We are currently revising our MSBOS. At our facility, the guideline is issued by our Transfusion Committee. When we update the guideline, we gather input from each surgical specialty (usually the department chariperson) regarding the types of procedures that should be listed on the guideline as well as what the maximum pre-op order should be. On occasion, we have differing opinions on what the maximum order should be. Sometimes the differences in opinion come from physicians that perform the same types of procedures (one MD feels that a type and screen order would be inappropriate while another performing the same procedure would routinely order a crossmatch). Who should decide what actually gets published in the final guideline? Should the transfusion committee have the final say? The issue seems petty at times, but as you can imagine, it can generate quite a discussion! Do others use a similar process to develop your guideline?

Also, if you are willing to share a copy of your MSBOS by posting it on the forum or directly e-mailing me, it would be most appreciated!

We currently use a MSBOS. We are slowly phasing it out. It is a painful process, but we want the surgeons to order their own blood (within reason). They are in fact the only ones who truly have any idea of how much bleeding to expect. The surgeons have this new surgical blood order entry screen. We print a report of their orders and enter them into our system. In a perfect BB the orders would be interfaced. (Probably not in my lifetime.) What often happens is the surgeons order a type and screen a few days before surgery. Then about 5 minutes prior to the start of surgery they order 4 units STAT. It makes you wonder why the term "brain surgeon" is used to imply intelligence.

The Transfusion Committee follows the same process of sending the MSBOS to the different services. We follow their direction because they are the ones who are performing the surgeries and they have the experience to support their decisions. On many occasions, the services have eliminated testing or reduced the requested order.

Our MSBOS was done away with many years ago (before I came onboard). Unfortunately, as well as didcontinuing ordering XMs on surgical patients, the surgeons stopped ordering the T&S also. We've ended up doing to many stat T&S ordered by the anesthesiologist during the patient's surgery. We are now trying to institute a MINIMUM Surgical Blood Order Schedule. In other words, a list of surgeries that require a T&S prior to surgery. We have told the physicians they don't need to order XMs prior to OR that we can provide I.S. compatible units quickly. Just trying to get them to agree to the Minimum SBOS has generated as much discussion and disagreement as your Maximum SBOS.

The MSBOS seems logical in that it saves the BB from the barrage of STAT's the day of surgery. However, it seems to be a step backwards. Why can't the surgeons order blood just like any other doctor? They are the only ones who know what to expect from their particular patient. We are considering a cutoff for pre-op orders. We will expect that they are all in by 5pm the day before. If not, the surgery will have to wait while we do it as a routine. (Our routine turn-around-time is published as 8 hours!)

We let the chairmen of the department make the final decision. Attached is our latest revision.

MSBOS-1.doc