Thanks Everyone! We do not require a copy of the transfusion order when blood products are picked up. I suspect that we have a fair number of 'crossmatch for 2' orders with orders to transfuse only 1. This creates a lot of 'held' inventory. We transfuse over 500 red cells/month in our hospital and our average daily inventory of uncrossmatched red cells is 130 units. I feel that this is a bit much.

With the Red Cross medical director's suggestion of not holding crossmatches >24 hours, I was thinking about A) requiring nursing to bring a transfusion order when they pick up blood products and asking that the physician's ordering screen NOT have an option for 'type and cross'. I hate that terminology anyway, but that is an aside. I feel that they need to assess the need for transfusion carefully before ordering the crossmatch. As stated above, we can generally get red cells ready pretty fast in the absence of alloimmunization.

Any thoughts on these proposed changes from a 'best practice' point of view?

We do not have "Type and Hold" or "Type and Crossmatch" anymore. We only have one test, Type and Screen. When the doc orders a transfusion (we have Epic) he/she has to put in a prepare order and a transfuse order. Frankly, we ignore the prepare order and follow our policy, which is:

Only set up what the doc indicated on the transfuse order. If he/she orders two units, but the patient only meets our transfusion for 1 unit, and is not actively bleeding, we only set up 1 unit and we call the nurse to document that. The physician has to re-evaluate the patient after the first unit to see if they qualify for a second. Then the doc orders another single unit.

So we only set up units that will be transfused. The only exception: patients with antibodies. Since they need antigen typing and AHG crossmatches, we set up two units and keep them on hold.

Our MSBOS now just lists all of the surgeries that need a Type and Screen with a disclaimer on the bottom that says we don't put units "on hold" for the OR unless they have antibodies.

THIS is exactly where I want us to end up

Soon!!!!

s

 

We do not have "Type and Hold" or "Type and Crossmatch" anymore. We only have one test, Type and Screen. When the doc orders a transfusion (we have Epic) he/she has to put in a prepare order and a transfuse order. Frankly, we ignore the prepare order and follow our policy, which is:

Only set up what the doc indicated on the transfuse order. If he/she orders two units, but the patient only meets our transfusion for 1 unit, and is not actively bleeding, we only set up 1 unit and we call the nurse to document that. The physician has to re-evaluate the patient after the first unit to see if they qualify for a second. Then the doc orders another single unit.

So we only set up units that will be transfused. The only exception: patients with antibodies. Since they need antigen typing and AHG crossmatches, we set up two units and keep them on hold.

Our MSBOS now just lists all of the surgeries that need a Type and Screen with a disclaimer on the bottom that says we don't put units "on hold" for the OR unless they have antibodies.