EP31-6Meeting (Trauma, Nursing Blood Bank)
Massive Transfusion Protocol February 10, 2011
Kacie Puderbaugh, Lynn Schutz, Bonnie King RN
As it exists now, the BB receives a call from the RN, ED MD or TS to begin the MTP. There are 2 BB techs on duty from 8:00-5:30, after this time there is only one tech. There is an OC tech that is available and is always called directly in after the MTP is initiated.
Pathologists Role: At the onset of a MTP, the pathologist OC is immediately notified and is available 24/7. During this process, the Pathologist will monitor the patient’s labs as the MTP progresses. They will only intervene if the labs are grossly abnormal. At night the Pathologist has Meditech access from home, Dr. Newton was going to ensure that all residents would also have this capability. He and I discussed the addition of a automatic lab draws every hour to include CBC w/o diff, PT, PTT and fibrinogen. Important info needed for the Pathologist would be:
Patient’s name, age, sex, co morbidities, ordering MD, recent coag and heme studies.
Blood Bank Tech: Receives call for MTP, calls in 2nd tech at night, notifies Pathologist and gives proper info. Gathers products, ensuring adequate inventories. Additional product can be obtained from Memorial, Bonfils and SFMC. Platelets are usually the concern because they only stock a limited amount; ideally 7 platelets at all times. When a trauma team is called, 2 Units of O- is sent to the ED, these do not count toward the initial shipment once the MTP is started. The current policy states that the initial shipment can be anticipated in 5 minutes, this is not a do able time frame per BB and needs to reflect more like 15 minutes. The patient’s BB card should be brought each time a shipment is picked up and an abbreviated crosscheck will be done. All calls to BB should cease once this first shipment has been sent. There are pink cards on each cooler reflecting the next pick up time, these should also be recorded on the large laminated recording tool. BB staff will also initiate what is termed as a BB initiated MTP if they see that a lot of product is being used, the pathologist is notified. BB staff expressed the need for an overhead page to go out so that all departments in the hospital are aware and know that all other BB transactions will cease for a time period and should not be attempting to contact the BB during that period. This was greatly emphasized by them, this causes great delays and impairs efficiency. Another item of importance was that when the MTP is discontinued by the TS, a prompt call be made to BB to stop preparing product, this alleviates wasted product.
Meditech: Lynn can insert a place in Meditech where MTP can be identified. Her thoughts were, go to: BB->BB Tests->Antibody Screen->here they can document time started/stopped and MD ordering. This will help the Trauma Department track MTP more effectively. The BB also has paperwork filed with each MTP (BB-T-503).
Pharmacy: They have stated that it ideally takes 30 minutes to prepare the Factor VII, but could be done in 15 minutes. During the day this is easily accomplished. After 11pm, there is one tech and one pharmacist. At any point this will take all priority, but after 11 pm it may take closer to the 15-30 minutes to prepare. The pharmacy will then deliver to the unit.
Nursing: From a nursing standpoint, this needs to be done on paper, as it exists now for general blood transfusions, there is a very time consuming process for accurate documentation with crosscheck at the bedside then multiple re-entries to the Meditech system.
Things to resolve:
- Can we get this paged out overhead
- I would like to see the primary RN in charge of coordinating all necessary interactions.
- How does OPS center fit in
- Can we do timed labs
- Firm up Meditech issues
- How this differs in each department
- Mass education
- Laminated chart