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.
Important to note is that 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.
Blood Product Ordering Context
Blood products are ordered using four methods:
Transfusion Medicine (Adult, Pediatrics, or Neonatal) order sets, when nursing is required to administer and document the blood (i.e., inpatient, PACU, and ED contexts).
Transfusion Medicine OP (Adult or Pediatrics) Ambulatory SmartSet order panel, for one-time ambulatory orders. These are signed and held until the appointment day.
Therapy Plans, for recurring transfusions (PRN or scheduled).
To avoid duplicate orders, it is important for prescribers to check whether any therapy plans have been placed for the patient that include blood products prior to placing new blood orders.
Blood Transfusion Preoperative (Adult/Pediatrics) order set or Intraoperative AHS Blood Quick Lists, for anesthesia administration and documentation in the operating room.
Blood Product Orders
Searching the keyword "blood" or "transfusion" in the "Orders" or SmartSet activities will list available "Transfusion Medicine" order sets appropriate to different age groups and clinical contexts.
Routine Blood Products
Routine blood products are when the patient requires blood but there is time to enter the orders and get type and screen resulted (if required). These are linked orders - both a Prepare order and a Transfuse order must be filled in:
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.
Emergent Blood Products
Emergent blood products are when the patient requires blood products urgently. Un-crossmatched blood is acceptable if a type and screen has not been placed. All emergent orders require the following:
A phone call to the blood bank, to initiate emergent preparation
A "Transfuse Emergent" order, so nursing can document the administration
Search "blood" to open the Transfusion Medicine order set (Adult, Pediatrics, or Neonatal). The Transfuse Emergent order is found in the "Transfusion Orders - Emergent" section of the order set.
An attestation comment, included in the Transfuse Emergent order, to confirm that the increased risk of use of un-crossmatched products is clinically necessary.
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 an MHP package; and
a "Massive Hemorrhage Protocol" order set (search "MHP") completed and signed by the ordering Connect Care prescriber, to allow for recurring lab test collections with the appropriate MHP STAT specimen labels.
Note: There are no orders for blood products placed in Connect Care during an MHP.
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.
Blood Derivative Orders
Blood derivatives (plasma protein products [PPP]) are also dispensed from the blood bank.
Note: Orders for PPP are built as a “per dose” order. If you require an order to be split over multiple days, enter the order you want given for each transfusion, not the total dosage.
Inpatient context
Search “PPP” or the specific name of the derivative to see the specific order panels. Similar to routine blood product orders, orders for PPP are linked orders - both a Prepare order and a Administer order must be filled in:
The Prepare order is transferred to the blood bank to create a product order in the WellSky system.
The Administer order provides dosage information to lab and the nurse administering the derivative, and populates the medication order to the MAR.
Ambulatory context
Ambulatory orders for PPP are placed using the Transfusion Medicine OP (Adult or Pediatrics) Ambulatory SmartSet or Therapy Plans, and are signed and held until released for the appointment day. There are 3 components to these ambulatory orders:
A Prepare order triggers the blood bank order in WellSky.
An Administer order provides dosage information to lab and administration instructions for the nurse, and populates the medication order to the MAR.
A Dispense request indicates the quantity required for lab and allows the printing of the pick-up slip.