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Ordering Emerg Blood


TMGal

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How do those of you in larger acute hospitals receive orders for emergency blood? Does the ward fax a request for blood or do you allow the ward to call the blood bank for emergency units? If you allow the wards to call in their requests for emergency blood, how do you ensure that not every order becomes "stat". Does the blood bank staff ever feel overwhelmed with calls?

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the doc is going to sign for emergency release.  If it seems to be abused the Medical Director will become involved.

HIstorically I accept phone calls for emergency release, get the blood out and the paperwork is completed after the excitement dies down.  Never had an MD refuse to sign after-the-fact.

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As a part of our Emergency Release and MTPs, we provide a specific phone number for calls and further state that a single person should be designated as the 'official communicator' with Blood Bank. If we receive a lot of phone calls from multiple people, we communicate this to nursing management for problem resolution. Do we have this problem fixed? nope - but it is much improved over what it used to be. We spelled out what they can expect from us in terms of general turnaround times, what products we will deliver for MTP. Then we spelled out our expectation for them - key requirement is don't ring our phone off the wall and interfere with our ability to take care of your patient. These policies were developed with involvement from key physicians, nursing management, nursing education and the trauma committee. Better buy in that way.

If there seems to be abuse or misuse of either process, specific cases would be reviewed by Transfusion Committee, then referred to nursing management or Med Exec if necessary.

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We also allow phone orders for emergency release and get the paper signed afterwards.  The only time we insist on a signature before issuing is if we know there is a problem with the patient, known antibody and no screened units, etc.  We feel this is important enough to have the paper already signed so the doc can't say, Oh we didn't know there was a problem...  That form is called the High Risk Transfusion form.

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We have 2 O Pos and 2 O Neg units all labeled and written on Emergency Issue and Blood Cooler forms ahead of time.  Segments are also set aside for these units.  When a full trauma is paged (we have full and partial traumas in our Level II Trauma Center), we call to find out the age and gender of the patient.  We then pack up the appropriate units in a blood cooler.  For most of our full traumas, someone comes from the ED to pick up the cooler.  Sometimes they call first, and sometimes someone just appears at the blood bank window for the blood.  These units are usually taken to the ED prior to the patient's arrival.

If the patient is an inpatient, the courier comes to pick up the units and brings patient identification.  Orders are not usually in the computer prior to picking up the units.  If a type and screen has been completed, we can quickly do an electronic crossmatch and have the units available.  If it has been necessary for us to put the order for the packed cells in the computer, we complete a sheet for verbal orders that the physician signs later.

If an MTP is needed, that order is place in the computer.  We prepare the first pack, and then blood bankers order any additional packs that are needed.  Since this is an approved protocol, we don't need additional signatures from the physician.

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We get a phone call ... very rarely does the MD have time to place orders in the HIS (EPIC) beforehand!  Besides, sometimes they call for 'Emergency Release/Uncrossmatched' blood and we have a Type and Screen completed so Uncrossmatched is not appropriate.  Also, we look up the patient in our LIS and determine if there is a significant reason that 'uncrossmatched' may be a higher risk than usual, e.g. clinically significant antibodies.  So, that conversation is important.

If Uncrossmatched is necessary, BB places the appropriate orders in the LIS (Sunquest) so they can allocate the units, etc.

At the transfusion site (ED, ICU, Birthplace, etc.), the Transfusion Documentation is performed on paper (2 person ID check, etc.).  The transfusion is recorded later in EPIC (there's a specific application/process for recording 'offline' activities).

MD Signature is obtained and faxed to the BB after the rush is over.

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Here they order EMERRGENCY blood in EPIC, which prompts the pager to go off.  If they order a massive transfusion, the LIFT team also get activated (dedicated people that will run the products from here to where patient is located. 

Floors still call us to give us a heads up that they are placing the order.

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