Physician's Transfusion Order Form

[jlmoses]

Can anyone tell me if the blood bank needs to receive a written order form for a transfusion? We do not receive anything other than the computer order for Type & Screen, crossmatchx2.

We do not know whether or not the patient has been screened for past hx of transfusion, has been pregnant, all the things you would want to know. Is there a regulation that can get me answers?

Thank you, JL

[tbostock]

Can anyone tell me if the blood bank needs to receive a written order form for a transfusion? We do not receive anything other than the computer order for Type & Screen, crossmatchx2.

We do not know whether or not the patient has been screened for past hx of transfusion, has been pregnant, all the things you would want to know. Is there a regulation that can get me answers?

Thank you, JL

Is the physician order placed directly into your EMR?

[jlmoses]

Yes, but only the request. We do not receive a diagnosis or have any proof that the appropriate screening questions have been asked. I am trying to have questions pertinent to transfusion added to the nursing review of the patient history upon admission.

[L106]

No, the Transfusion Service does not need to receive a written order from the physician to transfuse.  If the doc writes the order in the patient's chart or places the order directly into your EMR, that is adequate.

 

Yes, it is nice to know all that information about the patient (diagnosis, transfusion history, etc), and you can develop a set of requirements and review to be implemented at your facility, but I do not believe that there are any regulations that require that the Blood Bank has access to this information prior to issuing blood for transfusion.

 

 

Donna

[Abdulhameed Al-Attas]

Ditto, Donna

[Dr. Pepper]

You could try working with your LIS people. There are a few options that may work with your LIS: pulling those data automatically if already in the LIS, or having a few mandatory questions (hx of transfusion or pregnancy, diagnosis etc) pop up at order time that the MD or nurse has to complete. Some places include a reason for transfusion to kick off appropriateness review

[jlmoses]

Thank you. Jonilynn

[Karrieb61]

We require a Transfusion Order form which is filled out by the nursing staff based on the official written order in the patient's chart. The form requires the reason for transfusion including lab values for H/H, plt count, fibrinogen, etc to check off or fill in on the form where our transfusion criteria is noted. Usually this means that they put the diagnosis but not always. So basically its our way of monitoring if the Hospital's criteria for transfusion is followed. We don't give out products until we get this Order form.

[pbaker]

Does the nursing staff actually have correct data to put on the order form?  We also have a form, as well as CPOE, but the doctor still write "transfuse 2 units today".  Then the RN or unit secretary fills out the form and guesses as to the indication for tranfusion.  We have been fighting this battle for at least a year.  The blood bank gets iffy data and the nurses don't like having to guess.

[tbostock]

 

Does the nursing staff actually have correct data to put on the order form?  We also have a form, as well as CPOE, but the doctor still write "transfuse 2 units today".  Then the RN or unit secretary fills out the form and guesses as to the indication for tranfusion.  We have been fighting this battle for at least a year.  The blood bank gets iffy data and the nurses don't like having to guess.

 

Can you build in CPOE in your HIS transfusion indications that the physician has to select? Nurses guessing will be a potential liability for your hospital if the patient has an adverse reaction to the units.

[Maureen]

Our Cerner CPOE orders were built with lab input, and include a 'Reason for the (component) order', each with a unique dropdown menu.  The Reason menu options come from our hospital's Blood Usage Committee's 'Usual Indications for Transfusion...' policy.

 

After implementation we received many requests for an option of 'Other', particularly from the unit clerks, because the reason was not documented on the order they were entering into the LIS, but our Medical Director refused to allow that option.  I see a decreasing number of orders entered into the LIS by non-PCP, of the 18 orders we dispensed for on Sunday 13 were entered by the PCP, 2 were entered by phlebotomists with the reason 'Pre-op', one was Emergency Release, and only 2 entered by unit clerks.

[tbostock]

 

Our Cerner CPOE orders were built with lab input, and include a 'Reason for the (component) order', each with a unique dropdown menu.  The Reason menu options come from our hospital's Blood Usage Committee's 'Usual Indications for Transfusion...' policy.

 

After implementation we received many requests for an option of 'Other', particularly from the unit clerks, because the reason was not documented on the order they were entering into the LIS, but our Medical Director refused to allow that option.  I see a decreasing number of orders entered into the LIS by non-PCP, of the 18 orders we dispensed for on Sunday 13 were entered by the PCP, 2 were entered by phlebotomists with the reason 'Pre-op', one was Emergency Release, and only 2 entered by unit clerks.

 

We also didn't allow an "other" category, which physicians were not pleased with. But we felt it would be a dumping ground. And I totally agree, Maureen, the goal with CPOE, now that physicians have access to a computer almost anywhere, is for >90% physician entry.

[AMcCord]

If 'Other' is used as a reason, that should be an automatic review by the Transfusion Committee with a followup letter asking for an explanation for the transfusions that don't pass closer inspection. After having to explain themselves a few times, I'll bet most physicians will decide 'other' is not the easy way out.

[cthherbal ☆]

We built the required questions in to the electronic order. About 50% are electronic order entry. We require sickle cell disease and transplant (history of or on list) at order entry. The order will not be placed unless these questions are answered. We also put the same questions on the consent form that the patient fills out and signs.

[EDibble]

We built the required questions in to the electronic order. About 50% are electronic order entry. We require sickle cell disease and transplant (history of or on list) at order entry. The order will not be placed unless these questions are answered. We also put the same questions on the consent form that the patient fills out and signs.

I LOVE this idea!