Problem: Physicians/Nursing are ordering Rhogam on post-partum patients, but does not always include the Fetal Screen. A few inexperienced techs missed to add on the Fetal screen, consequently, Rhogam was given without the FS and I see it only during my result review.

Question to my colleagues: Do you have a different way in your LIS to order Rhogam, meaning ante vs post-partum? I thought I could create a post Rhogam profile: Rhogam, FS, blood type, DAT tube(IFU recommendation). Ante Rhogam profile would only include Rhogam and TS.

Thank you in advance for your input! 

We have a Rhogam Workup test built.   They order that and it orders two tests.  The Rhogam workup (Fetal screen) and a Rhogam administration (1 dose of rhogam).

So, if it is a threatened abortion Rhogam workup and they do not need the Fetal screen, we can cancel the workup and just be left with the Rhogam administration to give a dose.

 

 

 

In our facility, Nursing orders either the Post-partum RhoGAM protocol on the mother with the Cord Blood Workup on the newborn or the Ante-partum RhoGAM protocol.  After completion of appropriate testing,  Blood Bank automatically assigns RhoGAM syringe to mother (if indicated) and notifies Nursing the mother is candidate and RhoGAM syringe is ready for injection.  This is a one step process for Nursing.

4 minutes ago, Dansket said:

In our facility, Nursing orders either the Post-partum RhoGAM protocol on the mother with the Cord Blood Workup on the newborn or the Ante-partum RhoGAM protocol.  After completion of appropriate testing,  Blood Bank automatically assigns RhoGAM syringe to mother (if indicated) and notifies Nursing the mother is candidate and RhoGAM syringe is ready for injection.  This is a one step process for Nursing.

Does Nursing look at the mother's blood type and if Negative, order one of the 2 Rhogam protocol or it is ordered no matter what?

Yes, Nursing orders the Post-partum RhoGAM protocol on mothers known to be Rh negative (according to prenatal records) as well as mothers whose Rh type is not known.  ER orders Antepartum RhoGAM protocol on females known or suspected of being pregnant.

The only option our nursing service has is RhIG if indicated.  We order the appropriate testing to determine the answer to the question.  If RhIG is indicated, then the RhIG order profile includes a fetal screen and an Rh type (or Type and Screen if one hasn't been done).  The BB techs must cancel the Fetal Screen if it is for antenatal purposes.

You may be able to run a report from your LIS that will indicate those moms who need RHIG/FMST.   You could have this report run daily and make it routine for techs to review on a daily basis.