We are revisting all of our Order Sets as part of our EMR implementation.  A question came up regarding if a transfuse order must specify the infusion rate/time.  Alternately, can the Order Set state the infuse time to be  "per policy" with the option for the physician to specify a faster or slower time?  For example, the policy may say to transfuse a unit of red cells over "1.5-2.5 hours as tolerated".  The physican would only specify if the desired infusion time is faster or slower (not to exceed four hours).   

I think that as long as the Medical Staff has signed off on such a policy that it should be viable. It still leaves room for a doc to input alternate transfusion times . . . the only downside I see is with pts that may not be able to tolerate the "standard" time but falls through the cracks - like a CHF pt . . . will the Nurse be held culpable if the pt TACOs out? It gets easy to just say follow the protocol -

Interesting thought.  Everyone seems to have their own opinion on how the Transfusion Order set is built.  Nurses say there are some physicians who wouldn't have a clue what to put for a rate if you left it open for them to decide.  With the EHR build, they are trying to minimize the number of "clicks" the physician has to make. One clinician wants to be able to do everything in "three clicks or less".  I suspect we will go around and around for a while and finally make a decision.  Some will be happy, and others..... 

Our policy has a default rate and the transfusion order is generally "per protocol" unless they want it faster/slower.

Our policy has a default rate and the transfusion order is generally "per protocol" unless they want it faster/slower.

I would think that you would want the EMR to reflect the current policy, that's assuming the current policy actually is "current".  This is an excellent time to review policies but keep the matra "if it ain't broke, don't fix it" firmly in mind. 

Yes, by policy is fine.  We left ours in the EMR, but left it an optional choice if physicians want they can select 1-4 hours.