Blood Product Administration
The Connect Care clinical information system (CIS) uses Epic's integration engine to interface with the WellSky blood product management system. Related workflows ensure that the right information is exchanged at the right time, while addressing safety, accreditation and Canadian Blood Services requirements. Things physicians most need to understand are outlined here, with skills covered in linked tip sheets.
Blood Product Ordering
Blood products are ordered using order sets in inpatient and emergency department contexts. Outpatient blood product administration is facilitated with therapy plans when there are ongoing transfusion requirements, and with order sets for episodic transfusions. To avoid duplicate orders, it is important for prescribers to check whether any therapy plans are in play and include blood product administration.
Blood Product Orders
Entering the keyword "blood" or "transfusion" in the inpatient "Orders" activity will list available "Transfusion Medicine" order sets appropriate to different age groups and clinical contexts. Each order set includes instructions about eligibility, documentation, consent, tests and monitoring.
Express informed consent must be documented (written, electronic or two-provider) prior to the transfusion of blood components or products. This is done with the "Consent Navigator" (accessible via the Patient Storyboard), where the "procedure" is administration of a specified blood product.
Routine blood products require both a prepare order and a transfuse order for the blood to be both readied and administered:
The prepare order is transferred to the blood bank to create a product order in the WellSky system.
The transfuse order provides administration instructions and allows the nurse to release the products and document their administration in Hyperspace.
The prepare and transfuse orders are linked in the order sets.
Blood Derivative Orders
Blood derivatives (plasma protein products) are also ordered in Connect Care and dispensed from the blood bank. Similarly, a prepare order triggers the blood bank work, and a linked administer order provides dosage information to support the nurse administering the derivative. Order sets and order panels keep these tasks together.
Urgent Blood Product Ordering
Emergency blood product administration relates to any situation where blood is needed so quickly that a phone call better alerts blood services while efficiently communicating the urgency and expected needs. Connect Care orders are still needed, but the prepare and administer phases of transfusion are compressed.
If un-crossmatched blood is needed, an attestation step confirms that the increased risk of use is clinically necessary. All emergent orders for unmatched blood products require:
a phone call to the blood bank to initiate emergent preparation;
a "Transfuse Emergent Blood Product" order (as found in the "Transfusion Orders - Emergent" section of one of the "Transfusion Medicine" order sets) entered by the ordering provider; and
an attestation note (new note in "Notes" activity, select "Emergency Blood Transfusion" note type which automatically generates the required text) completed by the ordering provider and co-signed by the most responsible provider, if un-crossmatched products are used.
These additional actions allow the lab and nursing work to proceed quickly. If the attestation note is not entered, transfusion medicine staff will route a reminder-request to the ordering physician's In Basket.
Massive Hemorrhage Protocol (MHP)
In the event of massive hemorrhage and critical blood product need, the following is required:
a phone call to the blood bank to initiate preparation of a MHP package;
a "Massive Hemorrhage Protocol" order set is completed and signed by the ordering Connect Care prescriber; and
administration details (start/stop times) recorded on transfusion tags are scanned into Connect Care.
When the MHP event concludes, the Connect Care MHP orders should be discontinued and a phone call placed to the blood bank to inform them of no further need.