I work at a Level 1 Trauma Hospital that holds around 300 patients. Currently when we receive RBC orders, we crossmatch them right away. The problem is that a lot of the time, we end up tearing the units down due to sample expiration and we also end up ordering more replacement units for restock (the refrigerators get quite full at times). We tie up units that could currently be issued to patients that actually have transfusion orders.

I know some hospitals that do not crossmatch the units until they have a transfusion order. Our issue is how to keep track of the transfusion orders?

Do you get a paper RBC orders? 

Yes we do, we can track it that way. The problem is we can be overloaded with paper and it  could be difficult to keep track of it until the sample expires and patient is discharged. We currently use Cerner in our facility, we were wondering if anyone has an electronic method of tracking these orders. We would rather nursing kept track of the product orders  thru their "task" list and only sent us an actual order when they were ready to transfuse.

We went a few years ago to Physician's only ordering blood products for definite transfusion.  So our only units that are crossmatched that we do not routinely use are either ER patients or OR cases that we set blood up for the procedure.  After the procedure the OR cases have to get a transfusion order placed in our Hospital system.  We do not have a Type and Crossmatch order - only a Type and Screen and we guarantee that blood will be available if they need it crossmatched in less than 15 minutes.  The physician orders a Type and Screen and then when blood products are needed an order is placed for that.  All transfusion orders are separate in our system.  

It took a long time for the physicians to get it and every once in a while we get a doctor that wants blood "on hold" or a "Type and Cross" order.  We just explain how to order what they want and it works fine.

 

Have you considered getting your system programmed for electronic crossmatch/release).  At your size - that could be your best option to have zero units tied up on your shelf in "crossmatch" status.  It is a lot of work, but Cerner has the programming for it and it would be the best answer for you in the long run.  Especially if you get any bigger or busier.  Getting the Dr's to change their ordering patterns would be just as much work and wouldn't be the most efficient way to handle your overall problem - looking towards the future.   Just an opinion......

We keep our transfusion orders in a binder and place a unit number sticker on the paper when we issue a unit.  When the patient is discharged or the specimen expires, the order is removed from the binder.

When we went to electronic issue, we were able to decrease our routine inventory significantly because we no longer moved units back and forth from XM to available to XM to available.  We are still working to teach the physicians not to order products until they actually need to transfuse.  However, we did get the "keep ahead" order removed from the order set.  Baby steps

On 9/20/2017 at 3:44 PM, cswickard said:

Have you considered getting your system programmed for electronic crossmatch/release).  At your size - that could be your best option to have zero units tied up on your shelf in "crossmatch" status.  It is a lot of work, but Cerner has the programming for it and it would be the best answer for you in the long run.  Especially if you get any bigger or busier.  Getting the Dr's to change their ordering patterns would be just as much work and wouldn't be the most efficient way to handle your overall problem - looking towards the future.   Just an opinion......

We currently use Cerner and electronic crossmatch/release, but if we receive a crossmatch order, our policy is to perform the crossmatch on the patient. We love the electronic crossmatches, but unfortunately we are still having to put units on the crossmatch shelf. It is very hard to get the physicians to change and we are a teaching hospital as well and every July we start all over again on trying to train the newbies!! Thanks

On 9/22/2017 at 10:34 AM, pbaker said:

We keep our transfusion orders in a binder and place a unit number sticker on the paper when we issue a unit.  When the patient is discharged or the specimen expires, the order is removed from the binder.

When we went to electronic issue, we were able to decrease our routine inventory significantly because we no longer moved units back and forth from XM to available to XM to available.  We are still working to teach the physicians not to order products until they actually need to transfuse.  However, we did get the "keep ahead" order removed from the order set.  Baby steps

This is what we have thought about doing, let me know if you come up with a better solution!! Thanks for the input!!

4 hours ago, ChrisO said:

We currently use Cerner and electronic crossmatch/release, but if we receive a crossmatch order, our policy is to perform the crossmatch on the patient. We love the electronic crossmatches, but unfortunately we are still having to put units on the crossmatch shelf. It is very hard to get the physicians to change and we are a teaching hospital as well and every July we start all over again on trying to train the newbies!! Thanks

We are a similar size hospital as you with a Level 3 Trauma. We use Sunquest with electronic crossmatch. What you are describing as performing the crossmatch at the time of order defeats the biggest advantage of electronic crossmatch ... inventory control. For patients who are electronic crossmatch eligible we only crossmatch the unit at the time the unit is requested to be issued for transfusion. So that clinical staff know that we are not "ignoring" the crossmatch order we created a comment "Blood will be crossmatched when the order to transfuse is released. Contact the blood bank when ready to transfuse." This comment is resulted on the crossmatch order and goes to the patient chart. We have a box on the counter where we issue units that we keep the original crossmatch order in so we know what patients are currently electronic crossmatch. The tech that works that bench goes through it every morning to weed out the ones that are expired. When we receive the transfuse notice we pull the order out, match it to the transfuse order, do the electronic crossmatch and immediately issue the unit to the location (we tube units). If the original order was for more than one unit, we update the number of units on the paper order to reflect how many units are left on the order. The computer of course keeps track of it automatically as units are crossmatched and issued. Works well for us.

Only time we crossmatch ahead of dispensing to the floor is if the  serologic crossmatch is required. Then we electronically  crossmatch usually crossmatch/dispense when the floor calls for the product. We attach the order to a form we have(we call it the WIP) that has the patient's identifiers, ABORH/antibody screen interpretation, date of collection and special needs. We keep it in a file at our dispense area until the clot expires or patient is discharge. After that we filed it away in storage boxes that  are kept for 10 years. Since we have been doing this we seldom have red cells expiring on us. Now is I could say the same for the platelets ):