Blood Product Administration
The Connect Care clinical information system (CIS) has Epic's integration engine at its core, interfaced with a WellSky system for blood product management. Related workflows recognize this 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 (inpatient and ER) or therapy plans (outpatient and inpatient). 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. The chosen order set includes provider instruction about eligibility, documentation, consent, tests and monitoring.
Express (written, electronic or two-provider) informed consent must be documented prior to the transfusion of blood components or products. This can be facilitated with the "Consent Navigator" (accessible via the Patient Storyboard) where the consented "procedure" is administration of a specified blood product.
Routine blood products require both a prepare order and a transfuse order (linked) 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.
Derivatives (plasma protein products) are also dispensed from the blood bank and ordered in Connect Care. Again, a prepare order triggers the blood bank work and a linked administer order provides dosage information for the nurse to administer. The associated order set or panel facilitates.
Emergent Blood Products
Emergency blood product administration bears extraordinary risk. An attestation process confirms that the use of un-crossmatched blood is clinically necessary for patient care. All emergent orders for unmatched blood products require:
- a phone call to the blood bank to initiate emergent product 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;
- 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.
These actions allow the lab and nursing work to proceed. If the attestation note is not entered, Transfusion medicine staff will route a reminder-request to the ordering physician's In Basket.