ER Dept ordering practices

[knelson]

Hello, everyone!

I would like to know how other Emergency Depts order blood.  Our ER Director wants the Lab to build different order codes so that they can simply click on a test code and it will communicate to the Lab what blood is needed and how emergent (instead of calling the Lab).  For example, he wants to have the following as choices:

--Type & cross for __ units RCs (non emergent)

--Type Specific for __ units RCs (Lab would perform the ABORH and issue type-specific RCs before the ABSC is completed when they can't wait for the ABSC to be done, but have enough time for the ABORH to be done) (even though we will not issue anything but type O units unless we have two ABO types on record)

--Emergency issue of __ units O Neg (or O Pos) RCs

 

Currently, the ER just calls us when they need blood urgently or emergency release.  They may or may not have already ordered a Type & Screen or Type & Cross for units. We then determine what testing has been completed / is in process and issue units accordingly.   I feel that that will still be the quickest and least confusing way to do it. 

I appreciate any input.  Thank you!

 

[jalomahe]

The ER doc has a patient bleeding profusely so he clicks a button in the computer and voila, blood will magically appear at the patient bedside. This might be fine for non-emergent cases but what about the patient that needs blood right now?

How is the blood bank notified of this order? Does it pop up on a screen somewhere? audio alert? print on paper? Wherever/however the notification occurs is there someone present 24/7 to take immediate action?

 

We are a 400+ bed hospital with a level 3 trauma ED. When blood orders are entered in the computer a copy of the order prints in the blood bank HOWEVER there is not always someone in the blood bank to see that printout, especially on off-shifts where techs cover multiple departments.

 

For that reason ANY time there is an emergent need for blood/components whether ED or inpatient, the blood bank must be notified by phone because:

1-we have an open concept lab and there is always someone in earshot of the phone and

2-it gives the tech an opportunity to ask for clarification of needs i.e. your ordering 4 uncrossmatched O- pRBCs? Do you want FFP to go with that? 

You'd be surprised how many times the call for uncrossmatched pRBCs ends up being more components when blood bank asks the questions and how many times we have been able to anticipate additional need for product or staff (pt is being moved to OR for leaking AAA) because we asked the right questions. 

 

The ONLY exception to the call rule is when there is a Trauma patient brought in by squad, then the blood bank is alerted by a text pager (audible throughout the lab) with information about the type of trauma and patient conditions as observed by medics i.e. male, mvc, +loc, gcs 10, multi fx bilat legs. In these cases we immediately prepare a trauma cooler with 2 O- pRBCs for pickup by the ED runner. Any additional blood/components require again require a phone call.

 

So in the long run, what may seem like an easy fix to the ED director may not be the best fix for patient care. If the ED director/staff has no idea of your lab layout and your processes then it might be a good time to invite them down for a visit and for everyone to go over how the process works from the time the patient arrives to the time the blood they requested gets to the patient. This is what we did when we started Trauma services and it can be eye opening for everyone.

[SMILLER]

ANY STAT BB order here MUST be called as well as ordered.  I don't know what type of computer systems you have but there are a number of things that can go wrong with ours, including our BB system being down, the printer with the orders in BB not working, or the interface between the ordering system and BB being down. 

 

In addition to what JALOMAHE points out above, there are just too many scenarios where an electronic order may not arrive in the BB in emergent situations to rely totally on it being the only way BB knows about an order.

 

Scott

[tbostock]

We have the ER follow up with an order in the computer for documentation, but the phone call is what activates emergency release. Since we are not staring at our computer screen and/or printer every minute we would miss a critical order if it was not called.

[bxcall1]

Phone first, computer to make it official!

[cthherbal ☆]

Yes we do the same as Terri and bxcall1.