I'm looking for input from people who use Physician Order Entry for Blood Bank orders as well as transfusion orders. Can you give me a quick summary of the process beginning with the placement of the order by the physician to how transfusion orders arrive in the blood bank. Do most facilities have some kind of computer generated orders (for testing as well as transfusion orders) that prints in the blood bank? Thanks everyone.

Depends on whether you have interfaced computers all the way from the MD order entry to the BBIS or not. If so, the orders come through the system. If not, they may come via the LIS and you will get labels or printed orders from the HIS.

By transfuse orders, do you mean requests to issue products or are you wanting copies of nursing orders so you know which units ordered xmd are to be given?

We went live last summer with our first system that was interfaced all the way from order entry to the BBIS and have had some very interesting issues with MDs and nursing understanding the difference between an order telling a nurse to transfuse and a product order for us to xm or otherwise prepare a product. 6 mo. after go-live we are scheduling re-education sessions to cover this very issue. It also makes a BIG difference if they can tell if blood is already set up before placing a blood order because it is even more inefficient with a totally interfaced system to recieve duplicate orders when products are already available for issue. It also brings up issues with whether BBers are legally allowed to cancel MD orders per CMS rules and scope of practice laws. It definitely is not Lean Manufacturing! All the Phys Order Entry software makers need to figure out a way to prominently display blood availability information without the physician having to search back through multiple days' orders to figure it out--a sort of dashboard of blood availability. Maybe if we all keep asking for that, they will eventually do it.

Our system reflexes a Type & Screen order for all blood orders where the patient has not had a Type & Screen ordered in the past 3 days. Not perfect, but we are refining the rule and it still works pretty well.

Sorry, probably more than you asked for.

We will be one interfaced system. (Cerner) It will be able to check for duplicate orders. We are moving from a "paper" system where requests come to the blood bank and we order everything in the computer ourselves to physician order entry. We are trying to figure out how to alert the blood bank when orders have been entered. (Always looking on a pending list is impractical.) We are also trying to figure out how nursing knows when a physician has written transfusion orders. Of course, we would love to reduce the amount of phone calls that come into the blood bank as well.

We have "POE". The doctors can order the RBCs (or whatever other product they want) and comment on the order to transfuse it (with whatever pre-meds) or they can order a "transfusion". If they order a "transfusion" that order goes to nursing and nursing is to order the product if it isn't already ordered. Not the best system, there isn't one.

We get lots of duplicate orders (so we call, "you already have 2, do you want 2 more?") and we get lots of calls to see if the blood is ready (even though they can look it up in the computer.)

Good luck with POE! We also get all kinds of wrong orders for just about everything throughout the lab, because they select the first thing on the list that pops up in front of them.

Linda Frederick

Hi Linda,

It's not just because it's on a computer.

I know of one hospital where they had tick box paper request forms for Pathology. The doctors use to tick every box.

One Pathologist slightly redesigned the form, by adding a "None of the above required" box to the list, and if this was ticked, as was frequently the case, no tests were performed.

This form was quickly withdrawn, and the Pathologist received a ticking off from the Hospital General Manager, but, by then, he had made his point.

:):)

Hi Linda,

One Pathologist slightly redesigned the form, by adding a "None of the above required" box to the list, and if this was ticked, as was frequently the case, no tests were performed.

This form was quickly withdrawn, and the Pathologist received a ticking off from the Hospital General Manager, but, by then, he had made his point.

:):)

What a good idea and well done to the pathologist for sticking his neck out!!!

Steve

;)

Edited January 27, 201015 yr by Steven Jeff
Missed some of the quote out

Our experience with POE (Physician Order Entry) echos everything that bbbirder said. It's a mess! (However, orders entered by the nurses and unit clerks also have a significant number of problems/errors.)

We also use Cerner. When the physician places an order, we get a paper printout in the Blood Bank. We get a separate paper for the ABO-Rh, the IAT and the product. The floors can look on a Blood Bank tab in the EMR that will show them if there is a valid specimen and when the specimen becomes outdated, if there is product available, and transfusion history. When the floor is ready to transfuse, they put a Dispense order in Cerner, which generates a piece of paper in BB. We then dispense the blood in Cerner, and get a "packing list" which is sent along with the unit to the floor by pneumatic tube.

We call the floor to tell them units are ready for STAT orders, but routine orders we expect them to monitor their EMR. We also call the floor once the blood is in the pneumatic tube, and we monitor the return of the signed packing list to verify that they have received the unit and done the first check.

We do still get calls asking if the blood is ready, but before I tell them I walk them through looking in the electronic chart. They are usually happy to find out a way to get that information without a phone call, and the number of phone calls has steadily decreased.

IMO, the separate BB tab in the EMR is a necessity. Everything is displayed in an easy to read format in one location.

Sounds like you have about the best system/setup of any that I have heard about, MT15.

Thanks, it works pretty well (I can't take any credit, though, it was in place when I got here). Oh, we still have problems, no doubt, just like anyplace else.