Confirming order before issue

[ChrisW]

For those of you in busy transfusion services, how do you confirm the blood product order that you recevied in you LIS with the product that you are setting up or issuing? Our computer systems do not link the patient's chart order to our product issue so I am looking for a best practice manual process  to do this.

Thanks for any ideas!

Chris

[tbostock]

We have the blood product order in the HIS print in the Blood Bank as soon as the nurse acknowledges the order in the system. So if it is an order for 1 unit of red cells, we keep the order with that crossmatched unit. When the request form comes, we issue the unit, then staple that request form to that order and file it because it is complete. That way if another nurse sends down another request later, there won't be any units in the refrigerator with an order attached, so we will know not to issue it.

[David Saikin]

Our nurses bring a copy of our blood component request form with each pick up.  We keep these on file and they are also used by the Medical Director in evaluating appropriateness of transfusions.

[Dansket]

_{If an RN submits a properly completed Request for Blood Component form in person to Blood Bank and that blood component is available for issue, we release it after completing a computer transaction and retain the form.  What other steps does your facility require for confirmation?}

[cthherbal ☆]

We do same as Terri

[cthherbal ☆]

I should also add that if we set up units "in case" (ex. Patient has antibodies), we'd put little tags on the unit that say "Do Not Issue, Physician order needed"

[MAGNUM]

when we make a product ready for transfusion, we print what we call a pickup slip that the nurses bring back to the lab, plus we require them to bring either a copy of the order or the original order. We review the order, and initial the chart that we have reviewed the order. This goes back into the chart and becomes a permanent part of the file. We also require them to bring the order each time.

[SMILLER]

Simular to David, above.

Scott

[BB1956]

At our facility the nurse who transfuses has the responsibility of checking the physician order on the chart.  They present a requisition for the unit of blood to the blood bank however prior to coming to check out the unit the RN is responsible for checking for the physician's order.  The Blood Bank issues units to ED, OR etc which may never be transfused, so it makes sense to place the responsibility with the parties actually performing the task. 

[DOGLOVER]

Similar to above. The nurse (or courier) has to bring an issue slip with the product checked off. If we have the product reserved or crossmatched we issue it. It is up to the transfusionist to check the orders to make sure there is a "transfuse blood component" order. The issue slip must be signed by a nurse or physician extender or we won't accept it.

[Eagle Eye]

Same here .

Blood bank is not responsible to make sure that

Order is written in the chart

We need a request either verbal or on the specimen

Request form with number, type of product requested,

Physician name, indication

We document same for phone order.

But we do not take responsibility for documentation

In chart.

[bbbirder]

Ditto to the last 3 responses.  The nurses performing the transfusion are responsible for verifying the physician order.

 

Linda

[Brenda K Hutson]

Ah, this is along the lines of my recently posted Thread under Hot Topics....who should be responsible to ensure there is an "Order to Transfuse."  My predecessor here set it up so that the Transfusion Order printed out in the Blood Bank.  That had been a thorn in my side in my 2 years here; as I had never done it anywhere else and do not feel it is the responsibility of the Transfusion Service to confirm the Order to Transfuse.  In fact, the Standards and Technical Manual clearly reference this to the Transfusionist.  But as with other things (as I have learned through the years), the more you are willing to do for Nursing....the more they will let you do.  I had already told the Director of Nursing that I was going to discontinue this printout as soon as I got a chance (we just moved into a new Hospital).  That was ok with her until a Nurse transfused a couple of weeks ago, without a written Order from Physician (she said he told her verbally; and he later put the order in).  So Nursing wanted to know why the "Transfusion Service Issued blood when there was no Order to Transfuse?!"  Of course they did.....we had taken on some of the owness of their responsibility; so now they could blame us!  This has made my battle more difficult but I think it is one I have finally won.  The compromise (to assist Nursing to remember what is in their Policy and is their responsibility) is:

1.  An added space on the pick-up Form where the Nurse must write the Name of the Physician Ordering the Transfusion, and must Sign her/his Name to attest that they checked the Order

2.  Added wording on the Blood Chart Copy where there was already a space for the 2 Nurses identifying the patient to sign; also stating that they checked that there is an Order to Transfuse.

 

Brenda Hutson, CLS(ASCP)SBB

[bbbirder]

Like Brenda, our nurses must signe off that there is an order.  This is the responsibilty of both nurses doing the bedside ID checks.

 

Linda

[kirkaw]

Please pardon my confusion with terminology for 'issue order' or 'blood product order'. Are these terms synonymous with orders to transfuse?

No place I have ever worked puts the onus on the transfusion service to verify orders to transfuse. At my current facility, the providers use a physician order entry system (CPOE) to place orders for crossmatch and transfusion. The order to transfuse is a nursing 'sequence' so we, in the transfusion service, do not see that order.

It is the responsibility of the nurse to ensure that both the consent and order to transfuse are present before she/he hangs the blood. We comply with all orders for crossmatch. We do not require any additional documentation from the person picking up blood except the 2 patient identifiers (name, DOB and a unique blood band number).

I just want to make sure that I am not overlooking a Joint Commission or AABB requirement. Thanks.

[tbostock]

No regulation that I am aware of, but in the event of an error, the Blood Bank will be involved and scrutinized.  It's why we verify orders here.  Nurses will request a second unit when only one ordered, and now we catch it.  Yup, not our job, but here we are...

[Mabel Adams]

We also use CPOE with separate Nursing and Lab orders to transfuse or set up products respectively.  Our transfusion record has a spot that nurses sign off that they have checked the order--not just that there is an order but that they are giving autologous or irradiated as ordered.