Level III trauma center --help?

[Michaele]

Our 200 bed hospital (who is not part of a healthcare group, we are a stand alone hospital) has applied to be a level III trauma center.  I have some questions on how the blood bank needs to be changed to accommodate the trauma needs.  Currently, we do not keep platelets in house, and our supplier is an hour away.  That is one thing that I need to address, I know. 

 

I would like to talk to other facilities who have went through this process that are similar to our facility.  Would anyone who has went through this or have certification for a level II or III trauma be willing to talk to me? I can call your at your convenience...

 

Thanks so much!

[Brenda K Hutson]

We are likely headed in that direction; but are already taking on worse cases that come to us. So, I have already been making changes. What I have done so far:

 

2 new levels of coolers (besides what we were using to transport blood to our Cancer Center)

• 2 Blue validated coolers for 4 units of O NEG or O POS RBCs Uncrossmatched (which we keep "as ready to go as we can" w/o having patient information); which includes the chart copy with unit information; uncrossmatched stickers on units and paperwork; Form for Physician to sign accepting uncrossmatched; temperature monitors on back of units); segments pulled ahead of time and left with these units; units are in their own, uniquely colored trays in refrigerator).  I am a big proponent of color-coding things in the Blood Bank for emphasis.  
• 2 Red validated coolers for crossmatched blood for OR or ED.
• Both of these coolers also have a "very loud timer" velcroed to the lid.  The coolers are validated for 6 hours; so we set the timer for 5 1/2 hours when we send them out and that lets them know when they have 1/2 hour to get them back to us
• Need an understanding of how they will get urgent blood products (will you deliver...will they pick up....will you use pneumatic tube....etc.).  At 1 large Institution I worked at that was a Level I, they finally left the coolers and coolant blocks in the OR and they were responsible (with 25+ OR rooms); so units were sent via pneumatic tube and they placed them in cooler.  It worked there because it was a large Institution where these processes were used daily (maybe by the minute..  ).  But I would caution you at your size of Institution, regarding Policies on these Trauma patients....try to keep as much of the process, controlled by the Blood Bank as possible to eliminate errors just due to lack of frequency.

 

• We re-defined our urgent blood Order Sets; and definitions (including, redefining our Massive Protocol); Uncrossmatched protocol.
• Set up a ratio of 1:1:1 (we will give 4 RBCs, 4 FFP and 1 Platelet Apheresis for Massive)
• Of the 4 FFP "in these cases, " if no current Blood Type in computer, we will give 2 group AB and 2 group A (as per a previous topic I posted); so far so good.....
• You need to meet with Trauma Physicians, Surgeons, head of ED, etc. to work out the Policies so everyone is in agreement (for me, that included the CMO)
• Yes, you will need to keep Platelets "in-house" I would say.....
• Include in your Policy, guidelines for transfer of blood products should the patient be "shipped out" of your Hospital
• I met with ED, OR and L&D staff and did "show and tells" on the coolers; temp. monitors; Order Sets and what they could expect; timers.  Can't say we didn't receive calls the 1st time, as if they had never been inserviced.  .   but it all came back to them.  We are getting there.  

I'm sure there is more, but that is off the top of my head at the moment.....gotta run.

Brenda Hutson

p.;s. we are the same size as your Institution

[Sophie1210]

We are a level III and don't keep platelets in-house and our closest supplier is a hour away. The reason being is that we don't get many traumas and we don't transfuse many platelets. The price for platelets would be out of the lab budget and not the surgeons who wanted us to have platelets on hand. I figured out it would cost us about 18,000/yr in wasted units, so our lab director said no platelets.

 

We do have a level II trauma center 3 miles away, so that may be why we don't get that many traumas.

Edited May 23, 2014 by Sophie1210

[AMcCord]

Keeping the platelets in house may not be a necessity, but having a written plan to get them is. Your OR and ER staff need to be aware of that part of the plan (though they will forget). Your plan should state when you are going to order them, how they are going to get there and how long it's going to take. For those of us in rural areas, it's a fact of life.

[Brenda K Hutson]

We didn't used to keep platelets in-house at all times...but since we moved into a new Hospital (and even the change towards Level III), we have gotten busier (and have a very busy Cancer Center).  So we try to start out the day with 3 platelets...and get 1-2 more from one of our other local Hospitals if we use those (which is becoming more frequent).  Our Distribution Center is "hours" away....so waiting to get them when needed, would not work (though we can get them within an hour or so from another Hospital; depending on who can spare some).

Brenda