I'm curious how other facilities handle verifying that an "order to transfuse" was placed by physician before issuing blood to be transfused to said patient.  We've always relied on nursing to verify physician transfuse order before requesting product be sent to the floor (and this check is documented by nursing on their blood administration form).  We have had recent incidents where patients have been transfused with out a transfuse order - varied list of reasons were found during RCA investigations.   Nursing is requesting that blood bank be responsible for verifying transfuse order before issuing blood.  We are a 300 bed hospital that transfuses 1200 products each month, and the transfuse order is not placed in the same computer system that the blood bank uses.  This seems like a daunting task and am looking for insight from other facilities. 

Don't accept that responsibility, it is not yours!

We have a transfusion order form (paper at the moment) where the physician completes the products needed, with indication, rate of infusion - if not standard. Includes date of transfusion, signature (can be RN by telephone order) and any attributes needed (irradiation). We don't give out the unit until this faxed to the BB. Exceptions are the OR and emergent ED orders.

Liz

We have a form like Liz has . . . we get a copy with every unit released except for emergency/uncrossmatched release.  No tickey, no shirtey as they say.  This also serves as a proactive review as the docs must document the reason for the transfusion.  These are reviewed by the BB Medical Director monthly (retroactvely).

Our physicians place the order in Epic (our HIS). A copy of the order automatically prints in the Blood Bank. That's how we know to set up units for that patient based on how many units the physician ordered to transfused. We keep the copy of the order and file it with the request form to show that we only issued the same units that the MD ordered.

I agree with Liz that it should not be our responsibility but when there is a bad patient outcome, we are drawn in, and our Medical Director can be held ultimately responsible.

So if your physicians order units in a computer, even if a different system, see if you can contact your IT dept to get an auto print of each order. The real fun begins when you get 3 docs ordering blood on the same patient at the same time!

I have never heard of a facility where the Lab must verify standard orders such as for a transfusion. Its impractal. We do review orders as part of QA for various reasons, but that is na after the fact thing, and has more to do with tracking counts and usage and such things.

Scott

I agree entirely with those above.  This responsibility is not yours!!  A nurse should never request a blood product without personally seeing the order to transfuse.  It's simple enough that a college educated nurse should have no problem grasping the concept. 

We also have a form and/or computer generated order completed by the physician.  No order, no blood (except OR)

I'm curious how other facilities handle verifying that an "order to transfuse" was placed by physician before issuing blood to be transfused to said patient.  We've always relied on nursing to verify physician transfuse order before requesting product be sent to the floor (and this check is documented by nursing on their blood administration form).  We have had recent incidents where patients have been transfused with out a transfuse order - varied list of reasons were found during RCA investigations.   Nursing is requesting that blood bank be responsible for verifying transfuse order before issuing blood.  We are a 300 bed hospital that transfuses 1200 products each month, and the transfuse order is not placed in the same computer system that the blood bank uses.  This seems like a daunting task and am looking for insight from other facilities. 

 

Our hospital is approximately the same size as yours. We had several similar incidents take place. The executive group tasked us with checking transfusion orders prior to issuing blood as an additional barrier for patient safety. We kind of balked at this as well - after all most orders are electronic but they're in a different computer module that can be time consuming to load and search through. That and the nurse should be checking this before they request the blood: it's on the form they need to pick up the blood, it's in the blood administration policy, and it's a part of the paper/electronic transfusion record.

 

The problem is that there are always going to be miscommunications or misidentifications of patients, so we agreed to try and find a way of doing the check that would be conducive to our workflow. After 6+ months of looking into various avenues (transfusion orders print at a designated printer, having the nurse fax/bring the written order, etc) we were able to come up with an IS solution that made it very easy. We use Meditech and IS set up an order process board that shows nursing orders.

When a requisition form shows up to request blood to be released, we scan the patient's barcode into the order board and it instantly loads the patient's nursing orders related to blood transfusion. Pressing F11 instantly brings you to the patient's EMR. Takes less than a minute and has prevented inappropriate transfusions.

Currently we require that nursing documents on the blood request card that they have verified the physician order to transfuse. We only crossmatch units if there is an order to transfuse. We do not "hold" blood for anyone except the OR and those units are not issued to anyone but the OR. If they are to be transfused post-op we require the physician to place a new order to transfuse. We are in the process of creating a nursing order to transfuse that will print in the blood bank so that we know there is an order to transfuse.

First, that is not the Blood Bank's responsibility; it is Nursing's responsibility. Where I am at currently, my predecessor set it up so that a Transfusion Order prints out in the Blood Bank. I am planning to "cease and dissist" with that practice. What you do need is the Name of the Physician who ordered the Transfusion/Infusion (vs. Crossmatch; and it may be the same MD, or it may be a different one). One way to accomplish that (and what I am going to change us to here) is to have a place on your Blood Bank Pick-Up Slip for "Physician ordering Infusion." That then will also serve as a reminder to Nursing that they need this.

Brenda Hutson

I'm curious how other facilities handle verifying that an "order to transfuse" was placed by physician before issuing blood to be transfused to said patient.  We've always relied on nursing to verify physician transfuse order before requesting product be sent to the floor (and this check is documented by nursing on their blood administration form).  We have had recent incidents where patients have been transfused with out a transfuse order - varied list of reasons were found during RCA investigations.   Nursing is requesting that blood bank be responsible for verifying transfuse order before issuing blood.  We are a 300 bed hospital that transfuses 1200 products each month, and the transfuse order is not placed in the same computer system that the blood bank uses.  This seems like a daunting task and am looking for insight from other facilities.

 

In our system the Transfuse order has to be placed in order to for the nurse to print a pick up slip.  If there is a glitch in the print function we make them print a copy of the transfuse order and sign it the same as they do the pick up slip.  If they order 2 units they can print 2 pick up slips.  If they want more it is another transfuse order.  We are an Epic site.