We had an issue this week where a physician wanted to order a crossmatch based on a patient's hgb results from 4 weeks ago. Is there a time limit on when a physician can order a T&C after viewing Hgb results? I can't seem to find any documentation anywhere. I know that I'm probably looking in the wrong spot, but figured that you guys would be able to help me. The physician ended up ordering an H&H when nursing questioned it...

The very first thing I would do would be to contact the nurses who questioned this and compliment them on a job well done. For them to speak up they must be aware of some info. Ask them why they questioned it. That would be a good place to start.

I know of no universal standards addressing this but if some else does I'm sure they will speak up.

If you have a transfusion committee, that would be the best place to address this issue if a policy does not already exist. Then you have doctors setting the policies doctors have to follow and that seems to work better than most other options.

We question all the transfusion orders(all blood component) for appropriatness. Our RNs are use to our questions and they question teh dr.s if the oder doesn't fall under our guidlines.

Sometime when I call them to question RN would say "well I told Dr. XYZ but he didn't listen and wated to order. I know that Hgb is 9 and I told the dr. that blood bank will question this order". That time I really feel good that we are making a progress and all that training is going somewhere.:)

hello evrybody.

In our hospital the Hb result is within 24 hour to order transfusion.

There's no standard as far as I know. Wouldn't it be nice for hospitals to have some type of written 'common sense' policy which must be followed at all times?

For patients to be transfused in our institution, we require H&H values to have been drawn within 24 hours of the physician's transfusion order. The freshest sample gives the most accurate reflection of the patient's current status.

Would you give insulin based on a high blood sugar value from last month?:cool:

Hi there...

Uaually the values for CBC holds good for 24 hours in incapacitated/debilitated patients, if nothing untoward like bleeding etc etc happens. Otherwise,

in case the patient is doing well since the preceeding few days, and responding well to the treatment, there is no mistake on the doctor's side, to have referred the earlier report to have a general idea about the condition of the patient /

and progress.

But whether he should have depended on that value to order for x-match is anybody's guess.....

best wishes....

The only standard that would be applicable is AABB 8.2 Monitoring of Blood Utilization as Ordering practices, Appropriateness of use or Compliance with peer-review recommendations. A physician/ clinicial may order transfusions based on clinical symptoms of patient. Your facility should have guidelines for physicians and Blood Utilization Review and Transfusion Committee is the forum for discussion of physician practice. Our physician select an indication for transfusion when requestibg products. There is info on "Up to Date" for transfusion guidelines because I just finishe pediatric transfusion search of that physician reference.

Hi TSyec,

I feel that , majority of the hospitals, Blood Transfusion committee do not have any major role in the clinical settings. They do not have any voice in the clinical side...or majority of the clinicians dont want to be ordered by somebody........agree ?

Otherwise, how many surgeons or clinicians have waited for the Hb value of 7 gm% or a platelet value of 10000.cmm , before ordering a Transfusion all these years ? Very few....I am sure.....because like the Blood Banking people, the clinicians also want to play it safe !!!..... "play safer towards the patient's safety" !

play safe towards their own safety ...

and of course avoid medical legal problems....!

best wishes to you...

Edited June 6, 200817 yr by engeekay2003
correction

The clinical situation would have impact but even with something chronic like myelodysplastic syndrome, you'd think the doc would want to see if they are even lower. Most other situations might have mitigated themselves over 4 weeks making transfusion unnecessary or even dangerous. In a chronic outpatient I don't see how you should go back more than about a week--less if more acute causes are implicated.

Surely, if you don't have an up-to-date Hgb, (less than 24 hours) then you won't be able to assess whether the transfusion has been effective? And if the patient could wait 4 weeks, does he really need a transfusion anyway???