We allow verbal orders for MTPs and additional products from OR and ER.  We are able to place this order in our computer system (Cerner) as a verbal order.  This order then get sents to the ordering physicians message center for signature.

We can't place orders in our system so that they go back for MD sign-off.  Our nursing units use a massive transfusion flowsheet (paper) on which they record all of the unit quantities and the Surgeon signs this flowsheet at the end of the case.

Some hospital information systems have the option to enter verbal or telephone orders when received from the physician. The physician later has to sign them off in the computer. If they are not signed off the medical records department hunts them down.

Edited July 18, 201312 yr by tricore

We start our MTP with a specific pager call, which triggers off a verbal order from the doctor (who is often hands deep at that point). There is a set pattern for how much of each product goes in to each "cycle" of the protocol. It is in the procedure and posted in blood bank. All they have to do is set off the pager to start it. They are expected to record the MTP order in the patient record, We get emergency release forms for all blood that is released without crossmatch, but we get a sample as early as possible in the process to switch over to crossmatched.

and expecting the doctor to come to bb afterwards? what if it is next to impossible? no verbal request allowed?

I find the doctor later or ask a pathologist to find the doctor (they all hang out in the same lounge). If worse comes to worse, I have mailed the emergency release to the office, attention office manager with a sweet note explaining that I must have the release signed ASAP to meet hospital and regulatory requirements - got those back quickly. I figure I can fix paper work, but I can't fix exsanguination. However.........we do absolutely require positive patient ID to give blood and this may be a Typenex type band in trauma cases.

Same here. We get the blood to the bedside first, than fill in the blanks, or get the computer order after the fact. Yes, it's inconvenient, but you gotta keep the patient alive first.

• We do the same as most everyone here and allow a verbal order followed up with documentation at eariliest convenience.  We do however require proper patient ID written at request of the products.  For MTP I require the initial request to have paper documentation then the following products are sent without the request form.

It sounds like we do the same as everyone else.  We accept verbal orders for emergent needs.  We also accept a verbal order, but document what physician activates the MTP.  With just Emergency Uncrossed (initially two units), we get physician signature on the "Emergency Release" form.  I don't require an additional signature for activation of the MTP.  I just document the physician and time of activation.  Our Policy states that we have one pack ready once activated and keep doing so until deactivation of the MTP. 

 

Sometimes the ED nurses will call out of the blue and activate the MTP.  We begin preparing two "packs" (6 PRBC's, 6FFP and Plt Pher. q every other pack).  This has been problematic because the nurse just wanted uncrossed and not necessarily a MTP activation.  Then I'm stuck with 12 thawed plasma and no orders.  There's obviously and education issue there.  But that's a whole other topic.  They fly by the seat of the their pants sometimes- often times and it really concerns me.  There must be a balance between patient safety and providing the necessary blood products in a timely manner to save lives.  That is an ongoing struggle and may not ever be fully accomplished.

 

Also, our Transfusion Committee reviews all MTP activations and emergency releases.  You may be able to get some help there.  Risk Management is a great resource for this type of issue.

 

Sometimes the ED nurses will call out of the blue and activate the MTP.  We begin preparing two "packs" (6 PRBC's, 6FFP and Plt Pher. q every other pack).  This has been problematic because the nurse just wanted uncrossed and not necessarily a MTP activation.  Then I'm stuck with 12 thawed plasma and no orders.  There's obviously and education issue there.

 

We had this problem too, so now only physicians can order an MTP, and then it starts with 2 units of uncrossed red cells first, which gives us a few minutes for them to get past panic mode and decide that they don't really need the MTP and we get to save our FFP.