If Cardiac Surgery has a written policy to 'Keep two units ahead', does this fulfill CLIA, CAP, JCAHO requirements to obtain an MD's order for each lab test ordered?

CSU has tasked the Blood Tech dept with ordering units ahead as indicated by the acute useage of the patient.

In three hospitals that I have worked, nursing would accept this order BUT it is nursing responsibility to order the units. Blood Bank does not accept that responsibility.

My lab does that too. But it's the ward staff or operating threatre staff who will have to contact us to "keep the units available".

We would have no knowledge of any change in the "keep ahead" order.

Nursing informs us of a Keep Ahead order, and as a coutesy, we say "thanks". But it's up to them to do the ordering ...

The nursing unit informs us if we need to "keep ahead" on a patient. They are responsible for putting the order in the computer for the crossmatches. We let them know when the order is needed. My favorite MD is the one who writes keep ahead X units for 48 hours. It takes out much of the guess work.

So far, we are in the minority on this one, but we have a keep ahead order that nursing puts in the computer. Then Blood Bank orders as needed, and so far, none of our inspecting agencies have had a problem with it.

At our hospital, we tell the nurses that thanks for the information, but that it is their responsibility to order more units if desired. My Medical Director nor myself respect these "stay ahead orders". It is our opinion that by having the blood bank personnel order the ahead units that constitutes them writing the order and we do not feel nor do we want the responsibility for ordering the units.

At the last hospital I worked there was only one keep ahead order that we followed and that was on Trauma I cases and in those cases I had the Trauma Committee's procedure, signed by physician, state that it was only the BB staffs’ requirement to maintain the ahead orders for 24 hours. Other ahead orders where placed but we would just place a sticky on the patient's information and then when we were no longer ahead we would remind the clerk, at time of issuing, of the level of blood available and inform them that if they wished to have blood available that they would have to order it.

At my last posting, I failed to remember that we do have one stay ahead protocol and that is if there is a massive transfusion going on. But this is the only time, and it is very delineated in my policy about what and when.

Our doctors in specific units (ICU and Burn) have an order to Keep Ahead X units for 72 hours. We match the 72 hours to the expiration date of the type and screen. It works very well for us. We have not had any problems with any of our inspectors. We can stay on top of our patients needs easier when they are in surgery or having a large bleed if we are the ones ordering as we know when the last unit walks out our door and don't have to wait on anyone else to realize that nothing else is ready. Even with this procedure in place, we maintain an average C:T ratio of 1.3:1.

I thought there will be a lot of matched blood being unused if you use that method, but apparently, your CT ratio is very good if this is the way you "keep the units ahead".

Our doctors in specific units (ICU and Burn) have an order to Keep Ahead X units for 72 hours. We match the 72 hours to the expiration date of the type and screen. It works very well for us. We have not had any problems with any of our inspectors. We can stay on top of our patients needs easier when they are in surgery or having a large bleed if we are the ones ordering as we know when the last unit walks out our door and don't have to wait on anyone else to realize that nothing else is ready. Even with this procedure in place, we maintain an average C:T ratio of 1.3:1.

This is very similiar to experiences I have had in hospitals with busy transfusion services. All of them had "keep ahead" orders, whether it was from the trauma center or from surgery or ICU. I agree that it worked well with the blood bank monitoring when the last unit went out and when it was time to have a new sample drawn again. It sure cuts down of the "panic" and super-stat orders. Also creates a cooperative atmosphere within the "transfusion team".

We use keep ahead orders all the time and it works well. We monitor when we need a new specimen.

We accept that type of order, but it is up to the nursing unit to place the orders. Blood Bank does not place the orders, but may inform the unit of the patient's current inventory. Also, how do you handle this when you have a low inventory of blood supply?

John

We also use a a 'stay ahead' order. Most notably for post heart surgery (stay ahead 2 units for 24 hrs post op). Although this order is sometimes abused in cases other than heart surgery it's worked ok for us and we haver never had a problem with inspections.

Edited July 24, 200916 yr by bxcall1
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