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Quick Start

Guide

NICU Blood Product Transfusion

– NICU Providers

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Quick Start Guide NICU Blood Product Transfusion .................................................................................................................. 3

Ordering Blood Products for NICU Patients......................................................................................................... 3

***NEW FEATURES*** ........................................................................................................................................ 5

GLOSSARY OF TERMS AND DEFINITIONS ..................................................................................................................... 7

Type & Screen ...................................................................................................................................................... 7

Crossmatch........................................................................................................................................................... 8

Prepare Order ...................................................................................................................................................... 9

Transfuse Order ................................................................................................................................................. 10

Special Product .................................................................................................................................................. 10

Indication ........................................................................................................................................................... 11

Release ............................................................................................................................................................... 11

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NICU Blood Product Transfusion In order to provide the best experience possible for ordering blood products, the NICU Blood Product Transfusion Order Set has been updated to include weight-based dosing. This feature makes the process of ordering blood and blood products quicker and simpler with less waste and more reliable documentation.

Ordering Blood Products for NICU Patients

1. In the Labs section, choose the product to transfuse:

2. In the Prepare RBC (in mL) section, determine the volume to prepare:

1. The Volume field is defaulted to 15 mL/kg, update if needed. Based on the Volume selected and the Weight of the patient, the Amount to prepare in mL will be calculated automatically.

2. The Patient is field will default to Neonate. 3. Complete the Indications field with an accurate reason. (This is a hard stop) 4. The Request for Special Products field will be defaulted when the patient is less than 4 months

old. Both the CMV Negative and Irradiated buttons will be selected and the Reason for Special Products field will default with Neonate.

5. The Prepare product in a field will be defaulted to Syringe.

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3. In the Transfuse RBC section, choose the amount of blood product that will be transfused:

1. The Process Instructions give the provider the number of Occurrences that need to be ordered based on the dispensing product selected.

2. Enter the number of Occurrences based on the volume of blood to be given. 3. Volume (mL) must be manually entered based on the weight-based calculations. (This is a hard

stop) 4. After the volume is entered, the provider must Confirm that the correct # of occurrences were

selected based on the volume of blood entered. (This is a hard stop)

The amount to Transfuse may be less than the amount selected to Prepare depending on provider discretion. If the patient does NOT need to have a transfusion at this time uncheck the Transfuse order.

4. Accept the Transfuse order

5. Sign the Order Set

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***NEW FEATURES***

BLOOD ORDERING SIDEBAR (COMPOSER) REPORT

To support decisions when placing orders for blood administration, there is a report attached to each Prepare and Transfuse order. This report includes the following:

✓ Consents ✓ Type and Screen

o If no results in the last 72 Hours, will display a message “No lab results found w/in last 72HRS” o If a type and screen has been resulted, will display an Expiration time of when a new type and

screen will need to be collected. ✓ Blood Type – if on file ✓ Lab Results (Last 14 Days)

o Hemoglobin o Hematocrit o Platelet o INR o Fibrinogen o APTT

✓ CMV Status & Antibody Identification o CMV o Antibody Identification

✓ Blood History

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RECONCILIATION OF BLOOD PRODUCTS DURING TRANSITION OF CARE

When a patient is ready to be transferred to a different unit any orders a patient has for blood products, either prepare or transfuse, will be on the Review Current Orders tab under the Orders Not Needing Reconciliation section. If the provider does not take any action, then the orders will be carried over into the next phase of care. These orders can be Discontinued if needed by clicking on the blue hyperlink that states “Reconciliation Not Required”.

RESULTS REVIEW TREE

Using the Results Review activity is another way for providers to see results of a patient’s Type and Screen, and the type of Blood Products ordered for a patient as well as the Dispense Status of the blood products.

Dispense Status Options:

• Selected: The blood product has been associated with the patient.

• Issued: The Blood Bank has dispensed the blood product.

• Transfused: The blood product has been transfused.

• Returned: The blood product has been returned to the Blood Bank.

• Canceled: The blood product has been canceled and no longer available for the patient

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GLOSSARY OF TERMS AND DEFINITIONS Terms and Definitions for Blood Administration and Transfusion Safety can be found below.

Type & Screen

Definition:

Type: The portion of the test which determines the patient’s ABO blood type and Rh factor.

Screen: The portion of the test which detects the presence of most common antibodies. This also alerts the blood bank to when a special blood product or additional testing needs to be ordered based on the results.

Defining Information:

When It Is Used:

• A patient’s blood type is needed to select compatible blood products. Testing must be completed before the transfusion of crossmatched Red Blood Cells, Whole Blood, and Granulocytes. Other blood products do not need to be crossmatched.

• Neonatal patients require only one Type & Screen in the first 4 months of life during their initial hospital stay. If they are discharged and return to the hospital, they will need a new Type & Screen.

• In emergencies, a Type & Screen can be “skipped” initially and uncrossmatched blood products transfused. In these cases, type “O” red cells are used and type “AB” plasma products. A Type & Screen however should be

sent as soon as possible so that type specific blood can be transfused and type O blood preserved.

What It Does:

• This testing screens for antibodies and alerts the blood bank to when a special blood product or additional testing needs to be ordered based on the results of the screen.

• If there are unique antibodies that require special testing it may be sent out to the American Red Cross reference lab to be completed. This testing may take an additional 24 hours.

