole unit ordering is only a small portion of orders. Usually they are ordering by small volumes and each order they put in by volume, regardless of the volume, translates in SoftBank to 1 unit of blood. I do think it is interesting how you order the type and screen. If the docs don't order the type and screen, we call them and tell them to order it. It would be easier for us to order everything ourselves based on a written order, but I think that is what everyone is trying to get away from with physician ordering.

[David Saikin]

The docs don't know what it takes to provide blood products - they just think they do.

[bmarotto]

We have red cell orders print a requisition in Blood Bank. We then have control over where to place the order in Softbank. Sometimes there is a red cell order on a patient that already has blood available, e.g. left over from a surgical procedure or massive transfusion episode the previous day. They don't bother to check to see if blood is available before they place antoher order.

[sgoertzen]

We are a pediatric hospital, so the whole unit ordering is only a small portion of orders. Usually they are ordering by small volumes and each order they put in by volume, regardless of the volume, translates in SoftBank to 1 unit of blood. I do think it is interesting how you order the type and screen. If the docs don't order the type and screen, we call them and tell them to order it. It would be easier for us to order everything ourselves based on a written order, but I think that is what everyone is trying to get away from with physician ordering.

We are also a pediatric hospital and we do not allow anyone to order any products from CPOE - they can only place a request for products, which is basically a series of questions they answer so that we (the blood bankers) can edit/add the correct tests and products to the CPOE requisition to fill their request. We have an RBC Request, PLT Request, FFP Request, and CRYO Request. I also have a Type&Cross Request (just because that is the terminology so many doctors are familiar with using) but it is actually just a duplicate name for the RBC Request.

[Mabel Adams]

We have them order blood products and the Lab computer reflexes a type and screen if one has not been ordered in the past 3 days (the timing isn't perfect, but it orders most of them and we hand-enter or disable those that don't line up right). Our NICU orders a special pediatric RBC order that includes a volume for the aliquot. It creates an order in the BBIS that is fulfilled by our crossmatching a pediatric aliquot.

[tbostock]

We have our blood product orders being placed by physicians in Epic coming directly into SoftBank. And yes, we also have a lot of duplicates, because physicians didn't check to see that the units are ready. But with CPOE, we want physicians to order everything possible in the computer. So it's a continuous education process here. We're trying to work with Epic to build logic for these duplicates, or at least show some type of "transfusion report" every time a doc orders blood, so he can see a patient's transfusions: how many transfused, how many ready now, etc.

[Mabel Adams]

I hadn't thought of trying to build a lab test that somehow gets answered automatically whenever a unit changes status. Hmm. Need to think if that is possible. It is hard to expect them to look to see if blood is available when they have to click on 10 different crossmatch orders and add up which units are still in available status. We need to nag the computer companies to make a dashboard for transfusion information that shows current specimen and how long it is good, maybe whether it has been tested yet, what antibodies are known, what units are already available, whether irradiation has been indicated, maybe what has been transfused this admission and when. If we all nag them repeatedly at all levels, LIS, BBIS, HIS, maybe we can get some traction some day. Still can't guarantee docs would look or know what to do with the info.

[Kathy]

I hadn't thought of trying to build a lab test that somehow gets answered automatically whenever a unit changes status. Hmm. Need to think if that is possible. It is hard to expect them to look to see if blood is available when they have to click on 10 different crossmatch orders and add up which units are still in available status. We need to nag the computer companies to make a dashboard for transfusion information that shows current specimen and how long it is good, maybe whether it has been tested yet, what antibodies are known, what units are already available, whether irradiation has been indicated, maybe what has been transfused this admission and when. If we all nag them repeatedly at all levels, LIS, BBIS, HIS, maybe we can get some traction some day. Still can't guarantee docs would look or know what to do with the info.

Apparently someone managed to make a computer program at Virginia Commonwealth University Medical Center for this very purpose. Unfortunately, it belongs to them and is not available for purchase. See Medical Laboratory Observer January 2012 pp. 8-11. I would love to have something like that...it would save so much time on the phone.

[bldbnkr]

We have physician order entry in MedHost for the Emergency Department, and Clinical Suites for the nursing units. They order product only, red cells, FFP, Platelet pheresis or Cryo. They also place Transfuse orders into each system. Both the product orders and the transfuse orders print in Blood Bank. The orders cross into SoftLab/SoftBank, where it searches for a current Type and Screen, or ABO/Rh or Band and Hold (less than 3 days). The orders either attach to the current blood bank order, or they trigger an order in phlebotomy for a draw. Upon collecting and receiving the draw, the Type and Screen (or ABO/Rh) will reflex on to that order. It was a struggle to get everyone on the same page but they did learn.

[PAWHITTECAR]

I only wish it worked that well here..When I took over we were getting a lot of nurses down to pick up units with an order to transfuse but no orders to a TS or units. At that time we couldn't even see the "transfuse" order so it was like "surprise we need blood". So I worked with IT and now have it set up so when they put the transfuse order in we see it in BB. Great!! not so..now they just order the product and there is no transfuse order documented...I think I might be bald before I get this sorted out.