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For those in a hospital transfusion service...

Do you accept verbal orders for blood products?  I'm particularly interested in urgent/uncrossed blood. Are your blood bank staff permitted to place the order in the hospital/lab order system?

Thanks!

Carrie

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For Mass Transfusion and Emergency Release - Yes, we accept verbal orders for products for immediate transfusion and blood bank staff will place orders for what we need to carry through with the product requested. Once the dire emergency phase is past, nursing staff is asked to take care of the additional orders. My medical director and I feel that our #1 priority is to focus on what is best for the patient, not the paperwork.

If the request is STAT but less urgent than a MTP or emergency release, we ask the person who called to take care of the order. We will start doing what is necessary to get product ready for release, but release comes after we receive an order.

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We also allow for verbal orders in exceptional cases (i.e. massive transfusion, patient bleeding in the OR).  We document the call on the Verbal Order Log Sheet - includes the physician requesting, hospital number of patient, first/last name of patient, person phoning, type/number of products.  it also includes a check box for the MLT to document the issue checks before either handing off a crate of blood components or shooting the component off in the pneumatic tube system.

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Simular to AMcCord, above, except that once something like a massive transfusion protocol starts, we follow a documented P&P to get further units ready until the MTP is called off.  We do the ordering during that time ourselves.

Scott

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Our Massive Transfusion Protocol states that blood bank/lab staff will place orders for subsequent products needed.  Other than that, we have a "Written verification of Verbal Order" sheet that we complete and send to the patient location for the physician to sign.  This is used in those circumstances where the nurses are too busy to order so blood bank puts in the orders.  For Emergency Issue products, we have the physician sign a release for the use of the emergency products.

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On 8/11/2017 at 10:38 AM, SMILLER said:

Simular to AMcCord, above, except that once something like a massive transfusion protocol starts, we follow a documented P&P to get further units ready until the MTP is called off.  We do the ordering during that time ourselves.

Scott

Yes, we also have an 'automatic' release of additional products. Nobody at patient bedside has to worry about what is available - we take care of that accordingly to the MTP protocol.

Edited by AMcCord

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On 8/11/2017 at 11:38 AM, TreeMoss said:

Our Massive Transfusion Protocol states that blood bank/lab staff will place orders for subsequent products needed.  Other than that, we have a "Written verification of Verbal Order" sheet that we complete and send to the patient location for the physician to sign.  This is used in those circumstances where the nurses are too busy to order so blood bank puts in the orders.  For Emergency Issue products, we have the physician sign a release for the use of the emergency products.

I like the idea of your verbal order verification.

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Thanks for your responses!  We have a similar process for MTP.  Patient care staff place an initial order set (they have to order as medications are included), and BB issues product per the prescribed ratio until the event is over.  We have this routine down.  It's the occasional orders for two uncrossed that nurses are having a tougher time getting in the system.  I like the idea of the verbal order log.  It would make retrospective review easy!

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On ‎8‎/‎13‎/‎2017 at 7:45 AM, AMcCord said:

I like the idea of your verbal order verification.

Our Lab has a 'Documentation of Verbal Orders' - policy and form (available as Log Books), which the blood bank techs follow as needed.  Like most labs we strongly encourage transfusion orders to be placed by the provider, nurse or trained patient services personnel, but we will accept and order as necessary.

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We are able in the blood bank to receive verbal orders and to place them into our LIS system which is Meditech.  We realized this could cause issues so there is a field in Meditech when you place an order that defines whether the order is written or verbal.  Up until this time it was set to default as Written.    We requested a change from our IT department and now we have the option of selecting Verbal with the default setting of Written.   When we select Verbal the ordering physician is electronically prompted to sign orders.

  It worked much the same way verbal physician orders to the nursing units worked at our institution.  It seems to be working well.

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39 minutes ago, BB1956 said:

We requested a change from our IT department and now we have the option of selecting Verbal with the default setting of Written.   When we select Verbal the ordering physician is electronically prompted to sign orders.

Do you place the order under LAB under "enter requisitions" or under "Order Entry"?

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One of our issues is that our patients are not always in our blood bank system if nothing has been ordered during this stay.  To issue to that person would require the blood bank to place an order in the HIS (Epic).  We keep a "dummy" patient in the BB system so that we can issue to traumas that aren't registered yet, but that's not a great option when we know a name/MRN.  All of your replies are helping me work through a plan, though.  Thank you 😊 

Edited by Carrie Easley

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Our hospital IT people created a "uncrossed-emergency-MTP" order (actually just a notice) that can be entered into the hospital system that sends the patient's registration to the BB system.  That way, we can order whatever on our BB system when a MTP is started.  The "order" also serves to document a physician's order for using uncross-matched blood.

Scott

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We will take a Verbal Order (on an official Verbal Order Form which we keep) for the initial order for Emergent Release (4 uncrossmatched RBCs) or Massive Protocol.  Since both of those require a written document of acceptance from a Physician, we attach the Verbal Order Form to that.  After the initial order, we do ask that subsequent orders be requested with our official Blood Request form (as well as orders in the computer; but we can work off of an initial order in the computer for a LOT of products so we allow them to complete computer entries when time permits).  Our reasoning is that after the initial order, we may be processing a number of different products on the patient.  We want to send the "correct product" at the "correct time."  I do not feel comfortable just sending blood based on a phone call (especially with OR as they can end up with "too many cooks in the kitchen" sometimes).  If they are in a real hurry, we try to compromise (i.e. we will send up the blood product if you turn around and send the Request Form right back; or vice versa; we won't cause a delay over it).  We tend to work better together as long as they see we are not trying to hold up their products, and we are willing to work "with them."  This is our "policy," but when things get hectic, clearer minds do not always prevail so then we make sure they get what they need and I can follow-up on any issues once things calm down (and we can always document further on verbal order forms; but what we get from the Request Form is that we send the correct product, at the time when they are actually ready for it).

That is just our Policy....

Brenda Hutson, MT(ASCP)SBB

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