Keep in Mind:

• A type & screen takes between 45-60 minutes to complete.

• A Type & Screen must be done at the hospital or facility where a patient is receiving a transfusion. It cannot be prepared in a different site than where the transfusion is to occur.

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Crossmatch

Definition:

The process in which blood bank will take the results of the Type & Screen and match it to blood products in their inventory most compatible to the patient.

NOTE: This is only a 5-10 minute process once a Type & Screen and an ABOCAP are already completed.

Defining Information:

When It Is Used:

• Before transfusing crossmatched Red Blood Cells, Whole Blood, and Granulocytes. Other blood products do not need to be crossmatched.

What It Does:

• Matches the patient’s blood with donor blood products for transfusion that are compatible when transfused, or the closest match to the patient’s blood, by using a sample of the patient’s blood specimen to test against the donor unit for compatibility.

Keep in Mind:

• In emergent situations Blood Bank can issue products that are uncrossmatched.

Example: Massive Transfusion Protocol

• The crossmatch process takes less than 15 minutes if a Type & Screen and an ABOCAP are complete and current and no antibodies were detected.

• Special products may be needed from the American Red Cross to crossmatch some patients.

• Once a crossmatch can be completed, crossmatched blood should be transfused. The blood bank will switch to crossmatched products during an emergent event switch to crossmatched when time permits the completion of the testing.

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Prepare Order

Definition:

The portion of the blood order set transmitted to the Blood Bank to tell them to get a blood product ready in anticipation for a patient transfusion. A Prepare order is analogous to the traditional Type and Cross terminology for pRBC’s.

Defining Information:

When It Is Used:

•When a provider wants to order a blood product for transfusion

What It Does:

• Creates an electronic order that crosses from Epic to the blood bank software, SoftBank. This allows the blood bank to safely crossmatch, prepare and allocate the blood products specifically as ordered by the Provider.

• Each prepare order includes Indications for blood and any additional Special requests (CMV Negative or Irradiated).

• When blood bank has completed preparing the blood products, the product information will result to the Prepare order, providing RNs and Providers with the information about what products are available to transfuse.

Keep in Mind:

• It is possible to “Prepare” a blood product without ordering the “Transfuse” at the same time.

Example: Before a high-risk procedure.

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Transfuse Order

Definition:

The portion of the blood order set that notifies Transfusion Services and Nursing that the Provider has ordered a transfusion to be given to a patient.

Defining Information:

When It Is Used:

• When a provider wants to transfuse a patient with a previously prepared blood product.

What It Does:

• The electronic order in Epic to “Transfuse” a blood product communicates to nursing the intent to transfuse the blood products prepared for the patient. A “Transfuse” order creates the necessary transfusion documentation and flowsheets. An order is needed for each blood product administered.

Keep in Mind:

• Anesthesia uses a different process. They have the ability to create their own transfuse order for each blood product they will administer.

Special Product

Definition:

A special product ordered for each transfusion.

Defining Information:

When It Is Used:

• These special products and special attributes of blood are applied per provider order based on patient diagnosis and condition.

What It Does:

• Allows “Special Products” or special “attributes” of blood products to be ordered by the provider. Example: CMV tested negative blood and irradiated blood are two common attributes or special product orders.

Keep in Mind:

• Other than infants under 4 months of age always receiving CMV negative and irradiated blood, there is no rule about which patients should receive special products or attributes.

• Irradiated products must be ordered from the Red Cross for all sites except Boise and Magic Valley where it can be performed on site.

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Indication

Definition:

The clinical reason indicated on a blood order set by the Provider. It explains the reason for the transfusion.

Defining Information:

When It Is Used:

• Anytime a blood product is ordered, a provider must select a reason or “indication” for the transfusion.

What It Does:

• Indications are listed for each blood product type on the blood order sets for all patient populations.

• The “indications” serve as a reminder for providers about transfusions guidelines.

Keep in Mind:

• Indications are determined by evidence-based medicine practices and therefore can change.

• Indications are reviewed, revised and approved by the Medical Staff.

Release

Definition:

Is generated automatically by the blood product order to the nurse work list and Transfusion Report. When selected it prints in the Blood Bank as notification that the Nurse is ready to receive the blood product.

Defining Information:

When It Is Used:

• When the nurse has completed the pre-transfusion preparation and the patient is ready to be transfused, the nurse selects the “release” to notify the Blood Bank they are ready for the initial blood product

• Each subsequent blood product unit in an order requires another “release”.

What It Does:

• When the “release” is selected by the Nurse, a paper form prints out in the Blood Bank notifying the Blood Bank the nurse is ready for the blood product to be tubed or transported to the patient location.

Keep in Mind:

• The Blood Bank will call the unit when the product has been prepared, if released before this call there may be a delay before it is sent.

• The “release” should only be clicked once for each blood product unit being requested. Each time “release” is clicked a form will print.

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• If more than one product is accidentally released the Nurse should call the Blood Bank immediately. This cannot be corrected in the EHR.

• The intraoperative and MTP processes do not have a “release”. The paper “Blood Component Transport” form should be sent to the Blood Bank instead.

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This guide is based on Epic 2015.

Application: Orders Last Revised Date: 8/24/2018 8:32 AM Approved by: Michelle Hamland

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